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Sir,

The interesting study by Jackson et al.1 shows that how women perceive their referral to specialist services may profoundly affect how they subsequently avail themselves of these services, and it goes on to highlight the need for improvement of the interface between community and secondary antenatal services. While they provide some of the participants’ variables, they did not mention their level of educational attainment, which may have influenced their understanding both of the reasons for referral and the risks and benefits of the management options.2 Their continuing difficulties in understanding their referral and the nature of the clinic emphasise this point. Did the authors collect educational level, and if so, did it correlate with the participants’ level of understanding?

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