This chapter considers how healthcare services can support informed decision making within prenatal screening programmes. It discusses potential approaches to evaluating screening programmes that use informed choice rather than test uptake as the outcome measures. In the latest version of the Multi-dimensional Measure of Informed Choice (MMIC), ten knowledge items are measured. Of these ten, five are concerned with understanding the screening risk result and two with assessing knowledge of down syndrome. The emphasis on increasing informed decisions rather than promoting test uptake brings an additional challenge to the evaluation of fetal anomaly screening programmes. Central to the notion of informed choice, and to the definition on which the MMIC is based, are personal values. There are now a number of well-validated measures of decision making, for example the decisional conflict scale, that may be suitable for evaluating quality of decision making in prenatal screening programmes at the individual level.