Public health’s “elephant in the room”
Public health in the Middle East… we have so much to work on.
Let’s start with what it means. Public health is all about awareness (fatty foods cause diabetes and atherosclerosis, having children after 40 raises the chance of birth defects…) and prevention (screening, early diagnosis, limiting bad habits). Public health advocates respect your freedom in general, unless your actions can hurt someone else, then it’s downright war, as all the poor smokers can tell you.
But there is an “activity”, very common in the ME among all classes of society, which has potentially tragic consequences on the most vulnerable among us, and which many of us are oblivious to… Consanguinity “Marriage between cousins”.
Let’s start with the science:
The danger of marriage between relatives is that pesky “Recessive Gene”, which can cause many serious and usually fatal diseases. Luckily, those disorders are extremely rare, with the whole bundle affecting 3-4% of the population. That figure rises up to 6-7% in first cousin marriages, and to 12% if the offspring are the result of a double first marriage (as in the married couple are also offspring of first cousin marriages). This is no joke people…
10% of marriages worldwide are consanguineous, with skyrocketing percentages in our region. As we all know, the practice is encouraged in our culture. I have never seen its implications discussed before me, except for a casual racist remark I heard once in my life. Neither have I heard any attempt to raise awareness, except for my college pediatrician who shouts at villagers bringing children with heartbreaking conditions.
It’s understandable why the practice is attractive, the social benefits are vast. I also get why no government is attempting to tackle this behemoth. But wouldn’t you agree that this is a public health cause of utter importance? When the decisions of people can harm nobody except those who are closest to their heart, don’t they at least deserve to be aware about it? Is a long term goal of outright banning the practice ridiculous?
Please keep the comments lengthy, diversifying and personal 🙂
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The Diadochi 
July 6, 2010 at 12:03 pm
Wow that world map certainly looks scary! How bad is the situation in Lebanon? It’s too tiny for me to make out.
July 6, 2010 at 1:25 pm
Lebanon seems to be like us, 30-40%. Here’s an enlarged link http://www.consang.net/images/c/c4/Globalcolourlarge.jpg
Just a disclaimer though. It looks scary because they have no data on Subsaharan Africa, or Central Asia. I’m pretty sure that will result in a lot more red. Doesn’t make our situation any better however.
July 6, 2010 at 12:40 pm
Hi. 😀
I’m not against the marrying of cousins, but I know some people who are double cousins that got married, then their children married their cousins and they like all have the same grandma. That’s disgusting.
July 6, 2010 at 1:06 pm
Is that like triple cousin marriage? Woah!
If you find some 10 year old kid who knows he will die in a couple of years and hates his parents for it, do you blame him? What about the ethics of people who know they are putting their children at 3-10% greater risk of contracting something serious? What makes them better than a mom with AIDS?
July 6, 2010 at 1:16 pm
Yeah, that’s where it turns icky.
No I don’t blame him. I don’t blame any of them. But in this society, most marriages are arranged and most parents force their children into marrying their cousins to keep I don’t know what in the family. I have a lot of relatives who were forced to marry their cousins. It think that in order for this to stop, you need to destroy the society.
During these times though, I find that women here in Lebanon have had more of a say on who they want to marry. Back then, if a girl from my village would have brought a man home to her dad saying she wanted to wed him, her father would probably lock her up. Now, she has a choice and hopefully because of that, this marrying cousin saga will lessen.
July 6, 2010 at 1:18 pm
Also, I forgot to say that in Islam you can marry your cousins so I guess that’s why a lot of people don’t mind it. I feel as though most people interpret it wrong, because Islam doesn’t FORCE you to marry your cousins (there are billions more other eligible spouses in this world, other than your cousin), but it says you can.
Same thing with the four wives thing…it doesn’t advertise these kind of marriages and it doesn’t say it’s good for you, but it says you can. And that’s all people hear.
Toodle loo for now. 😀 I like this discussion.
July 6, 2010 at 1:30 pm
This is exactly what I want to see, discussion. Why aren’t talk shows talking about it? Why aren’t there advertisements about its effects? You’re not gonna hear Oprah or the doctors discussing this, this is strictly our issue?
Are families who are making choices like this, aware of the implications? Why is the preventable source of so much anguish not being challenged? Just let the people be informed, and a great many will opt out of the practice.
July 6, 2010 at 8:04 pm
I actually saw Al Jazeera English do a report about cousins marrying cousins. It talked about the dangers and such…this was about two months ago. It’s nice to know some news agencies have picked up on this.
And you’re right, rich or poor- everyone’s doing it. Some of the most educated still cousins with cousins. I’m not against cousins who marry cousins, but it’s totally out of the question for me. I think when I say I’m not against it I mean “I respect your choice, but don’t bring it up to me”. Lol.
July 6, 2010 at 2:02 pm
OK lets get to the roots of the problem, you may blame religion or society but if you look at the big picture here you realize that most of the cases is pushed by the parents being “taking care” of their children by providing them a known well and guaranteed husband or wife ( the one you know is better than the one you don’t know ).
its about the family system in our region,I think if we wanna do anything about it we should start there which is impossible in our area at this time …
I remember now how dr. Fadia acts when the patient tells her that her husband is also her cousin, God help that patient 😀
July 6, 2010 at 2:12 pm
Lol Zilal is not better, not better at all…
I’m not saying challenge the problem with all your might, I just want the information to be out there, like the smoking or AIDS information is. So the person who’s going to “take care” of his daughter just have this factor in the back of his mind.
July 6, 2010 at 2:37 pm
you are suggesting to tell abo 3abdo that marrying his daughter to her cousin (abo 3abdo jr.) is bad … good luck with that
there are some area’s here where they beat the crap out of the red Crescent members who wanna help them ,and they are helping them for God’s sake not telling them to change how they have been living the last couple hundreds of years…
July 6, 2010 at 2:59 pm
It’s found in all the classes, from the ridiculously poor, to the filthy rich. People of all educations and backgrounds engage in it. It’s not as “backwards” as you think.
I say it again, I’m not with banning outright, the risks are the same as a women getting pregnant after forty (not the double first time though, that’s bad). Just do shows about it. Where’s Zaven? Where’s “a7mar bilkhatt il3areed”. Or are doing shows about Jinn all we care about?
July 6, 2010 at 3:59 pm
I agree that this is an issue that needs more exposure in our area of the world. We should be pushing this issue into the spotlight just like we push awareness of Cancer prevention. Genetic defect prevention (sort of :p).
July 6, 2010 at 6:06 pm
This is an awesome post and I must say one which has nagged at me for several years now. My father’s cousin has married his other cousin (the couple are first cousins) and that never made sense to me as a child, and I was surprised when no one reacted to that as vehemently as I had expected them to. They instead shushed me and told me not to ask questions.
But as soon as they’re gone, the comments and hisses of disapproval begin to flare. Which makes me wonder how everyone is in fact opposed to this evolutionarily unfriendly practice, yet they condone it when the actual Darwinian exceptions are copulating babies that risk endangering the human gene pool…
Problem is split into 2 parts in my opinion. The first is the kind that villagers suffer from, which is mostly religious and social, but most importantly lack of education. They don’t know why it’s wrong, much less the risks to their mutant offspring. The second is the one suffered by adequately educated people like my dads cousins, which is mainly social complexities that result from a very family-based lifestyle and the desire to maintain that healthy nuclear family bond, more or less
July 7, 2010 at 12:46 am
Ahhh, Arabs and their insatiable appetite for gossip…
I have to say, although my opinion isn’t formed on the issue yet, I’m steeply inclined against banning, and 100% against discrimination. This activity is no more dangerous than people who have babies after 40, who smoke around children etc. We have no business chlorinating the gene pool. This isn’t eugenics.
Cousins who are in love and want to get married, when adequately informed, are perfectly capable of taking their own decisions. We’re not gonna love their children more than they do.
July 7, 2010 at 2:33 am
Unfortunately Saudi Arabia is among the countries of the world with a high rate of genetic blood disorders such as sickle cell disease and thalassemia specially in the eastern region among the rural areas and those with limited education.
cultural socio-economic factors play a major role in making marriages between relatives increasingly common. if medical issues are an important concern, then families should test their children before getting them married.
In the last few years, the government have established premarital screening centers everywhere. Couples who have applied for a marriage licence are required to visit a centre together. If the doctor determines that one of the two carries an inherited disease, the couples are informed, and then they have the choice to do whatever they want.
Still, the problem persists because the concept of a childless marriage based on love is socially unacceptable in Saudi, where having five or more children is normal.