Pressure on Emirati mothers to have more children 'raises Down's risk'

Once you hit 40 be careful, doctor warns women who, she says, are under 'tremendous pressure to have more babies'.

(From left to right) Sonia AlHashimi, President of the UAE Down Syndrome Association, Hani Al-Amayreh, Occupational Therapy Specialist and Saif Aldabal look at some of Saif's finished writing exercises, at the UAE Down Syndrome Association, in Dubai, UAE, on April 15, 2010. (Ana Bianca Marin For The National).
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DUBAI // The pressure on Emirati mothers to have more children is probably the main reason for the "alarming" rate of Down's syndrome in the country, an official has said. The risk of a child being born with Down's syndrome, a genetic disorder that causes lifelong damage to mental development, increases with the age of the mother.

Globally, about one in 800 to 1,000 new-born babies have Down's syndrome. A study published in 2007 that looked at more than 63,000 new-born babies in Dubai between 1999 and 2003 estimated an incidence of Down's syndrome in one in every 449 live births, with the rate among nationals at one in 319. "This was very alarming," said Dr Eman Gaad, the director of disability services at the Community Development Authority. "Many children [with Down's syndrome] are born to young parents, but the only factor we can put our hands on is the maternal age of mothers."

The study concluded that more than 41 per cent of Emirati mothers were over 35, the age at which the risk of Down's syndrome increases. "At the moment, girls are getting an education. By the time she graduates from university and finds her soulmate, we're talking about the late 20s, not like before," said Dr Gaad, speaking a week after she addressed a Down's syndrome symposium that tackled the rights of children with disabilities.

A woman was under "tremendous pressure to have more babies" in a society that, understandably, wanted to grow, she added. "It's OK to have a child or two, or five, but once you hit 40 you have to be really careful," Dr Gaad said. "If it's God's will and an accident it's OK, but it's a phenomenon that many women keep having children. There is no awareness that it's really time to stop." Dr Gaad suggested that pregnancy often carried alluring connotations of fertility and youth, whereas education about the risks of high maternal age was lacking.

Pressure from the authorities to increase the birth rate was unlikely to work, but social influence was certainly a driving force for high maternal age, said Dr Suaad al Oraimi, assistant professor of sociology at UAE University and an expert on women's education. High maternal age was the result of "simple, traditional, tribal" culture, she said. "Simple cultures consider children a form of honour, and we are a traditional society," Dr al Oraimi said.

Having children was not particularly expensive for nationals, she said. The Government paid for the education and health care of Emirati children, and women often had maids or extended family to help in looking after them, said Dr al Oraimi. Dr Khawla Bu Hmaid, a gynaecologist at Al Baraha Hospital in Dubai, said new research was needed to bring Down's syndrome figures up to date. Higher maternal age was not unique to the UAE, she said.

"Of course, women are now working, the age to get married and to have babies is older, especially because more people want to do higher studies," Dr Bu Hmaid said. She agreed, however, that women in the region were under pressure to have up to six babies. A test can determine if a foetus is likely to have a defect. In amniocentesis, a needle takes a sample of amniotic fluid, which covers a foetus in the womb, between 14 and 20 weeks of pregnancy.

According to the Harvard Medical School, the test is often recommended for women over 35. A study published in Britain in 1999 said 92 per cent of cases in which a foetus is diagnosed with Down's syndrome ends in an abortion. Most Islamic scholars prohibit abortion except in extreme cases where pregnancy threatens the life of the mother. Some scholars have argued that abortion with strong cause is permitted during the first six to eight weeks, before the foetus develops a pulse, or during the first four months before the foetus is infused with a spirit, according to Islamic tradition.

However, in the UAE abortion is prohibited unless doctors certify it is life-threatening for the mother. A disability is not considered a justifiable reason for an abortion, according to the General Authority of Islamic Affairs and Endowments.