Oshaz Fatima
As a doctor in Pakistan, I have witnessed firsthand the tragic outcomes of a tradition that, while deeply rooted in our culture, poses significant health risks to generations: cousin marriages. While these unions are socially accepted and even encouraged in many families, the medical reality paints a far more sobering picture. From genetic disorders to high infant mortality rates, the consequences are real and often irreversible. Addressing this issue requires not only a medical understanding but also a compassionate, culturally sensitive approach that acknowledges the many forces—tradition, ignorance, media portrayal, and lack of awareness—that keep cousin marriages prevalent in our society.
Cousin marriages, medically termed consanguineous marriages, are unions between individuals who share a common ancestor—typically first or second cousins. In Pakistan, the practice is widespread; studies estimate that approximately 60% of all marriages are consanguineous, and nearly 80% of these are between first cousins. While these marriages may appear harmless on the surface—celebrated as a means of preserving wealth, keeping familial bonds strong, or ensuring compatibility—they carry a significant burden in terms of public health.
From a genetic standpoint, cousin marriages double the risk of passing on autosomal recessive disorders. Conditions such as thalassemia, cystic fibrosis, congenital deafness, metabolic disorders, and certain intellectual disabilities are far more common in children born to consanguineous couples. In my clinical experience, I have encountered numerous cases where young children suffer from life-limiting conditions simply because their parents—often unknowingly—shared the same faulty genes. According to a study published in The Lancet, the risk of birth defects in children of first cousins is 6–7%, compared to 3–4% in unrelated couples. This risk doubles again if cousin marriages persist across generations.
Beyond genetic disorders, cousin marriages are linked to higher rates of infant mortality and morbidity. A 2013 study by the Pakistan Medical Association found that the infant mortality rate was significantly higher—up to 12%—in consanguineous unions compared to non-consanguineous ones. Furthermore, many couples face recurrent miscarriages, stillbirths, and infertility issues, often without knowing the underlying cause is genetic in nature.
Yet despite these stark medical realities, cousin marriages continue unabated. Why?
The answer lies in a complex web of cultural norms, economic dependencies, patriarchal control, and misinformed religious beliefs. Many families view cousin marriages as a way to ensure “trust” and maintain inheritance within the family. Women, in particular, are often pressured into marrying cousins to avoid “outsiders” and protect family honor. In rural areas and low-literacy communities, there is minimal awareness of genetic risks, and even when complications arise, they are often attributed to fate, black magic, or “God’s will,” rather than biology.
One of the most overlooked contributors to this issue is our media. Television dramas and films frequently romanticize cousin marriages, portraying them as the ultimate happy ending. Rarely do these storylines address the health risks or long-term consequences, further reinforcing the idea that cousin marriages are both safe and desirable. This is dangerous. Media has the power to shape public opinion—when used responsibly, it could instead be a tool for awareness and change.
Religious interpretations are also misused to justify the practice. While Islam permits cousin marriage, it does not mandate it, nor does it ignore the importance of safeguarding health and lineage. Yet these nuances are rarely discussed in public discourse. The absence of religious scholars in public health conversations on this issue creates a vacuum, filled instead by myths and hearsay.
As healthcare professionals, we face a dual challenge: not only treating the medical complications of cousin marriages but also navigating the cultural sensitivities surrounding the topic. However, this does not mean we should remain silent. It is crucial that genetic counseling becomes part of routine pre-marital and antenatal care, especially for couples from the same family. Unfortunately, such services are nearly non-existent in public hospitals and rarely affordable in private clinics.
We also need to advocate for nationwide awareness campaigns, driven by the government, supported by the media, and backed by the religious community. Incorporating basic genetics education into school curricula can go a long way in helping the next generation understand these risks. Television dramas and radio shows should include medically-informed narratives that portray the real consequences of cousin marriages—whether through affected children or the emotional toll on parents.
Moreover, the government should invest in accessible screening programs for common genetic disorders, such as thalassemia, and offer counseling services in both urban and rural areas. Marriage registrars and nikah-khwans should be trained to provide information or direct couples toward testing and counseling services before marriage, especially in cases where there is a known family history of genetic disease.
Some might argue that cousin marriages are too culturally entrenched to change. But change does not mean banning the practice outright—it means offering information, promoting informed decisions, and ensuring that families understand both the rights and risks associated with these unions. Health, after all, is not just a personal matter—it is a societal responsibility.
As a learning doctor, I have watched many seniors deliver devastating news to too many parents who asked me the same question: “Why did this happen to our child?” And every time, I wished I had been able to speak to them before their marriage, rather than after their child’s diagnosis.
We owe it to future generations to break this cycle. Cousin marriage may be a tradition—but health, dignity, and informed choice must define our future.
The writer can be reached at
oshazfatima@kemu.edu.pk
