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
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
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
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%
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,”
“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
“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
“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
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
“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%
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
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
“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
of upload: 20th Jun 2012