Why you should not marry your cousin

Miscarriages, still-born babies, mutations, diseases - inter-family marriages pose a grave danger.

Nida Hasan October 05, 2011
Doctors are often looked up to, and it is common for people to ask for advice, suggestions and treatment. As a medical student, I have come across questions and situations that have alarmed me, however, I have never been overwhelmed. The story I heard on a flight from Lahore to Karachi particularly struck me. It concerned a woman's struggle to bear children, a seemingly ordinary ordeal, magnified by the fact that she was married to her first cousin.

I was sitting comfortably in an aisle seat when a man came by asking to exchange seats as he was sitting next to a lady who would prefer a woman.  Since it didn’t make much of a difference to me, I volunteered to to exchange seats with the man. This is how I ended up sitting beside Leena* who was married to her cousin.

We got to talking, and when she found out I was studying medicine she told me about herself. She was on her way to consult a geneticist at Aga Khan University Hospital. The trials and tribulations Leena* had while trying to conceive and give birth to a healthy baby brought tears to my eyes. She had suffered a miscarriage, two still-born babies, and poly-cystic ovarian disease, yet she was still hopeful that she'd be a mother soon.

To me, she was an example of courage and determination. After going through such a traumatic ordeal, the persistence exhibited by this lady struck me as nothing short of remarkable. It was fortunate that she had a supportive husband who would constantly reassure her that with the words:
"Every black cloud has a silver lining."

I wasn't sure what caused Leena and her husband's problems but her story inspired me. After landing in Karachi, I made it my personal mission to research inter-family marriages. I knew that there are numerous cases of inter-family marriages in Pakistan. With awareness cousin marriages have become highly stigmatized in the West, but in Pakistan and the Middle East I would estimate that up to 50 per cent of marriages  are between cousins or distant family members.

To this date, many are blissfully unaware of the complications that a couple can face when marrying within the family. There can be a myriad of genetic aberrations and chromosomal mutations that could result in sometimes fatal congenital anomalies. Children, for example, can be born with a hypoplastic heart, a condition where one side of the heart is severly underdeveloped, agenesis of a kidney, where one or both kidneys fail to develop and many more.

These mutations occur primarily because first cousin couples possess a higher than normal consanguinity; they have, on average an increased chance of sharing genes for recessive traits. A positive association between in-breeding and a very wide range of common adulthood disorders, including hypertension, coronary heart disease, stroke, cancer, uni/bipolar depression, asthma, gout, peptic ulcer, and osteoporosis has been reported. Therefore it is very important to make known the risks inter-family marriages pose and provide appropriate counselling to people in this relationship.

Here are a few things that can be done to protect children from being born with birth defects:

  • Comprehensive genetic education and premarital genetic counselling programs can help to lessen the burden of genetic diseases

  • Genetic education programs should be directed towards high school students

  • Preconception reproductive options should be explained to parents

  • All pregnant women should be given Folate,Vitamin B12 and Calcium to prevent neural tube defects, and serum levels of proteins (Alpha Feto Protein) should be monitored for Down Syndrome

  • New borns should be screened for hearing loss and inborn errors of metabolism

It is very important for our community to understand this message because many people are confronted with such problems.


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Nida Hasan A second year medical student at Dow Medical College.
The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.