Objective: The aim of this study was to evaluate which of the following factors affect the uptake of the combined test (CT) in the Netherlands: women's socio-demographic background, attitude towards Down syndrome, attitude towards termination of pregnancy, counseling process, reimbursement policy, and knowledge on the aim of the CT. Methods: Cross-sectional survey in the Northwest (NW) and the Northeast (NE) region of the Netherlands. Results: Analyses were based on 820 questionnaires (73% response rate). Women from the NW region opted more often for the CT than women from the NE region (52.1% and 16.5%, respectively, p<0.001). Women of 36years and older opted more often for the CT than younger women (59.4% and 28.2%, respectively, p<0.001). Women's socio-demographic background and their attitude towards Down syndrome and termination of pregnancy (TOP) had contributed independently on CT choice. Conclusion: The uptake of the CT in this study is low. The main reason for the low uptake is the relatively positive attitude towards Down syndrome and a negative attitude towards TOP. Moreover, the perception of maternal age as strong predictor of Down syndrome risk and the inequality of access to care, due to the financial threshold for younger women, are likely to affect participation in screening.