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Nearly all amish can be traced back to a small group of immigrants. Given the nature of their closed community, they share many common ancestors. With very few outsiders joining the Amish community, they lack the diversity to marry anyone who is not in someway related to them. As a result they suffer from a disproportionate number of genetic disorders. Through education programs such as those of the CHC in pennsylvana, the CDC in Ohio and the CHC in Indiana most Amish are aware of the Genetic issues and the cause within their communities. As a result, many Amish do try to avoid marrying a close relative when possible. Marrying a third or fourth cousin is common, but in smaller communities there is often little choice.

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