European Journal of Obstetrics & Gynecology and Reproductive Biology
Decisions regarding pregnancy termination among Bedouin couples referred to third level ultrasound clinic
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.
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