Abstract

The diffusion of antenatal screening programmes for Down syndrome has triggered much discussionabout their powerful potential to enhance pregnant women’s autonomy and reproductive choices.Simultaneously, considerable debate has been engendered by concerns that such programmes maydirectly contribute to the emergence of new and complex ethical, legal and social dilemmas for women.Given such discussion and debate, an examination of women’s decision-making within the context ofantenatal screening for Down syndrome is timely. This paper aims to undertake a meta-synthesis ofqualitative studies examining the factors influencing pregnant women’s decisions to accept or declineantenatal screening for Down syndrome. The meta-synthesis aims to create more comprehensiveunderstandings and to develop theory which might enable midwives and other healthcare professionalsto better meet the needs of pregnant women as they make their screening decisions. Ten electronichealth and social science databases were searched together with a hand-search of eleven journals forpapers published in English between 1999 and 2008, using predefined search terms, inclusion andexclusion criteria, and a quality appraisal framework. Nine papers met the criteria for this metasynthesis,providing an international perspective on pregnant women’s decision-making. Twelve themeswere identified by consensus and combined into five core concepts. These core concepts were: destinationunknown; to choose or not to choose; risk is rarely pure and never simple; treading on dreams,and betwixt and between. A conceptual framework is proposed which incorporates these themes andcore concepts, and provides a new insight into pregnant women’s complex decision-making processeswith regard to antenatal screening for Down syndrome. However, further research is necessary todetermine whether or not the development of a model of decision-making may empower pregnantwomen in making choices about screening.