Despite the widespread use of prenatal screening, women's perceptions and experiences of prenatal care have only recently been addressed in scientific research.1 Several studies show that perceptions of and participation in prenatal testing can be quite different among women of different ethnic, cultural and social backgrounds.2 3 Especially little is known about how Muslim women experience prenatal care in a Western society.4 Our aim was to examine how these experiences and perceptions differ from the experiences and perceptions of non-Muslim women in Flanders and Brussels in Belgium.

Semi-structured interviews were conducted with Muslim and non-Muslim women. The respondents for this qualitative study were recruited through the maternity departments of three university hospitals and one general hospital. The study was approved by the ethics committees of the hospitals where this study took place.

A total of 15 Muslim and 15 non-Muslim women who gave birth within the last 4 days participated in this study. For all women, reassurance about the welfare of the unborn child was the main reason for undergoing prenatal screening tests (Table 1). Yet, two tests were not accepted among most Muslim women in this study: the combination test and nuchal scan. Refusing to participate in these tests could be strongly associated with Muslim women's opposition to abortion (Table 1).

Most Muslim women indicated that they had always been given a choice of whether or not to participate in the combination test and nuchal scan. Among the non-Muslim women, all the lower educated and some of the highly educated women claimed that the tests were performed as a matter of course, without much discussion with the gynaecologist.

In general, highly educated primigravidas, both Muslim and non-Muslim women, indicated that they received detailed information from the gynaecologist on prenatal testing (Table 1). Moreover, they sought additional information about these tests, in contrast to lower educated primigravidas, which resulted in better knowledge about the prenatal tests.

In contrast to almost all non-Muslim women in this study, most Muslim women in this sample did not take a combination test and nuchal scan. The combined test calculates the probability of having a child with Down's syndrome, but can never offer complete certainty, which can create distress for pregnant women.5 Many Muslim women therefore chose to avoid this distress by not participating in the combination test and nuchal scan. Refusing prenatal tests was always closely related to an opposition to abortion, which for all Muslim women could be associated with their religion.

Not all women felt that they had a choice in the implementation of certain prenatal tests. While most Muslim women said that they had been given the choice about participating in the prenatal tests, the lower educated non-Muslim women in particular felt that the tests were performed as a matter of course. It is noteworthy that the effect of education asserts itself only in the group of non-Muslim women. A possible explanation for this finding could be that gynaecologists are aware that the denial of the combination test and nuchal scan is frequent among Muslim.

The main similarity between Muslim and non-Muslim women could be found in the effect of educational level on the knowledge of prenatal testing among the primigravidas. Most multigravidas had a good knowledge about the prenatal tests, which could be explained by the experience of previous pregnancies.

We observed important differences between Muslim and non-Muslim women with regard to participation in the screening tests and their attitude towards abortion. However, the differences were most marked between women with a lower education and women with a higher education. This suggests that education could eliminate a great deal of the differences.