Knowledge and Attitudes of Pregnant Women in Southern Israel Toward Genetic Counseling in Two Different Ethnic Communities: Jewish and Bedouin Women

The infant mortality rate in the Arab population is 2 times that of the Jewish population. This inequality is even more striking in low socioeconomic subgroups such as Israeli Bedouins. ¹ The main cause of infant mortality among Bedouins (43% of all causes) is congenital birth defects and genetic diseases. ² The high rate of congenital birth defects and genetic diseases is explained by the common practice of consanguineous marriage (especially among cousins) and religious laws against termination of pregnancy. ²

The aims of the study were to compare rates of genetic counseling, level of knowledge, and attitudes toward genetic counseling between pregnant Jewish and Bedouin women. The study was conducted in 2 woman's health care centers of the Clalit Healthcare Services – one serving a primarily Jewish population, and another serving a Bedouin population.

The study population included pregnant women aged 18–35 years who were in the waiting room of one of the study centers to see a gynecologist for a non-acute reason. The instrument was a self-administered questionnaire in Hebrew and Arabic. The study population consisted of 142 women, 72 in each group. The Jewish women were older, the Bedouin women had more children. Jewish women had more years of education and more Jewish women were employed. Many more Bedouin women were married to second-degree relatives or closer (41.7% vs. 1.4% respectively, P < 0.0001) and third-degree relatives (6.9% vs. 0% relatively, P < 0.0001). Many more Bedouin women identified themselves as religious (95.7% vs. 18.1% respectively, P < 0.0001).

More Jewish women knew about genetic counseling (88.9% vs. 72.9% respectively, P = 0.019), had undergone genetic counseling (75.0% vs. 47.9% respectively, P = 0.001), were aware of the risk that consanguineous marriage could cause birth defects (95.8% vs. 65.3%, P < 0.0001), and thought that it was preferable to marry a non-relative (94.5% vs. 76.4%, P < 0.0001). More Bedouin women had undergone a termination of pregnancy in the past (28.6% vs. 12.5%, P = 0.022).

More Jewish women were of the opinion that genetic counseling could prevent fetal congenital anomalies (75.0% vs. 40.8%, P = 0.001). Jewish women were more inclined to think that termination of pregnancy was permissible if a birth defect was detected in the fetus (77.8% vs. 38.5%, P < 0.0001). More Jewish women were active in the decision to seek genetic counseling (94.4% vs. 69.4%, P < 0.0001) and were more involved in the decision to terminate the pregnancy (88.1% vs. 48.0%, P < 0.0001).

Logistic regression analysis showed that women who had not heard about genetic counseling previously and Bedouin women did not believe that genetic counseling could prevent congenital birth defects.

In summary, there is a large difference between Jewish and Bedouin women regarding knowledge about and use of genetic counseling. The finding that prior knowledge about genetic counseling increases belief in its effectiveness leads to the conclusion that a major effort should be invested in increasing levels of knowledge and awareness on this issue among Bedouin women.