Background
Methods
National statistics and legal documents
Documentary analysis
Sample and procedure
Stakeholder interviews
Sample
Development of the interview schedule
Ethical approval
Interview procedure
Analysis
Results
Documentary analysis
Population characteristics, health and social care
The Netherlands | United Kingdom* | Denmark | |
---|---|---|---|
Birth rate per 1000, 2010
| 11.1 | 13.0 | 11.4 |
Maternal age, 1st child, 2010
| 29.4 | 29.5 | 29.1 |
Reported religious affiliation (2009)
| 56% | 85% | 80% |
Foreign-born population (2008)
| 10,9% | 11% | 8.8% |
2.5% EU | 3.5% EU | 2.6% EU | |
8.4% Non EU | 7.5% Non EU | 6.2% Non EU | |
% of population aged 30–34 yrs with tertiary education qualifications (2009)
| 35.8 | 37.9 | 41.2 |
GDP per capita in PPS**
| 133 | 112 | 127 |
The Netherlands | United Kingdom* | Denmark | |
---|---|---|---|
Healthcare system
| Social Security Healthcare system | National Health Service | National Healthcare system |
Funding of healthcare system
| Earmarked premiums | General taxation | General taxation |
Organisation healthcare system
| Health care provided by non-profit hospitals and individual practitioners | Stated owned hospitals and general practitioners have contracts with NHS | State owned hospitals and general practitioners have contracts with NHS |
Strong influence of healthcare providers and (social) insurers | Strong influence of state: SSSMinister of Health responsible for budget | Strong influence of state: Minister of Health responsible for budget | |
Government responsible for accessibility, affordability and quality of healthcare | |||
Legislation regarding equality for disabled individuals
| Act on Equal Treatment of Disabled and Chronically Ill People (2003) (WGBH/CZ) | Equality Act (2010) | Parliamentary Resolution on equal opportunities for and equal treatment of people with disabilities (1993) (BSF 43) |
Wet gelijke behandeling op grond van handicap of chronische ziekte
|
Folketingsbeslutning om ligestilling og ligebehandling af handicappede med andre borgere
|
The Netherlands | United Kingdom* | Denmark | |
---|---|---|---|
Termination of pregnancy (TOP) for social reasons
| Legal until 24 weeks gestation | Legal until 24 weeks gestation | Legal until 12 weeks gestation |
TOP for fetal anomalies
| After 24 weeks only in very limited cases | No gestational limit if there is a substantial risk the child would suffer from such physical or mental abnormality as to be seriously handicapped | Permitted up to 22 weeks if there is a substantial risk that the child would suffer from severe mental or physical abnormality |
Payment for TOP
| Free at the point of delivery | Free at the point of delivery | Free at the point of delivery |
Availability, provision and access to DSS in the Netherlands, England and Denmark
Stakeholder interviews: qualitative data
The value of informed choice
“….there are more people being offered the test, but if the question is, are we encouraging women’s decision one way rather than another, to have a test or not, the answer is definitely not…” (C2-English, research).“…we don't want to have an uptake target, because it is about choice....”(C1- English, policy/ development).
“I don’t decide what they want, I just tell them that there is a choice here and then they will actively have to say yes or no” (B2-Danish, professional specialism/research).“I have spoken to thousands of women……they are very pragmatic and it's also my impression actually that Danish women take this seriously…..even if they have differences in education right now, they seemed to understand the whole aspects of this…” (B6-Danish, development/research).
“….being explicitly informed before making a choice is important to consider all the pro’s and con’s before making a choice…..” (A1-Dutch, policy/development).“…women are being counselled in a non-directive way, so they are able to make an individual choice....”(A4-Dutch, professional specialism).
Influences on screening choices
“…the uptake is very much influenced by what the midwife says to them....and also of what they are hearing from family and friends. Their preconceived ideas and what is being said to them by the midwife is going to be what decides what they do” (C3-English, professional specialism/ development).“....the uptake is influenced by the information that is available and how the screening is offered and how it is brought across by the healthcare professional” (C4-English, development).
“…a lot of women make the choice they feel this is reasonable, and they use the fact, that colleagues, their sisters etcetera went for screening…I probably think that in practice terms, it is probably an opt-out, whereas it intended to be an opt-in….” (B6-Danish, development/research).“….it’s a culture signal…..and you know from your sister when she was pregnant, or your best friend when she was pregnant, how it is a good thing to do….” (B5-Danish, policy/development).
“…..and if you present an offer.......a woman has to make a decision and it is very hard to say no to something, off course it is like that, so there can be a pressure just by presenting it…” (B4-Danish, professional specialism/research).“…[it] means that some women may think that this is a test recommended by the government and therefore equals ‘this must be good” (B1-Danish, professional specialism/research).“….because the offer is made by the government, there might be people who say I cannot decide, I will go with the flow....”(B2-Danish, professional specialism/research).
“The woman has to make an active choice of saying I want this screening…..women have to book on the internet or make a phone call…..” (B1-Danish, professional specialism/research).
“…I sometimes think, we put too much effort on informed choice…..in normal life how many real informed choices do we actually make…..” (A3-Dutch, professional specialism).
“….the effort being made on informed choice can be of influence on low uptake rates in the Netherlands….” (A4-Dutch, professional specialism).
“Before counselling women are asked if they want information on the test” (A4-Dutch, professional specialism).“....a woman can indicate that she does not want to know about any prenatal test, then that’s also ok, one shouldn’t overwhelm women if they don’t want that” (A1-Dutch, policy/development).
“....there is a problem attached to it [the right not to know]....if you ask somebody if they want to know [about DSS], and they don’t, is it clear for the parents what it is about?....do they exactly know about the consequences?” (A3-Dutch, professional specialism).
“....women have the right not to know, but when you offer the screening you are already sort of pressurizing it…”(B6-Danish, development/research).
“So the subject is raised with everybody, if she says, no, I don’t want to hear anything more, then she won’t be told anything more….” (C2-English, research).
Financial considerations and impact on screening choices
“……For some people the charge of €160,00 could cause distrust. For some people the amount of money has impact on their available budget…..” (A4-Dutch, professional specialism).”….in one Dutch region where the test was reimbursed for everybody, the uptake increased by 50%.....but one could question whether these women were able to make an informed choice…” (A3-Dutch, professional specialism).
“.…money can play a role in decision making, but that is something we don’t know yet” (A1-Dutch, policy/development).“....I wonder whether the fee of €160,00 could be a reason to decline the test.....” (A2-Dutch, development/research)“preliminary research showed that costs have not affected the uptake much.....” (A2-Dutch, development/research).