Breaking the Taboo: Cousin Marriage in the Middle East

 

In the Middle East and in North Africa, love may be blind, but genetics sure aren't. It is time for the inhabitants of the region begin breaking the cycle of cousin marriages – at least to prevent family reunions from  turning into a genetic counseling sessions.

 

In many Middle Eastern countries, it is culturally okay to marry a cousin, especially a first cousin. But the practice is linked to a higher risk of genetic disorders because people are more likely to share harmful genetic variants from parents they share. This is because people who are linked closely share more of their DNA than people who are not related. Studies have shown that cousin marriage in the Middle East raises the chance of inherited diseases like thalassemia and cystic fibrosis, which can have serious effects on the people who get them and their families. To reduce these risks, genetic counseling and premarital screening programs have been set up, but more information and awareness is still needed to solve this problem in that part of the world.

Just consider this scenario: Ali Ahmed (the name has been changed to retain anonymity), a professor of clinical genetics at Egypt's National Research Center, shows Mostafa, Cleopatra, and their family to his room. At least three of their five children have a rare brain disease that shows up around the age of four and causes mental retardation, loss of use of limbs, and death later on. The ten-year-old girl of the couple slumps and jerks. Ali and Cleopatra, who are husband and wife, are also first cousins (the names have been changed to protect privacy). This birth defect has shown up because of this.

As I noted earlier, this kind of thing happens too often in the Middle East and north Africa. When a person marries a close cousin, the chance that both parents have dangerous recessive genes goes up by a lot. When a child gets a copy of the gene from both parents, which happens 25% of the time, the child can get sick. Some of these diseases are well-known, like microcephaly, which causes children to have extremely small heads. Others, like thalassemia, are completely new. Based on what has been written, 90% of the cases seen by doctors in the region  are caused by marriages between relatives.

There aren't many statistics about how often close cousins get married today. Estimates show that the Middle East and North Africa continue to have the highest levels, even though it used to be popular in the West. About 40% of people in Egypt marry a cousin. The studies conducted  in Jordan, especially the one done in 1992, found that 32% of people were married to a first cousin and 17.3% were married to a more distant relative. People think that rates are even higher in tribal countries like Iraq, Saudi Arabia, Yemen, and Kuwait.

 

Genetic Roulette

People in the Middle East and North Africa today look to marry within the family because they know a lot about them: who they are, what they do for a living, and any mistakes they've made in the past. And having a lot of them means they have a big family. The people in the area are looking for morals and good behavior. Getting married within the family also makes sure that property stays in the family. Rates are highest in Upper Egypt, which is mostly a farming area.

In contrast to the West, there are no social stigmas. Sara (the name has been changed to retain anonymity), a 40-year-old Egyptian woman who married her cousin and has two sons with micro-syndrome (which causes cataracts, small genitalia, and learning problems), says that her family still criticizes her for letting her 18-year-old daughter get engaged to a stranger, just  because the fiancé is not a relative.

Many people think wrongly that cousins on the mother's side are not blood relations. Intermarriage is more common among Muslims, but it also happens among Christians. The Koran says that Muslims can marry anyone, except for parents, brothers, aunts and uncles, nieces and nephews. Thus, in another Middle East family, Cleopatra, who was Ghali's daughter, married her cousin Mostafa (name changed to protect privacy).

But many people in the area just don't know about the risks of marrying someone from the same family. When told about the problems, people in a small study in Saudi Arabia were 50% less likely to think it was a good idea to marry a cousin.

Some countries make blood tests for fiancés a requirement in order to cut down on genetic diseases. This has helped cut down on diseases like sickle cell anemia. In Tunisia, everyone who is getting married to a cousin has to go to premarital counseling. A lot more needs to be done in Egypt, where schooling is often very basic. Couples who are aware of the risks often think (sometimes because their doctor tells them so) that basic blood tests rule out the risk of any genetic illness. Truth be told: The only way to escape suffering is to not marry a family member, cousin, or other relatives. But that may not be possible in the Middle East and North Africa, unfortunately.

 

Notes

 

Abdalla, B., & Zaher, A. (2013). Consanguineous Marriages in the Middle East: Nature Versus Nurture. The Open Complementary Medicine Journal, 6(5), 1-10.

Bittles, A. H. (1995). When Coursins Marry: A Review of Consanguinity in the Middle East. Perspectives in Human Biology, 1, 71-83.

Khoury, S. A., & Massad, D. (1992). Consanguineous Marriage in Jordan. American Journal of Medical Genetics, 43(5), 769-775.

Temtamy, S., & Aglan, M. (2012). Consanguinity and Genetic Disorders in Egypt. Middle East Journal of Medical Genetics, 1(1), 12-17.

The Economist . (2016, February 25). Keeping It in the Family. Retrieved from https://www.economist.com/middle-east-and-africa/2016/02/25/keeping-it-in-the-family