Maternal serum screening, political decision-making and social learning.

OBJECTIVE: Analysis and evaluation of the process by which serum screening has been introduced in Dutch maternity care. In our analysis of Dutch medical journals, reports of the government and the political and cultural debate, we use a theoretical framework in which the process of introduction of new technologies is described in terms of different social learning processes.
RESULTS: The analysis shows a dual-track pattern: promotion by the medical community, and control and regulation of serum screening by the political decision-makers. This process left little room for social learning processes. This applied in particular to learning processes about the social and cultural meaning and acceptability of serum screening. Acceptability of the new serum screening was framed nearly exclusively in terms of freedom of choice.
CONCLUSIONS: A too limited framework of assessment was used. Health technology assessment (HTA) should incorporate in the evaluation process the ethical, social, cultural and political dimensions of health technology, and stimulate the interplay between different perspectives and preferences among parties involved. As a new promising approach, we suggest the use of pilot experiments that are designed as social experiments involving different parties in a common learning process.