Cousin marriage, sometimes referred to as "consanguineous or blood-related" marriage, is a socially acceptable practice in many states, including Pakistan. The social norms around cousin marriage are rooted in religious interpretations and customs. The prevalence and social acceptance of cousin marriage in Pakistan stands in contrast to the global patterns, and due to the inherited health risks, the concept itself has been surrounded with many myths and realities.
A "silent endemic" is prevalent in Pakistan which subtly maintains hereditary illnesses and socioeconomic inequalities because public awareness and government intervention programmes are woefully insufficient. It is pertinent to distinguish between myths and scientifically-supported facts here to comprehend the genetic implications of cousin marriages.
Commonly, cousin marriages are promoted as a means to fortify familial connections in Pakistan (also known as “Biradari” or “Khandaan”) and a guarantee for assets, property, and money to stay in the same family. Furthermore, cousin marriage is sometimes the result of the “watta satta”, which is best defined as the simultaneous marriage of a brother-sister pair from two families - the daughter of one house is offered in return for a daughter of another.
There are a lot of myths surrounding cousin marriage. It is considered to be a guarantee of closer family ties, that enhances fertility and preserves the purity of bloodlines. It is also regarded as a "backward" or rural practice only, and more stable than other forms of marriages. The idea that the offspring of cousin marriage would always have genetic issues is one of the most pervasive fallacies. The shared genetic pool does raise the likelihood of some genetic problems, but it is vital to remember that not all cousin marriages produce unhealthy children. The family history of genetic illnesses is one of the many elements that determine the genetic risk. Cousin marriages can produce healthy offspring, particularly if appropriate genetic screening and counseling are obtained.
There are studies that indicate that the general population has a 2-3% likelihood of birth abnormalities, while cousin marriages increase that risk to approximately 6-8%. When both parents carry the same defective gene, it raises the chance that children would inherit autosomal recessive diseases like sickle cell anemia or cystic fibrosis, blood disorders, Thalassemia, fertility problems and several rare genetic disorders.
Another common misconception is that cousin marriage is exclusive to Muslims or Islamic culture. In reality, a number of groups worldwide, including Christians, Jews, and Hindus, have been involved in the custom of cousin marriage. Yes, Islamic law does not forbid cousin marriages. However, the two most prominent Sunni scholars, Imam Shafi and Imam Ahmad, disapprove of cousin marriage and have deemed it to be makruh (detestable). Imam Ghazali and other scholars have likewise disapproved of cousin marriage. He quoted a Hadith to support his opinion: "Do not marry a woman who is a close relative of yours because your child will be weak and puny" (Tarbiyatu'l-Awlad, 1:39).
According to the latest Pakistan Demographic and Health Survey 2022 (PDHS), consanguineous (blood-related) marriages account for around 65-70% of marriages in rural areas and 55-60% in urban areas, indicating that the frequency is still greater in rural areas. The survey also informs that first cousin marriages make up 46.3% of all marriages. About 25% of children born through cousin marriage need long-term medical care because of genetic illnesses. According to a research conducted by the Pakistan Institute of Medical Sciences (PIMS) in 2023, almost 5000 to 9000 infants are born with Thalassemia (an inherited blood disorder) per year in Pakistan, making it a serious health issue.
According to a research conducted by the Pakistan Medical Association and the Sciences (PIMS), just 15% of consanguineous couples knew about the genetic risks prior to marriage.
According to a UNICEF Pakistan report on consanguineous marriages, infant mortality is "twice as high," with around 78 fatalities for every 1,000 live births. A Lancet Global Health research shows that consanguinity causes one of the highest rates of inherited genetic abnormalities in Pakistan, accounting for more than half of all birth defects in the nation. The economic burden of addressing genetic illnesses associated with consanguinity is high; in 2023 alone the yearly cost of genetic abnormalities to the healthcare system is estimated to be about $1.5 billion.
Genetic counseling is still not widely implemented in Pakistan, despite the country's high cousin marriage rates. According to a research conducted by the Pakistan Medical Association and the Sciences (PIMS), just 15% of consanguineous couples knew about the genetic risks prior to marriage. As a comparison, the World Health Organization (WHO) published a research in which Pakistan has a greater percentage of consanguineous marriages than other South Asian nations, such as Bangladesh and India, where the rates are between 10-15%. While in countries like Saudi Arabia, Jordan, and the United Arab Emirates, it makes for 25–40% of all marriages.
Despite being overblown and misinterpreted, the genetic dangers connected to cousin marriages are genuine. In order to combat the epidemic of cousin marriage, a multifaceted strategy involving public health campaigns, legislative reform, and education is needed. Comprehensive sex education programs in schools and community outreach activities can enable people to make well-informed marriage decisions. A balanced understanding of the scientific realities that debunk the common myths of cousin marriage will help reduce the genetic healthcare burden associated with it in Pakistan.