The buzz: Cousin marriages in Pakistan

MsT speaks about consanguinity and its various health implications.

In modern society, marrying one’s cousin is considered wrong and frowned upon. In fact, considering that cousin marriages are legally banned in 24 out of the 52 states of America, one can conclude that such unions are a little too close for comfort for most people.

Due to globalisation, awareness about the issue has spread at home and the average, urban Pakistani is becoming increasingly opposed to the concept as well. “We see our cousins as brothers and sisters,” says 26-year-old Shanzay Malik. “The bonds we share with them are purely platonic in nature and nothing more.” Also, 24-year-old Mohammad Jaffer*, who was coerced into marrying his cousin agrees. “There is so much extra burden in a cousin marriage, like family feuds, jaidaad issues and the pressure to make your relationship work lest the entire khandaan react.” Jaffer and his wife succumbed to the same pressure and bowed down to the will of their families to keep everyone happy.



Despite this, however, cousin marriages are far more common in Pakistan than we know. Awareness in urban centres may be making youngsters think twice before entering into it but our rural population still has a long way to go. Many parents consider it easier to marry off their children to easily-accessible cousins from within the ‘baradri,’ as opposed to searching for suitable spouses elsewhere.  Parents are fearful their children will acquire a bad reputation or get excommunicated in case they marry outside the community and so, prefer intermarriages. This is ideal for families seeking to maintain a certain caste type within the household unit. In addition to this, the motives behind cousinly nuptials are purely monetary in nature and it is common for one cousin (usually the female) to be offered in exchange for money, farmlands, or shelter.

According to a study conducted by Dr Muhammad Aslamkhan, founding head of the Department of Human Genetics at the University of Health Sciences Lahore, nearly 82.5% of parents in Pakistan are blood-relatives of first, second or third generations (and so on). Out of these, 6.3% hail from the same extended families or castes while 6.8% are immediate cousins. Only about 4.4% of couples in Pakistan are married outside of their brethren. Although these figures are based on a sample size of 9,503 families, located primarily in rural Punjab, it is hardly breaking news that unions between cousins – scientifically called consanguineous marriages – are rampant in Pakistan. Aslamkhan’s study also concedes that children born out of consanguinity are twice as likely to contract genetic hazards as those who are not. Unfortunately, much of the country remains oblivious to or chooses to ignore the potential drawbacks of such a marriage, in favour of financial or social gains.



“What people overlook is that medically, consanguinity can be very problematic,” says Maleeha Jawaid, a final-year medical student. “Consanguineous unions increase the expression of autosomal recessive disorders, leading to the infant being at a higher risk of contracting them,” she explains. In simpler terms, every human being carries certain genetic mutations which are recessive (hidden) but run the risk of becoming dominant in the smaller gene pool of a cousin marriage. “The closer the relationship of the parents, the smaller the gene pool and greater the risks,” adds Jawaid.  According to Dr Shaneela Asad, a paediatrician at a leading hospital in Karachi, “There is a 25% chance that an offspring of a cousin marriage will contract a disease or disorder coming down from one parent.” Both doctors cite deafness, blindness, mutism, asthma, Down’s syndrome, thalassaemia and other skin, heart, kidney and neuro-degenerative conditions as consequences of inter-breeding between close relatives.

There has been considerable research undertaken to gauge the extent to which consanguinity causes physical disabilities in children, most of which offer alarming results. Most recently, a research project was conducted in Bradford, United Kingdom, to study over 2,000 babies of Pakistani origin, born out of cousin marriages between 2007 and 2011. The study conceded that the high levels of intermarriage within the Pakistani community doubled the risk of birth defects, with six out of 100 babies showing one defect or the other as opposed to a ratio of three out of 100 for non-consanguineous marriages. This constitutes roughly one-third of all birth defects in the British city. The most common defects included heart and lung diseases, as well as Down’s syndrome.



Closer to home, there are plenty of troubled cousin-parents to corroborate the facts. Beenish Hamza* from Hyderabad resents the concept saying that, “My mamoo married his first cousin and had a child with Down’s syndrome. Later on, I was married to my khala’s son and our only child is deaf and mute. I may be wrong but I believe that these defects are due to the history of intermarriage in my family.” Shah’s family is now apprehensive of the idea of intermarriage after seeing how problematic it can be.

A point to note, however, is that a physically-impaired child isn’t the outcome of every cousin marriage. On the contrary, if a couple itself isn’t the end product of inbreeding for the last few generations, chances are that a one off cousin marriage will be harmless. In fact, many families with frequent cousin marriages have smooth sailing throughout, such as that of Alina Shah from Lahore. “Both sets of my grandparents were consanguineous couples. Then, my parents got married and they are cousins, as are my aunt and her husband. Fortunately, there have been no birth defects in our family, ever.” Much like Shah, Mateen Rahman is grateful for his 10-months-old, perfectly healthy baby girl Hafsa, despite being married to his uncle’s daughter. One must also remember that should there be a genetic issue, it might well be due to some other factor or purely coincidental, as opposed to consanguinity in the parents.

Nevertheless, considering that in many parts of Pakistan, such unions are customs that span decades, it is advisable to educate and be educated about the health risks before starting a family. “The chances of disability often depend on how much interbreeding has occurred in the family, prior to this,” says Jawaid. “Consanguineous couples need to be aware of these potential genetic problems and seek medical counsel before conception,” she adds. “Doctors now offer full-scale evaluations of the hopeful parents’ genetic makeup that can help determine the chances of a baby developing problems.” Dr Asad also prescribes seeking medical and professional help prior to entering into such a marriage. “I recommend DNA and blood tests prior to the nuptials. Haemoglobin Electrophoresis, for example, can detect the chances of thalassaemia. Similarly, an overall genetic DNA test can also help.”

Globally, cousin marriages are still going strong, with almost 10% of all global marriages taking place between cousins. Proponents of the practice boast of relatively low divorce rates in consanguineous couples. Also, they highlight the perks of keeping it within the family like the prestigious banking family, the Rothschilds, did – ‘it’ referring to the family wealth and property. In Pakistan, where marriages between cousins have prevailed for centuries, it is advisable to educate and be educated about the potential risks they entail and how they can be eradicated.

*Names have been changed to protect privacy

Published in The Express Tribune, Ms T, May 11^th, 2014.