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Consanguineous marriages and their detrimental outcomes in Pakistan: an urgent need for appropriate measures

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Abstract

Consanguineous marriage is a union between first or second cousins. This practice is very common in developing Asian countries especially Pakistan. Around 70% of marriages in Pakistan are consanguineous. The major factors that promote consanguinity are arranged marriages, illiteracy and inter-caste marriages. The complications that follow include, small birth size, congenital malformations, neonatal mortality, rare genetic disorders, congenital deafness, congenital heart disorders and mental retardation. Serious steps must be taken to overcome this ongoing crises. Counselling, genetic screening, pre-natal diagnostic tests are some of the measures that are essential. Government involvement is also necessary to promote awareness and discourage consanguinity.
International Journal of Community Medicine and Public Health | January 2018 | Vol 5 | Issue 1 Page 1
International Journal of Community Medicine and Public Health
Ullah MA et al. Int J Community Med Public Health. 2018 Jan;5(1):1-3
http://www.ijcmph.com
pISSN 2394-6032 | eISSN 2394-6040
Editorial
Consanguineous marriages and their detrimental outcomes in Pakistan:
an urgent need for appropriate measures
Muhammad Anzar Ullah*, Aisha Maryam Husseni, Syed Uzair Mahmood
Consanguineous marriage is a union between first or
second cousins, the former being more common. Cousin
marriage, the more commonly used term, has been
practiced over a long period of time but it is more popular
in developing Asian countries especially Pakistan.1
Studies have shown that in Pakistan consanguinity was
present in 60% of marriages out of which 80% were first
cousins, further studies highlighted a similar rising trend
of consanguinity among married couples.2-4 Pakistan is
said to be the leading country to practice consanguinity
with around 70% of marriages being consanguineous.5
Some regions of Pakistan have shown an alarming ratio
of consanguineous marriages such as the Sargodha
district of Punjab and Khyber Pakhtunkhwa.6,7
There are various factors that promote the practice of
consanguineous marriages in Pakistan. Being an Islamic
country opposite gender interaction is usually restricted
only to close family members especially cousins.
Therefore, arranged marriage is a major factor. Difficulty
in finding a partner of same caste and status outside the
family, the security of knowing the spouse and in-laws
prior to marriage and strengthening interfamily ties are
other important factors that have made consanguineous
marriages so popular.4
Consanguineous marriages are also common in rural and
less educated population which are the tribal areas of
Pakistan such as the Khyber Pakhtunkhwa province.1,7
There has been a culture of dowry and very lavish
weddings in the Pakistani community and considered as a
matter of pride and honour, especially for the girl's
family. However, it seems easier for blood
relatives/cousins to negotiate on such expensive affairs.8
Consanguineous unions lead to some drastic outcomes
that need to be highlighted. An increase in small birth
size and neonatal mortality due to consanguineous
marriages has been noticed; Consanguinity is also linked
to underweight children (under five years old) being a
major risk factor; A study from a rural area of Sindh
stated that children who were underweight were 1.5 times
more likely to have consanguineous parents compared to
normal children.9,10
Cousin marriages are also linked to many rare recessive
genetic disorders; members of the same family carry
certain recessive genes that are usually supressed in their
genetic makeup. When interfamily marriages take place,
the chances of these genes to be expressed in the
offspring is greatly increased due to a homozygous
condition.11 Many serious diseases are also diagnosed
later in childhood such as internal malformations,
learning difficulties and many single gene disorders such
as neurological disorders, thalassemia and cystic
fibrosis.11 Autosomal recessive intellectual disorders are
very common in populations with frequent parental
consanguinity.12 Recently a team of Pakistani scientists
concluded that the prevalence of mental retardation in the
Pakistani population is due to cousin marriage, they also
discovered 30 new genes in these children that were
responsible for this abnormality.13 Every year 700
children are born with genetic disabilities due to cousin
marriage and this was worse among British Pakistani
communities.14
Children with congenital heart diseases are 2.3 times
more likely to be born of a consanguineous marriage as
compared to those without a congenital heart disease.15
Punjab is the largest province of Pakistan and deafness
consanguinity is very common in different castes of this
province, the highest percentage of congenital deafness
was found in the Rajput families.16 Consanguinity was
also found associated with increased prevalence of
Jinnah Sindh Medical University, Karachi, Pakistan
*Correspondence:
Dr. Muhammad Anzar Ullah,
E-mail: ullahanzar610@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20175757
Ullah MA et al. Int J Community Med Public Health. 2018 Jan;5(1):1-3
International Journal of Community Medicine and Public Health | January 2018 | Vol 5 | Issue 1 Page 2
bipolar disorder and its severity as highlighted in a case
report.17
There is an urgent need to address these crises. A
nationwide approach is required to prevent these
catastrophic outcomes in the future generations. Cousin
marriages are a norm in the majority of our population,
the masses being unaware of its consequences. Therefore,
measures should be undertaken by not just the
community but on the government level as well.
First of all, people need to be aware of all these possible
diseases, awareness should spread through media and
other sources of communication and special education
camps should setup in the remote, inaccessible areas of
Pakistan where the major part of this problem lies.
Secondly, marriages should be the couple’s decision
entirely without any family pressure whatsoever.
Pre-pregnancy counselling sessions should be carried out
as well as genetic screening. Pre-natal diagnostic tests
should be regularly done. It should be a regular practice
in Pakistan as well for couples who are first or second
cousins to be tested for these traits, as well as prenatal
diagnostic tests as per schedule. This practice is already
done regularly in countries like Jordan, Saudi Arabia,
Bahrain, Iran, Iraq and Turkey where consanguineous
marriages are very high just like Pakistan.8
Cyprus has seen a decline in cousin marriages by passing
certain laws prohibiting marriages between blood
relations similarly China has reportedly annulled
marriages of close relatives by law, such laws should also
be passed in Pakistan.3,18
The literacy rate of Pakistan has slipped to 58%, and 41%
of girls in Pakistan fail to complete primary
education.19,20 Therefore, education should now be the
primary objective and steps should be taken urgently to
promote education, consanguinity is observed mostly in
an uneducated population, educating them especially girls
will make them independent and enable them to make
better decisions in life.
Pakistan has the second highest number of youngsters
(60%) in the world, who are considered as an asset of the
county, and has a major role to play in its development.21
But a youth with severe intellectual disabilities and other
genetic abnormalities will further increase the burden on
this already struggling country. It’s about time that this
menace should be taken seriously before it’s too late.
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International Journal of Community Medicine and Public Health | January 2018 | Vol 5 | Issue 1 Page 3
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Cite this article as: Ullah MA, Husseni AM,
Mahmood SU. Consanguineous marriages and their
detrimental outcomes in Pakistan: an urgent need for
appropriate measures. Int J Community Med Public
Health 2018;5:1-3.
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Consanguinity is a deeply rooted social trend among one-fifth of the world population mostly residing in the Middle East, West Asia and North Africa, as well as among emigrants from these communities now residing in North America, Europe and Australia. The mounting public awareness on prevention of congenital and genetic disorders in offspring is driving an increasing number of couples contemplating marriage and reproduction in highly consanguineous communities to seek counseling on consanguinity. Primary health care providers are faced with consanguineous couples demanding answers to their questions on the anticipated health risks to their offspring. Preconception and premarital counseling on consanguinity should be part of the training of health care providers particularly in highly consanguineous populations.