Skip to main content
SpringerLink
Log in

Perceptions of Prenatal Testing for Birth Defects among Rural Latinas

  • Original Research
  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Objectives To examine rural Latinas’ understandings of prenatal testing, birth defects, and risk in the context of their expanded AFP (XAFP) screening decisions. Design We conducted a qualitative study using data from in-depth interviews with 33 Latina women receiving prenatal care at three clinic sites in rural areas of California. We analyzed qualitative data by identifying themes that emerged during iterative transcript readings. Quantitative data was used to generate descriptive summary statistics. Results The majority of the participants had not completed high school and had low levels of acculturation. Women in our study tended to view XAFP screening as a routine component of prenatal care that was important for the “health of the baby.” Reasons for accepting the XAFP test included reassurance, emotional preparation, and desire for information. Misconceptions included a belief that a normal screening result provides a guarantee of the fetus’s health. Generally, participants indicated that, regardless of the screening results, they would not undergo amniocentesis because of the potential miscarriage risk nor would they terminate a pregnancy if their fetus was found to have a chromosome problem. Numerous specific beliefs that differ substantially from medical models regarding birth defects were articulated. Conclusions XAFP screening decisions among rural Latinas are sometimes based on misconceptions of the meaning of test results and the risks associated with undergoing or foregoing testing, and therefore are frequently incongruent with personal testing philosophies and values. Educational efforts and counseling should include clear communication regarding the goals of prenatal screening programs to help these women make informed testing decisions that are reflective of their values and preferences.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. ACOG (2007). Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: Screening for fetal chromosomal abnormalities. Obstetrics and Gynecology, 109, 217–227.

    Google Scholar 

  2. Cal. Code of Regs. tit 17, s 6527, 2006.

  3. Tabor, A., Philip, J., Madsen, M., Bang, J., Obel, E. B., & Norgaard-Pedersen, B. (1986). Randomised controlled trial of genetic amniocentesis in 4606 low-risk women. Lancet, 1, 1287–1293.

    Article  PubMed  CAS  Google Scholar 

  4. Antsaklis, A., Papantoniou, N., Xygakis, A., Mesogitis, S., Tzortzis, E., & Michalas, S. (2000). Genetic amniocentesis in women 20–34 years old: associated risks. Prenatal Diagnosis, 20, 247–250.

    Article  PubMed  CAS  Google Scholar 

  5. Tongsong, T., Wanapirak, C., Sirivatanapa, P., Piyamongkol, W., Sirichotiyakul, S., & Yampochai, A. (1998). Amniocentesis-related fetal loss: a cohort study. Obstetrics and Gynecology, 92, 64–67.

    Article  PubMed  CAS  Google Scholar 

  6. Lippman, A., Tomkins, D. J., Shime, J., & Hamerton, J. L. (1992). Canadian multicentre randomized clinical trial of chorion villus sampling and amniocentesis. Final Report. Prenatal Diagnosis, 12, 385–408.

    Article  PubMed  CAS  Google Scholar 

  7. Smidt-Jensen, S., Permin, M., Philip, J., et al. (1992). Randomised comparison of amniocentesis and transabdominal and transcervical chorionic villus sampling. Lancet, 340, 1237–1244.

    Article  PubMed  CAS  Google Scholar 

  8. Kuppermann, M., Gates, E., & Washington, A. E. (1996). Racial-ethnic differences in prenatal diagnostic test use and outcomes: preferences, socioeconomics, or patient knowledge? Obstetrics and Gynecology, 87, 675–682.

    Article  PubMed  CAS  Google Scholar 

  9. Browner, C. H., & Preloran, M. (2000). Interpreting low-income Latinas’ amniocentesis refusals. Hispanic Journal of Behavioral Sciences, 22, 346–368.

    Article  Google Scholar 

  10. Press, N., & Browner, C. H. (1998). Characteristics of women who refuse an offer of prenatal diagnosis: data from the California maternal serum alpha fetoprotein blood test experience. American Journal of Medical Genetics, 78, 433–445.

    Article  PubMed  CAS  Google Scholar 

  11. Learman, L. A., Kuppermann, M., Gates, E., Nease, R. F., Gildengorin, V., & Washington, A. E. (2003). Social and familial context of prenatal genetic testing decisions: Are there racial/ethnic differences? American Journal of Medical Genetics, 119C, 19–26.

    Article  PubMed  Google Scholar 

  12. Kuppermann, M., Learman, L. A., Gates, E., et al. (2006). Beyond race or ethnicity and socioeconomic status: predictors of prenatal testing for Down syndrome. Obstetrics and Gynecology, 107, 1087–1097.

    PubMed  Google Scholar 

  13. Cunningham, G. C., & Tompkinison, D. G. (1999). Cost and effectiveness of the California triple marker prenatal screening program. Genetics in Medicine, 1, 199–206.

    Article  PubMed  CAS  Google Scholar 

  14. Bernhardt, B. A., Geller, G., Doksum, T., Larson, S. M., Roter, D., & Holtzman, N. A. (1998). Prenatal genetic testing: content of discussions between obstetric providers and pregnant women. Obstetrics and Gynecology, 91, 648–655.

    Article  PubMed  CAS  Google Scholar 

  15. Press, N. A., & Browner, C. H. (1993). ‘Collective fictions’: similarities in reasons for accepting maternal serum alpha-fetoprotein screening among women of diverse ethnic and social class backgrounds. Fetal Diagnosis and Therapy, 8(Suppl 1), 97–106.

    Article  Google Scholar 

  16. Press, N., & Browner, C. H. (1997). Why women say yes to prenatal diagnosis. Social Science and Medicine, 45, 979–989.

    Article  PubMed  CAS  Google Scholar 

  17. Browner, C. H., & Preloran, M. (1999). Male partners’ role in Latinas’ amniocentesis decisions. Journal of Genetic Counseling, 8, 85–108.

    Article  PubMed  Google Scholar 

  18. Browner, C. H., Preloran, M., & Cox, S. (1999). Ethnicity, bioethics, and prenatal diagnosis: The amniocentesis decisions of Mexican-Origen women and their partners. American Journal of Public Health, 89, 1658–1666.

    Article  PubMed  CAS  Google Scholar 

  19. Blewett, L. A., Davern, M., & Rodin, H. (2005). Employment and health insurance coverage for rural Latino populations. Journal of Community Health, 30, 181–195.

    Article  PubMed  Google Scholar 

  20. Kasirye, O. C., Walsh, J. A., Romano, P. S., et al. (2005). Acculturation and its association with health-risk behaviors in a rural Latina population. Ethnicity and Disease, 15, 733–739.

    PubMed  Google Scholar 

  21. Conrad, J. K., Hollenbach, K. A., Fullerton, J. T., & Feigelson, H. S. (1998). Use of prenatal services by Hispanic women in San Diego County. A comparison of urban and rural settings. Journal of Nurse-Midwifery, 43, 90–96.

    Article  PubMed  CAS  Google Scholar 

  22. Heilemann, M. V., Lee, K. A., Stinson, J., Koshar, J. H., & Goss, G. (2000). Acculturation and perinatal health outcomes among rural women of Mexican descent. Research in Nursing and Health, 23, 118–125.

    Article  PubMed  CAS  Google Scholar 

  23. Browner, C. H., Preloran, M., & Press, N. A. (1996). The effects of ethnicity, education and an informational video on pregnant women’s knowledge and decisions about a prenatal diagnostic screening test. Patient Education and Counseling, 27, 135–146.

    Article  PubMed  CAS  Google Scholar 

  24. Carnevale, A., Lisker, R., Villa, A. R., & Armendares, S. (1998). Attitudes of Mexican geneticists towards prenatal diagnosis and selective abortion. American Journal of Medical Genetics, 75, 426–431.

    Article  PubMed  CAS  Google Scholar 

  25. Browner, C. H., Preloran, M. H., Casado, M. C., Bass, H. N., & Walker, A. P. (2003). Genetic counseling gone awry: miscommunication between prenatal genetic service providers and Mexican-origin clients. Social Science and Medicine, 56, 1933–1946.

    Article  PubMed  CAS  Google Scholar 

  26. Hunt, L. M., de Voogd, K. B., & Castaneda, H. (2005). The routine and the traumatic in prenatal genetic diagnosis: does clinical information inform patient decision-making? Patient Education and Counseling, 56, 302–312.

    Article  PubMed  Google Scholar 

  27. Martin, J. A., Kochanek, K. D., Strobino, D. M., Guyer, B., & MacDorman, M. F. (2005). Annual summary of vital statistics–2003. Pediatrics, 115, 619–634.

    Article  PubMed  Google Scholar 

  28. Shaffer, C. F. (2002). Factors influencing the access to prenatal care by Hispanic pregnant women. Journal of the American Academy of Nurse Practitioners, 14, 93–96.

    Article  PubMed  Google Scholar 

  29. Berry, A. (1999). Mexican American women’s expressions of the meaning of culturally congruent prenatal care. Journal of Transcultural Nursing10, 203–212.

    Article  PubMed  CAS  Google Scholar 

  30. Pearce, C. W., Hawkins, J. W., Carver-Chase, D., et al. (1996). Comprehensive interdisciplinary care: making a difference in pregnancy outcomes for Hispanic women. Public Health Nursing, 13, 416–424.

    Article  PubMed  CAS  Google Scholar 

  31. Patton, M. (1990). Qualitative evaluation and research methods. Newbury, Park, CA: Sage.

    Google Scholar 

  32. California Department of Health Services: Genetic Disease Branch. (2003). The California expanded AFP screening program. Basic booklet for women under 35 years of Age (pp. 1–8). Richmond: California Department of Health Services, Genetic Disease Branch. .

  33. Marin, G., Sabogal, F., Marin, B., & Sabogal-Otero, R. (1987). Development of a short acculturation scale for Hispanics. Hispanic Journal of Behavioral Sciences, 9, 183–205.

    Article  Google Scholar 

  34. SPSS [computer program]. Version 12.0. Chicago: SPSS, 2003.

  35. NVIVO [computer program]. Version 2. Australia: QRS International, 2002.

  36. Santalahti, P., Hemminki, E., Latikka, A., & Ryynanen, M. (1998). Women’s decision-making in prenatal screening. Social Science and Medicine, 46, 1067–1076.

    Article  PubMed  CAS  Google Scholar 

  37. Moyer, A., Brown, B., Gates, E., Daniels, M., Brown, H. D., & Kuppermann, M. (1999). Decisions about prenatal testing for chromosomal disorders: perceptions of a diverse group of pregnant women. Journal of Women's Health and Gender-Based Medicine, 8, 521–531.

    PubMed  CAS  Google Scholar 

  38. Eichmeyer, J. N., Northrup, H., Assel, M. A., Goka, T. J., Johnston, D. A., & Williams, A. T. (2005) An assessment of risk understanding in Hispanic genetic counseling patients. Journal of Genetic Counseling, 14, 319–328.

    Article  PubMed  Google Scholar 

  39. Lichter, D. T., & Johnson, K. M. (2006). Emerging rural settlement patterns and the geographic redistribution of America’s new immigrants. Rural Sociology, 71, 109–131.

    Article  Google Scholar 

Download references

Acknowledgements

Thanks and gratitude to Annie Lim and Rocio Medina for their help with data coding and to Michaela Kiernan for her advice, guidance, and comments on manuscript drafts. This study was funded in part by the Stanford University School of Medicine Community Partnership Medical Scholars Research Award. The funding sources had no involvement in the study’s design, conduct, or interpretation

Author information

Authors and Affiliations

  1. Lucile Packard Children’s Hospital, Stanford University Hospital and Clinics, Stanford, CA, USA

    Courtney Griffiths

  2. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    Courtney Griffiths

  3. Departments of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, School of Medicine, University of California, 3333 California Street, Suite 335, San Francisco, CA, 94143-0856, USA

    Miriam Kuppermann

  4. Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA

    Miriam Kuppermann

Authors
  1. Courtney Griffiths
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miriam Kuppermann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Miriam Kuppermann.

Additional information

All parts of this study were reviewed and approved by the Stanford University Administrative Panel of Human Subjects in Medical Research and the University of California at San Francisco Committee on Human Research.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Griffiths, C., Kuppermann, M. Perceptions of Prenatal Testing for Birth Defects among Rural Latinas. Matern Child Health J 12, 34–42 (2008). https://doi.org/10.1007/s10995-007-0214-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-007-0214-3

Keywords

Search

Navigation