Consanguinity in Pakistan: A Tradition’s Toll on Health and the Need for Genetic Awareness

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Cousin marriages is a widely accepted practice in many developing countries. Pakistan is one of the nations where this practice is quite widespread. Though it is quite looked down upon in the west in Europe and the United States, this practice is quite popular in the Middle East, West Asia and North Africa. There is historical precedence for the practice and it is estimated that 80% of all marriages taking place across human history have been between first and second cousins. 

Consanguinity as this is known as is still prevalent in about 1/5ths of the people even in the modern-age. The rates for Consanguinity are high even in the west in recent decades due to the practice being exported there through emigrants from countries like Pakistan, Yemen and Palestine. 

Unfortunately, this practice comes with its pitfalls and is the sole reason for heightened rates of genetically transmitted diseases among populations that do this. Pakistan is in the forefront of the countries with high rates of consanguinity and this has led to a lot of cases of inherited illnesses that have left large swathes of the population disabled and suffering in one form or the other. 

Statistics to back it up

Around 15 million people in the country suffer from genetic disorders. In addition to this, more than 1.5 million mutations have been discovered in these diseases that can lead to these disorders. The rate of consanguinity in Pakistan are around 75% of the population as the tradition is not only tolerated but encouraged in many cases in both urban and rural areas. 

Prof Dr Arndt Rolfs, a neurologist and psychiatrist from Germany, shared his research in consanguinity in Pakistan and stated “Seventy percent of birth defects can be prevented due to genetic services. There is no genetic testing infrastructure (no diagnostic labs and genetic expertise) in Pakistan”.

According to the BMJ Global Health website, “Children of consanguineous marriages are twice as likely to have genetic disorders as the 2-3% rate among children of non-related couples”. This was by Salman Kirmani, professor of pediatrics at the Aga Khan University in Karachi and one of the few doctors in Pakistan to have specialized in genetics.

These disorders are known as autosomal recessive genetic diseases and they are scientifically proven to be caused by cousin marriages. 

Thalassemia, Cerebral Palsy, Downs Syndrome, and Cystic Fibrosis are horrible diseases with dangerously high rates among the Pakistani population. 100,000 transfusion dependent thalassemia patients are currently being treated through various centers across Pakistan. This in addition to a large amount of children with weaknesses and in particular deafness are born each year as a result of consanguine marriages. 

But why are cousin marriages so prevalent in the country and what is the history of the tradition?

Traditions behind Cousin Marriages

Cousin marriage has often been practiced to keep cultural values intact, preserve family wealth, maintain geographic proximity, keep tradition, strengthen family ties, and maintain family structure. 

In ancient times this was more common because people lived in smaller communities with a lack of individuals within mating age within a given population. These practices remained strong in even modern communities because of economic and political reasons. 

Ancient Egyptians used to practice incest to preserve the bloodline whilst the English monarchy practiced cousin marriages to keep political power within the family. In the modern age in Pakistan arranged marriages are popular and it makes more sense for people to be marrying their children into families they were most familiar with. This consequently leads to a high rate of consanguinity. 

Bans on Cousin Marriages

Ancient Romans and the Chinese used to clamp down on this practice and passed laws against the practice as early as 506 AD. The roman catholic church banned the practice within four tiers of consanguinity and this even led to large donations by wealthy English and European families to allow exemptions from the church in order to retain political power and wealth. 

The United States began banning cousin marriages close after the American Revolution and the Civil war. This was initially mainly due to their association with the nobility and the English Monarchy and this was reinforced after scientific research was done to show the diseases caused by the practice. 

Conclusion

Though there are difficulties in banning cousin marriages outright due to the deep-rooted traditions associated with the practice, certain types of legislation can help reduce the impact of this trend. There has always been resistance to a state telling its citizens whom to marry and whom not to marry. This is amplified in Pakistan further due to the taboo associated with anything to do with procreation and child-planning. 

For example, in 2020 Yasmin Rashid announced that there would be mandatory thalassemia carrier screening as it would help offset the cost of thalassemia treatment (expensive transfusion) and reduce the burden caused by the disease. 

Similar legislation and awareness drives are required to help promote genetic screening before cousin marriages and a discouragement of too close relatives getting married in the country. Higher rates of literacy and sexual education can help prevent a lot of pain for our future population and reduce the strain on our economy caused by genetic disorders.