Decisions regarding pregnancy termination among Bedouin couples referred to third level ultrasound clinic

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Abstract

Objective: To identify predictors of parental decision whether to terminate a pregnancy after a diagnosis of a major congenital malformation in a traditional society. Study design: The Bedouin Arabs in southern Israel are a traditional society, with a high incidence of congenital disorders. Data were abstracted from medical records of 295 families who sought counseling in the third level ultrasound clinic between 1990 and 1996. Statistical analysis included univariate and multiple logistic regression. Results: The diagnosis of a major malformation was confirmed in 64% of the cases. Pregnancy termination was a realistic option for 125 women (66.5%) as the rest were too advanced in their pregnancy. Such a delay was less common in cases of multiple malformations than in a single malformation (19.2% versus 39.0% respectively, P<0.01). Forty-nine of the 125 women (39.2%) chose to terminate their pregnancy. The only significant predictors of termination decision were earlier gestational week at diagnosis and previous uncompleted pregnancies. Conclusions: These findings indicate the importance of promoting early genetic counseling and early prenatal diagnosis, for any population where abortions are not readily acceptable.

Introduction

The decision on pregnancy termination following the prenatal detection of a malformed fetus presents a complex process involving psychological, cultural and sometimes religious conflicts 1, 2. Therefore, not all couples seeking prenatal diagnosis will necessarily opt to abort a pregnancy if a severe abnormality is detected 3, 4, 5. This situation is even more complicated in a traditional society like the Bedouin Arabs, a Muslim minority of about 100 000 people residing in the Negev (the southern part of Israel), who are undergoing a rapid transition from a semi-nomadic to a sedentary way of life. The Bedouin culture attributes a great importance to familial and tribal cohesiveness and to high fertility. The Bedouins have large families, most women do not work outside the house and about half of them have less then elementary level of education. Most men have less than high-school level of education, many are unemployed or hold low paying jobs. About 60% of the Bedouins' marriages are consanguineous, the most common pattern being first cousin marriage [6]. Due to this high prevalence of inbreeding, the Bedouins are at a high risk for congenital malformations and autosomal recessive disorders. Recently, several genes for autosomal recessive disorders in the Bedouins have been mapped 7, 8, thus providing specific prenatal tests for some families. While prenatal diagnostic services are available, they are generally under-utilized by the Bedouins, mainly due to religious restrictions on abortions beyond 120 days after conception. Nevertheless, the most commonly used prenatal diagnostic service is fetal sonographic imaging.

The purpose of the present study was to identify predictors of parental decision whether to terminate a pregnancy after a diagnosis of fetal defects, either incompatible with life or severe enough to significantly interfere with normal living, which was detected on second level sonographic examination and confirmed at a third level ultrasound clinic. Abortions for major congenital malformations can be legally obtained in Israel through a pregnancy termination committee, prior to 24 weeks of gestation.

Section snippets

Setting

The third level ultrasound clinic is located at the Soroka Medical Center, which is the only referral clinic in the Negev region for women in whose pregnancy a fetal malformation of any kind had been detected at a second level sonographic screening, or an abnormal value of maternal serum alpha-feto-protein (MSAFP) was found. Second level ultrasound which is performed by a certified technician is fully covered by national health insurance. MSAFP test entails a fee of 14 US $. Both tests are

Results

The majority of the 295 couples (72%) who comprised the initial study group were consanguineous, 53% of them were first cousins. The consanguinity rate in the study group was higher than in the Bedouins' population (60%) [6]and higher than in other Israeli Arabs (44%) [9]. Fetuses with major malformations were diagnosed in 188 (64%) of the 295 pregnancies seen at the third level ultrasound clinic. Of those, in 63 cases (33.5%) the pregnancy was advanced beyond 24 weeks of gestation, and the

Discussion

The very few studies investigating determinants of choice after a prenatal diagnosis of a defected fetus, were conducted in western societies. Most couples obtaining a prenatal diagnosis of a major birth defect in the fetus will opt to terminate an otherwise wanted pregnancy 3, 10, 11. The Bedouin Arabs represent a traditional, religious society where fertility and a large family are central values, while late abortions in general are prohibited by religious laws. Weitzman et al. [6]found that

Condensation

Early gestational week at diagnosis of major fetal malformations as well as a previous uncompleted pregnancies were found to predict the decision on a pregnancy termination in a traditional society of Israeli Arab Bedouins.

References (14)

  • R.M. Furlong et al.

    Pregnancy termination for genetic indications: the impact on families

    Social Work Health Care

    (1984)
  • S.L. Kenyon et al.

    Termination of pregnancy following diagnosis of fetal malformation: the need for improved follow up services

    Clin Obstet Gynecol

    (1988)
  • A. Drugan et al.

    Determinants of parental decisions to abort for chromosome abnormalities

    Prenatal Diagn

    (1990)
  • M. Holmes Siedle et al.

    Prenatal decisions regarding termination of pregnancy following prenatal detection of sex chromosome abnormality

    Prenatal Diagn

    (1987)
  • L. Denayer et al.

    Reproductive decision making of aunts and uncles of a child with cystic fibrosis: Genetic risk perception and attitudes toward carrier identification and prenatal diagnosis

    Am J Med Genet

    (1992)
  • Weitzman D, Shoham-Vardi I, Belmaker I, Siton Y, Carmi R. Factors affecting utilization of prenatal diagnostic tests in...
  • D.A. Scott et al.

    An autosomal recessive nonsyndromic-hearing loss locus identified by DNA pooling using two inbred Bedouin kindreds

    Am J Med Genet

    (1996)
There are more references available in the full text version of this article.

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