Doha Debates

Consanguineous marriage: Should it be discouraged?

Middle East Heath was invited to attend the Doha Debate on consanguineous marriage. Marriage between cousins is fairly widespread in the Arab world, however it appears there is growing sense in the younger generation that the practice should be discouraged because of the increased possibility of hereditary disorders in the offspring of such marriages. Imogen Lillywhite reports.

The medical implications of consanguineous marriage, such as hereditary disorders, were a key feature of a high profile and globally televised debate in Doha. At the end of the debate most students attending the session voted to discourage unions between cousins.

The Doha Debate on consanguineous marriage, held in the Qatari capital in March, was one of a series of debates which began in 2004. The debates are moderated by former BBC correspondent Tim Sebastian and give young people in the Arab world a chance to speak out about issues that affect them.

Marriage between first cousins has been common in the Arab World for centuries, but the debate showed that many in the younger generation may want to rethink the tradition.

At the event, held at the Georgetown University campus in Doha and televised on BBC World News, 81% of the audience voted to support the motion ‘This house believes marriage between close family members should be discouraged’ – 19% opposed it.

Just five members of the 350-strong audience, made up of students from countries spanning the Middle East and North Africa, admitted that they were married to or planned to marry their first cousin.

They heard from panellist Ohad Birk, an Israeli geneticist and head of the Kahn Genetics Research Centre at Ben Gurion University, who has spent 10 years researching hereditary disorders in Bedouin communities in which 60% of marriages are between first or second cousins.

He gave an emotive argument as to why consanguineous or close family marriage should be discouraged. “The instances of severe birth defects are four times higher than in other communities,” he said.

“At the end of the day, these are human beings. Two days ago a couple came into my office with their two bright, beautiful girls, both born with no eyeballs. This couple is devastated.

“Last week I visited the home of a family of a high school teacher, three of his kids ages 23, 20 and 18, are in diapers, severely mentally retarded, they don’t recognise their parents.

“These families send a very clear message – marry within your community, marry even within your remote family, but do not marry your first cousin.”

Professor Alan Bittles, an expert on community genetics with professorships at two Australian universities, argued against the motion saying some of the statistics presented were ‘spurious’. He acknowledged there was an increased risk of birth defects in cousin marriages, but that increase is small.

“I will give you some statistics based on 5 million births from 75 studies from around the world. The risk of excess stillbirths in first cousin offspring is 0.5 per 1,000; infant deaths: 12.5 per 1,000; deaths from late pregnancy through to 10-12 years: 34 per 1,000.”

He added that the degree to which discouraging people from marrying their first cousin and telling them instead to marry from their remote family or community would reduce genetic diseases was ‘limited’.

He also asked: “Who is going to monitor this? Who is going to run this? Will we impose sanctions or take a stance against those who don’t want to agree to this? “As a geneticist of 30 years standing, I am well aware of the difficulties that have been in the past as the result of the misuse of genetics.

“At the start of the 20th century, hundreds of thousands of people were murdered or sterilised on eugenic grounds. What can appear to be a reasonable stance can turn out to be monstrous.”

Saudi Arabian columnist and broadcaster Samar Fatany also opposed the motion. “Culturally, the lifestyle here, there is a lot of respect for the family,” she said.

“Families feel comfortable if their daughter marries within the family rather than marry a stranger, they do not know if she is going to be happy or safe if they know nothing about her husband’s background.

“The segregated lifestyle does not allow for the mixing of sexes outside the family environment, consequently you have cousins falling in love and parents will not stand in the way of love.”

But she was opposed by British Pakistani journalist and social commentator Sarfraz Manzoor who argued that young people should have more freedom of choice about who they married and that cousin marriage was ‘unhealthy for the couple and unwise for society’.

“Most of us are too scared to speak out. It is time to stand up and say that cultural tradition is not a good enough reason to be sticking with this practice,” he argued.

“This is not a situation where two people fall in love and happen to be cousins, these marriages are arranged by families who want to keep wealth and property in the family or obtain entrance for someone to a country.

“They have got nothing to do with people getting married and everything to do with pleasing others.”

He also blamed the high instances of genetic disorders in Qatar on cousin marriages adding: “I think societies are healthier when more communities mix and integrate, the more families marry within each other, the less chance of creating an integrated society.”

Panelists from both sides advocated couples undergo genetic testing before marriage to find out if there is a risk of birth defects in their offspring. While the youngsters in the audience at the Doha Debate showed signs of wanting to move against the tradition of consanguinity, the fact remains that the medical community will continue to be divided on whether or not it is to blame for the prevalence of genetic disorders in the Arab world.

Middle East Health spoke to Dr Ghazi Omar Tadmouri, assistant director of the Dubai-based Centre for Arabic Genomic Research (CAGS) whose research was cited in the debate.

He advocated for better counselling services for couples concerned about genetic disorders in their offspring but said it was important not to solely blame consanguinity for the high rate of such disorders in the Arab world.

Unions between family members may account for more than half of marriages in the current generation of UAE nationals, according to Dr Tadmouri.

A once per generation survey compiled by the centre states that between 40% and 54% of UAE nationals’ marriages are between family members, up from 39% in the previous generation and between 21% and 28% of marriages of UAE nationals were between first cousins.

Dr Tadmouri, who is also a Fellow of the Royal College of Physicians in Edinburgh, said: “I receive calls from people who say to me, ‘I have got this test result, what do I do? Should I still get married? Should I have children?’

“People can consult their own doctor, but they may be too close to the subject and are not trained in genetic counselling.” He said he knew of genetic counsellors who were trained in the UK but were unable to find work despite an obvious need for the service in the Arab world.

In Saudi Arabia marriages between relatives are reported to be as high as 67% with up to 42% between first cousins. The practice is also common in Qatar and Yemen where the figures for marriage between first cousins is 35% and 34% respectively.

In contrast, there were calls to ban marriage between first cousins in the UK last year amid claims that the practice, particularly among British Pakistanis, threatened the health of future generations of children.

CAGS, however, advises that while consanguinity is a factor in the prevalence of genetic conditions, there are other contributors, such as that Arab women tend to have more children and continue having them until menopause.

Dr Tadmouri said conditions rare in the rest of the world, such as skeletal abnormalities, were common in certain UAE tribes, but conditions such as diabetes will continue to be prevalent with or without consanguinity as they already affect up to 33% of the Emirati population.

He stated that at present, there is a ‘passive’ method in the UAE of discouraging marriages between those whose combined genes have a more likely outcome of a genetic disorder.

Since 2004, all couples who want to marry in the UAE, whether ex-pat or citizens, are required to undergo tests for diseases including HIV and also for inherited blood disorders.

“There is a marriage fund for UAE nationals. Anyone who has this test and gets positive results will not receive their grant,” he said. “This is a passive method.”

Qatar introduced a similar law in 2003 and pre-marital screenings began in 2009.

 Date of upload: 20th Jun 2012


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