Objective. The aim of the study was to elucidate the questions: 1) Why are some women declining an alpha‐fetoprotein (AFP)‐test? and 2) Do women who decline an AFP‐test differ in background and in attitudes towards abortion issues from women who accept the test? Furthermore the study was aimed at clarifying some aspects of the decision process.Design. Questionnaire study over a one‐year period from October 1, 1988 to September 30, 1989.Setting. Hvidovre University Hospital, Copenhagen, and the county hospitals of Sønderjyl‐land. Denmark.Subjects. 336 women who declined the AFP‐test and 3331 women who had the test performed.Main outcome measures. Main questions concerned reasons for declining AFP‐testing, attitudes to abortion issues and how the decision was made.Results. The main reasons for declining were found to be ethicalireligious reasons or the view that the test was not reliable enough. The frequencies of women with a high school degree (46.4% versus 30.8%) and of women who had had a previous spontaneous abortion (24.1% versus 14.8%) were both significantly higher in the declining group. Regarding abortion issues, women who declined the test were significantly more restrictive in their acceptance of abortion than women who had taken the AFP‐test. 5.7% of the women who declined reported that they had perceived pressure to accept the offer to have the test.Conclusion. The study has clarified the questions as to who declines the AFP‐test and why. It is discussed whether the AFP‐programme and its consequences are, in fact, too difficult for some women to grasp and understand in detail. From the Health Service's point of view, it is noteworthy that a considerable number of women who declined the test offer might make a different choice if the AFP‐p