Since its introduction into maternal health care more than 30 years ago, prenatal diagnosis (PND) is being debated controversially in Germany. The main ethical dilemma associated with PND is the option of selective termination of an affected pregnancy. Another point of concern is PND being presented as a "routine" procedure making it difficult for women to refuse it. When PND was introduced three decades ago there was unanimous agreement that PND should be embedded in pre- and post-test counselling, that PND should only be done with informed consent and that informed consent can only be given if accurate non-biased counselling is provided in a non-directive manner. However, today only a minority of women undergo qualified pre-test (13%) and post-test counselling (18%). Utilization rates of pre- and post-test counselling services are influenced by PND centres and practices and vast regional differences can be observed. Decisions regarding termination of pregnancy depend on many factors including the severity and prognosis of a condition, gestational age and the way in which information about the condition is communicated. In conclusion the uneven availability and accessibility of quality counselling services may impact the wellbeing of women undergoing PND.