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PAPERS: J Fletcher, N R Hicks, J D S Kay, and P A Boyd Using decision analysis to compare policies for antenatal screening for Down's syndrome BMJ 1995; 311: 351-356 [Abstract] [Full text]

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Do we know if women 35 and over prefer pregnancy termination?

Ibrahim Awad Ibrahim   (1 December 1999)

Do we know if women 35 and over prefer pregnancy termination? 1 December 1999
Ibrahim Awad Ibrahim, Assistant Professor Pennsylvania State University Send response to journal: Re: Do we know if women 35 and over prefer pregnancy termination?	I read this article with interest as a good example of decision analysis for policy choices. In fact I used this article as a case study in my class on decision analysis. A question was raised during discussion that I found valid and worth a response from the authors. The question is: do we know what proportion of women 35 years old and over opt for pregnancy termination and the proportion who continue the pregnancy? The question, to me, is valid because it seems that women at this age would like to have such a precious baby who if delayed further would have a higher risk of Down's syndrome because of the mother's age. This will have a bearing on the policy because if a good proportion of older women chose to keep the pregnancy anyway, we need to take this into consideration in the decision tree and in examining the policy. I tried to logically place such a choice in the decision tree in the article and found it difficult and thought that simply placing this choice in (choice 5 in the decision tree in the article) would not solve the problem. Furthermore, if this is an option, wouldn't be appropriate in this case to also look at the lifelong cost of a Down's syndrome child and incorporate such a cost in the analysis?