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In the majority of Middle Eastern countries, consanguineous marriages currently account for 20% to over 50% of all unions with no evidence to suggest a significant decline in their popularity. Consanguinity generally is associated with increased fertility, and mortality is higher among consanguineous progeny due to the expression of detrimental recessive genes. There also is evidence of greater morbidity in children born to consanguineous parents, which may extend into early and late adulthood. With improved primary health care, deaths and disability due to infectious diseases can be expected to decline in prevalence and genetic disorders will absorb an increasing proportion of the future health care budget in the region. Under such circumstances the burden of ill-health will fall disproportionately on communities in which consanguinity is strongly favoured. However, when assessing the overall effects of inbreeding, and to ensure that counselling programmes are devised to match the requirements of the population, it is important that the traditional social and economic benefits associated with marriage to a close relative are fully taken into consideration. It is suggested that there is an urgent need for prospective multi-disciplinary studies into the medical, biological and social consequences of consanguineous marriage with, as an interim measure, the formulation and introduction of training programmes for genetic counsellors recruited from local populations.