Intended for healthcare professionals

Feature Inherited Disease

Keeping it in the family: consanguineous marriage and genetic disorders, from Islamabad to Bradford

BMJ 2019; 365 doi: (Published 29 April 2019) Cite this as: BMJ 2019;365:l1851
  1. Martina Merten, freelance healthcare journalist
  1. Islamabad
  1. info{at}

Marrying close family members is a tradition in many countries and among their emigrants, leading to higher rates of genetic disorders. Reporting from Islamabad, Martina Merten asks how these disorders can be reduced

One billion people worldwide live in countries where marriage among relatives is common. Of this billion, one in three is married to a second cousin or closer relative or is the progeny of such a marriage.12 The frequency of genetic disorders among such children is around twice that in children of non-related parents.12

In some South Asian, Middle Eastern, and north African countries, as many as half of marriages are consanguineous.1 In Pakistan, half of the population marry a first or second cousin, more than in any other country.3 In rural areas this can be 80%, says Hafeez ur Rehman, an anthropologist at the Quaid-i-Azam University in Islamabad. Emigrants from these regions sometimes maintain these traditions.

The custom in all of these countries is similar, he told The BMJ, as marrying within the immediate family guarantees that wealth stays in the family. Partners will have similar socioeconomic status and similar family customs. A good relationship may already exist among parents in law. And divorce rates are believed to be lower.

Hafeez adds, “In our culture, marrying for love is still not highly looked upon, even if younger, educated people increasingly choose that path.”

According to the Pakistan Demographic and Health Survey in 2012-13, the probability of marriage for love increases with the woman’s level of education. But education remains an exception: only 36% of women and 46% of …

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