Consanguineous Marriage in the UAE

Consanguineous marriages are extremely popular among the United Arab Emirates (UAE) population. The UAE hold a top position among other countries regarding this issue. Many scientists find a direct connection between such marriages and congenital malformations, autosomal recessive diseases, mental retardation, postnatal mortality higher pre-reproductive deaths, and androgen receptor mutation syndromes (AR). Relaying on researches of leading scholars, this paper would like explore the problem of diseases caused by high rate of consanguineous marriages that are so prevalent in Arab countries. Among other questions, this paper will review the rating of consanguineous marriages, its popularity among young generation, the statistics of consanguineous marriages, the advantages and disadvantages of such unions, and the reasons of their popularity in the UAE. 

Consanguineous Marriage in the UAE

Marriage in Arab culture has a special definition since it is influenced by a special worldview. Thus, marriage is regarded to have a beneficial impact on a couple’s live and contribute to its prosperity and wealth. The phenomenon of consanguineous marriage prevails quite often, but it is always frowned upon in the Western countries. It raises a host of questions such as how it works, whether it is still popular in Arab countries, or what influence it has on future generations. With the help of new technologies and medications it is much easier to study, examine, and treat diseases caused by consanguineous marriages. Consanguinity is a worldwide phenomenon with extremely high rates in the UAE regardless of adverse health outcomes. It is popular among young generations, and it has many social, economic, religious, and cultural factors. Relaying on researches of leading scholars, this paper would like explore the problem of diseases caused by high rate of consanguineous marriages that are so prevalent in Arab countries. Among other questions, this paper will review the rating of consanguineous marriages, its popularity among young generation, the statistics of consanguineous marriages, the advantages and disadvantages of such unions, and the reasons of their popularity in the UAE.

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Phenomenon of Consanguinity

Consanguineous marriage is a union between two genetically related people who usually have a common ancestor. Traditionally, this union is of first related cousins who are chosen by the families of both sides. In case such an arrangement is not suitable or available, then comes the union of second related cousins or more distant relatives. In most countries in the world, consanguineous marriage are strongly prohibited and condemned. However, more than 20% of human population practice consanguineous marriage and more than 8.5% of children are related to consanguineous parents. Consanguineous marriages are usually practiced in Asia, North Africa, Middle East, in some parts of Japan and China, and among some communities in Europe and America. Its highest rates are observed in Arab culture that comprises 22 states of the Arab League. Thus, Arabs share core cultural values that claim family to be the central structure of society. Therefore, consanguineous type of marriage is encouraged by strong religious beliefs and tradition of Arabs.

Benefits of Consanguineous Marriages

Benefits of consanguineous marriage can be interpreted from the cultural and religious point of view. This type of marriage is regarded to bring stability and prosperity for a couple and their families.  A consanguineous couple usually bears the same traditions and beliefs even on the household level, and in this way, they can avoid even slightest misunderstandings. They do not need much time to adjust to each other since they know each other from childhood, and they can avoid strangers as families are closely related. Consanguineous marriages have significant economic and social benefits.

Rates of Consanguineous Marriages

Rates of consanguinity fluctuate in the UAE according to tribes, economic classes, isolation of society, and other factors. Al-Gazali and Hamamy have observed the rate of such marriages in the UAE between 39 %– 54.2 %, which takes a top place among other countries in the world. The rates of consanguineous marriages differentiate in the main cities of the UAE. Thus, in 1997, Al-Ain was observed to have 54.2% of such marriages, which was obviously higher than in Dubai (39.9%). The most preferred type is a first-cousin marriage, and it constitutes about 20.7%- 29.7% of marriages in total. The percentage of such marriages within Bedouin communities is relatively high. In order to preserve family name, some Bedouin tribes arrange marriages only between relatives. The couples bear moral responsibility and believe that a husband will protect, support, and respect his wife because they are relatives. It is proved that consanguineous marriages are more stable than non-consanguineous because of low rate of divorce between consanguineous couples. The highest rates of consanguinity are observed among tribal communities.

Rates o Consanguineous Marriages

Western people usually associate consanguineous marriages with low socioeconomic standing, rural residence, and illiteracy. Although one can observe that the rate of consanguineous marriages has dropped in most parts of the world, the rate of consanguinity in Muslim countries is on the constant rise. A slight decline may be connected with female education and empowerment, working status, urbanization, and economic development of these countries. In 1995, the rate of first cousin marriage in the United Arab Emirates was 24%, and in 2014, this rate increased to 29.7%. This is an object lesson and evidence one cannot deny. For the last four decades, more than half of Arab population has practiced consanguineous marriages.  One cannot predict whether the rate will rise or drop in the United Arab Emirates, but judging from figures, it is likely at least to remain constant for the next few decades. Thus, consanguinity is a constant phenomenon of Arab culture.

Female Factor in Consanguinity Rate

The age of a woman, her working status, and social environment are the most significant factors that determine her marriage. Few generations, ago woman did not have any right to study or work. Her responsibilities were restricted to taking care of children and home. Environment is a crucial cause of consanguineous marriage. Nowadays, an educated woman usually has a wider range of choosing a partner, and she has a right to reject and give her opinion concerning the marriage. The other significant factor is the age of the woman. After examining statistics, it is noticeable that when the age of woman is about 15-19, the rate of first cousin marriage is about 50.3%; with the increasing age, the rate of first cousin marriage drops to 16.5%. Thus, women can be an important decreasing factor of consanguinity. 

Attitude of Young Generations

Although society has changed greatly, the decisions of marriage are arranged according to traditions and religious factors. Al-gazali and Hamamy (2014) say that “social, religious, cultural, and economic factors still play their roles in favoring consanguineous marriages among the new generations just as strongly as they did among the older generations.” Parental influence concerning marriage very often affects the decisions of mates. Many young Emiratis relay on their parents to choose the partner for the marriage.   Usually, parents discuss and arrange marriage agreement based on the traditions, and only after that, they ask a man’s and woman’s agreement. As a rule, it is easier to agree on the same conditions with relatives than with strangers for both sides of a family. For this reason, families prefer marriages between relatives. At the same time, marrying a relative may be less expensive or it even cost next to nothing as in other case, bridegroom must pay much for a bride. Thus, children give their consent to their parents to choose them a partner, and usually, it is a consanguineous one. 

Health Impacts as Disadvantages of Consanguinity Marriages

Rapid economic and industrial development of the UAE has caused advancement of the healthcare system and the improvement of genetic services. This allowed identifying a high frequency of genetic disorders and autosomal recessive traits as a leading cause of infant mortality of the UAE. Thus, rates of congenital malformation of Arabs (72%) among other nationalities are extremely high as compared to Asians (26%) and Europeans (less than 2%). More than a half of observed cases are connected with sporadic conditions and multifactorial disorders. Cardiovascular and genitourinary disorders are the most prevalent ones among these two categories. Another common disorder is related to chromosomal anomalies and most observed abnormality trisomy 21. Gastrointestinal, cardiovascular, and central nervous system syndromes are regarded to be most common, and in 28% of cases, they are potentially preventable. Very high proportion of neonatal mortality is caused by genetic disorders and congenital abnormalities. One can also observe three main factors that contribute to this - more than 60% of pregnant woman are at the age of 35-45, it is difficult or impossible to terminate pregnancies, and there is a high rate of consanguineous marriages. Health abnormalities are closely related to consanguineous marriage rates, and this leads to the increased frequency of recessive disorders, learning disorders among schoolchildren and psychiatric morbidity, anomalies of central nervous system, reproductive wastage, reproductive decrease, and neonatal mortality.  After conducting experiments in Al-Ain, it was noticed that almost 24% of schoolchildren suffered from mental health problems. Consanguinity and positive family history are considered to be most significant factors of learning disorders. The UAE children (even from affluent families) are more likely to suffer from psychiatric morbidity than non-UAE children. Studies in the three major Al-Ain hospitals (1995-1997) indicated abnormalities of central nervous system caused by recessive genes. Extremely rare syndromes where observed in patients with high level of inbreeding. Children of consanguineous parents had a higher frequency of illnesses (37.1%) in comparison to the children of non-consanguineous marriages (29%). About 95% of neonatal deaths are the result of premature birth, asphyxial conditions, and lethal malformations. After examining infants in Al-Ain, almost half of deaths were found as resulting from specific autosomal syndromes that were observed mostly in consanguineous unions. One can also point out earlier parental age at marriage, higher number of infant birth, younger age of women at first live birth, small rates of abortion, higher numbers of infant mortality, and a high risk of birth defects in children of consanguineous parents. Therefore, consanguinity has adverse impact on the health of a child, and it is one of its disadvantages.

Categories of Syndromes

It is possible to define three major categories of syndromes among Arab population: Thus, there are AR syndromes common in the entire Arab population, AR syndromes prevalent in certain relatively isolated communities, and AR syndromes that are found only in certain Arab families. The second group of AR syndromes affects special tribal groups and families that are relatively closed and that practice consanguineous marriages for few generations so these syndromes are rooted inside and even in variegated mutations. These syndromes include Sanjad-Sakati syndrome, AR Faciodigitogenital syndrome, Ehlers-Danlos syndrome VIA, and others that are not described and identified enough on molecular basis since they are mostly prevalent among Bedouins or other tribes. They also have a small risk of diffusion outside because of a closed nature of those communities. The first group of syndromes is highly prevalent among Arab countries. However, because of health service improvement, many scientists have been able to study these syndromes on the molecular level. They have managed to describe several novel mutations, genetic and allelic heterogeneity. This group includes such syndromes as Bardet-Biedl syndrome, which also affects Europe and North America and Ellis-van-Creveld syndrome (homozygous mutation in exon 13 of the EVC1 or in the exon 8 of the EVC2 gene). There is also Meckel syndrome, which is largely studied now and is caused by mutations in different 10 genes and three novel genes such as C5orf42, EVC2, SEC8, and Joubert syndrome - AR developmental brain disorder caused by mutation in six genes (CEP290, TMEM, INPP5E, TMEM237, CC2D2A, AHI1). Joubert and Ellis-van-Creveld syndrome are highly prevalent among UAE population. The third group comprises a large number of syndromes that have sporadically occurred in some families and now undergo investigation and examination on the molecular base. All three types of syndromes are not equally distributed in Arab population and some are not studied on the molecular base.

Impact on Fertility

It is not proved yet that consanguinity can positively or negatively affect fertility. First cousin and non-consanguineous couples in Kuwait, Saudi Arabia, and Qatar have high fertility rates. It could be biological means of compensation for the high risk of postnatal loss or simply the result of marriage at an earlier age, longer reproductive span, and earlier maternity. After examining fertility and infant mortality in Beirut, one can notice a higher rate of total pregnancies, live births, and deaths of children among consanguineous couples. Because of long-term practice of consanguineous marriages, the final analysis lacks significant patterns to examine its impact on fertility.

Genetic Reasons of Diseases

First cousin marriages are more harmful than second cousin marriages are for the health of children. Inbreeding is a process of mating or breeding individuals between mates who are similar genetically. If first cousins share 1/8 of their genetic material, their children will inherit 1/16 of their genes. If the second cousins share less than 1/32 of their genetic material, their children inherit 1/64 of their genes. In case both parents have the same disease, the child is more likely to be affected with it. If parents are first cousin relatives, the risk of the genetic defect in children is estimated to be 5%. Child deaths and recurrent abortions are more prevalent among consanguineous marriages than among non-consanguineous ones. Thus, it is considered that second cousin marriage would be less risky for children.

Solutions to Avoid Adverse Outcomes

Because of the rapid development of medical system and health awareness of the population, it is mandatory for couples to undergo in-depth medical examination before the marriage. These safety measures are taken to reduce the risk of diseases in future generations. Couples are advised by practitioners and genetic counseling how to avoid undesirable health consequences. Couples also should undergo special health education. Clinics advance and develop all the time, which can also be said about medication and new technologies; thus, it is much easier to diagnose patients more thoroughly. 

Conclusion

Consanguineous marriage is highly prevalent in Arab countries and the UAE in particular. First cousin marriage is the most popular type. The distribution of such couples is not homogeneous and it increases in rural tribes and communities. Consanguineous marriages influence the health of children by increasing frequency of recessive disorders, learning disorders, psychiatric morbidity, neonatal mortality, reproductive wastage, and anomalies of central nervous system. Because of a rapid medical development, it is easier to determine health consequences for future children even before the marriage and provide the couple with a special treatment. There are three major categories of AR syndromes, and they differ in frequency and occurrence in Arab countries. It should be noted that first cousin marriage would be more risky for a child. Despite all negative outcomes, consanguinity in Muslim countries constantly increases, and it is popular among younger generations.

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