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Haemoglobinopathy screening: an end to institutional racism?

The NHS Sickle Cell and Thalassaemia Screening Programme was launched in 2004. The objective of the programme is to offer a sickle cell and thalassaemia screening programme to all pregnant women in high prevalence areas in a timely manner, and to facilitate informed decision-making.1 Thomas et al report an action research project, conducted in 1999–2000, investigating the early offer of antenatal screening for haemoglobinopathies in primary care.2 Among those screened, the results suggest that when screening is offered in primary care, it is conducted earlier in pregnancy (on average at 9.7 weeks gestation) than when conducted during a hospital visit (13.7 weeks gestation) or by a community midwife (12.5 weeks gestation). However, the proportion of pregnant women screened in primary care was only 35% – far fewer than would be expected to have had the test had it been offered to all. Thomas et al highlight a number of problems concerning the feasibility of screening in primary care. Since the study was conducted, there has been a demonstration project in which many of the difficulties outlined by Thomas et al of engaging primary care in conducting antenatal screening for sickle cell and thalassaemia, were overcome.3 Despite this apparent success, Wright et al noted that they failed to record an increase in knowledge about screening in those having the test. The findings of these studies highlight a number of issues that all of those charged with providing antenatal screening for sickle cell and thalassaemia need to consider.

As reviewed in the background section of the paper by Thomas et al , …