Comparison of women who do and do not have amniocentesis or chorionic villus sampling

Even in areas where prenatal diagnostic testing is offered at no cost to women over a certain age, uptake of testing is not complete. We have studied the factors that affect uptake in Victoria, Australia. In 1988-92, 43% of 37-39-year-old women and 29% of those 40 years and over had no diagnostic testing despite their eligibility for a free test. We compared the characteristics of untested women (n=3074) with those of tested women (2462 amniocentesis, 1575 chorionic villus sampling) by use of record-linkage between the Victorian birth register and fetal diagnosis data collection. The indication for testing was maternal age alone. Women who had had 3 or more previous births were less likely than those of lower parity to undergo testing (odds ratio 0·54 [95% Cl 0·46-0·63], p<0·001), whereas those who had had a previous termination of pregnancy were more likely to be tested than those who had not (1·52 [1·26-1·83], p<0·001). Women born in non-English-speaking countries and women who lived in rural areas were less likely to be tested. Women who gave birth in private hospitals were more likely to be tested than those who gave birth in any public hospital or at home. These data help to distinguish between issues of choice and access to diagnostic testing. Factors that hinder testing of rural women and of those from non-English-speaking backgrounds should be addressed.