Keeping it in the family: consanguineous marriage and genetic disorders, from Islamabad to BradfordBMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1851 (Published 29 April 2019) Cite this as: BMJ 2019;365:l1851
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The success of a society is to be evaluated by the freedom that members of that society enjoy- Amartya Sen, Nobel Laureate (Economics) 1998
Martina Merten highlights a source of genetic disorders in babies borne to emigrant parents from Pakistan.(1) During last century, and in particular last half a century, Low and Middle Income Countries have been successful to reduce their gross mortality rate(2) and gross birth rate(3) reaping the dividends of medical, social and economic advancements in all walks of life. But as mortality rates dropped rapidly, birth rates did not proportionately. Therefore nowadays several regions of the world are facing a problem of so called ‘population explosion’. And this increase in population is temporary as per estimates of international organizations- including World Bank.(4) Hence in our contemporary world there is a strain on natural resources. On the one hand we are facing rapid increase in ageing population, which is projected to rise with every passing decade,(5) we also face the issues of babies borne with congenital errors- sometimes needing life long treatment. Therefore although our resources are limited, our challenges are rapidly changing their contours. Hence whatever resources we have at our disposal, we should use them wisely.
If we waste these scarce resources in ‘defence’ of our borders ,there will be a dearth of finances and other resources and logistics for enhancing human well being. If we fight more, we have to cut somewhere what masses need for its raising awareness, education, medicines and books. If we purchase more bullets, we will have lesser capacity to purchase more books. As our neighbour nowadays faces financial crisis, all these issues become more stark.(6) In this arms race everyone is a loser- except the gun lobby. Future will judge us not by our fire power ,but by our willpower to wipe someone’s tears, to lift them with hope, to give people what the need the most- a fair understanding that illnesses are a source of constant worry, misery and trouble. If we drain our meagre resources on buying arms and ammunition, there will be a shortage of hospitals and schools. Therefore if we want to increase mass -awareness for this genetic abnormality, we have to find a population living not under the constant fear of danger to their lives. So a peaceful world is a necessity for a making a happy and a healthy world. And to make our world a happy place to live in, we are the decisive forces to steer it towards that elegant future of non violence, free from illnesses.
Then there is a contribution of female subjugation in consanguineous marriages. If a woman is not allowed to get proper education, and then doesn’t get economically productive employment; she is in no position to operate her free will to chose her life- partner. If they are confined behind four walls of their homes and veils, how should one expect them to break free out of these chains!(7) To empower women, my country recently made a law to grant them six months’ paid maternity leaves,(8) outlawed practice of oral triple divorce (talaq e biddat)(9) and are in the process of reserving seats in our national parliament to give them higher representation. Along with these measures we also need to promote intercaste and inter-religion marriages. Right now a cowardly practice of honour killing exists, where a woman is killed if she marries a man outside her caste. Our neighbouring country recently outlawed it.(10) We believe that soon a day will arrive in near future where these illnesses plaguing our society will become history and that open ,free ,fair, just, fearless, impartial & unbiased society will harbour healthy babies; without these genetic disorders. Responsibility lies on the shoulders of our present generation to put foundation for that desire and to dream for that aspiration is the first step in that direction.
1 Merten M. Keeping it in the family : consanguineous marriage and genetic disorders, from Islamabad to Bradford. BMJ 2019; 365 :l1851 https://doi.org/10.1136/bmj.l1851
2 Bishai DM, Cohen R, Alfonso YN, Adam T, Kuruvilla S, Schweitzer J (2016) Factors Contributing to Maternal and Child Mortality Reductions in 146 Low- and Middle-Income Countries between 1990 and 2010. PLoS ONE 11(1): e0144908. https://doi.org/10.1371/journal.pone.0144908
3 Fertility levels and trends in countries with intermediate levels of fertility. UN Population division ,available at https://www.un.org/en/development/desa/population/publications/pdf/ferti...
4 Population growth, (Annual %) ,World Bank ,available at https://data.worldbank.org/indicator/SP.POP.GROW?page=6
5 World Population Ageing , United Nations 2017 ,available at https://www.un.org/en/development/desa/population/publications/pdf/agein...
6 Masood S. At US urging, Pakistan to be placed in terrorism- financing list. New York Times. fEB 23, 2018 ,available at https://www.nytimes.com/2018/02/23/world/asia/pakistan-terror-finance-li...
7 Sen A. Missing women -revisited. BMJ 2003; 327 :1297 https://doi.org/10.1136/bmj.327.7427.1297
8 Maternity Benefit (Amendment) Bill, 2016 passed in the parliament. Press Information Bureau, Government of India, Ministry of Women and Child Development. Mar 9, 2017 ,available at http://pib.nic.in/newsite/PrintRelease.aspx?relid=159039
9 Cabinet approves proposal for promulgation of the Muslim Women (Protection of Rights on Marriage) Second Ordinance ,2019. Press Information Bureau. Government of India. Feb 19, 2019, available at http://pib.nic.in/PressReleseDetail.aspx?PRID=1565275
10 Boone J. Pakistan makes ‘honour killings’ punishable by mandatory prison time. Guardian .Oct 6, 2016 ,available at https://www.theguardian.com/world/2016/oct/06/pakistan-honor-killing-law...
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Competing interests: No competing interests
Re: Keeping it in the family: consanguineous marriage and genetic disorders, from Islamabad to Bradford
Marriage, consanguineous or otherwise, is an institution developed over the years with the input of great experience from society, community and the region in question. Most of the places where people marry in the family it is with the fond hope that the property and security of the married partners can be maintained and monitored by the family. The story of such marriages start with this ideal of keeping the wealth and the culture in the family as well as in the community. The awareness about genetics and genetic disorders is not freely available for citizens to understand the impact of such unions. Rather, there are no trained genetic counselors to educate these people. The loss of the family physician system has a telling effect on populations. Religious dogmatism may make such communities still follow such a system of marriage.
There is now a shift from a joint family system to a nuclear family because of cosmopolitan culture and corporate influence. It has outgrown these type of marriages where living together has come into practice. It is a very sad state of affairs to witness consanguineous marriage and the other state of living together. With the first type the family ends up with genetic disorders. The other practice has resulted in broken relationships and frequent divorces. The clash of these extreme forms of marriage system has led to domestic violence, marital discord and other outlets of discord. We are witnessing now violence to such an extent that few indulge in killing each other.
In the process, the affected community is the innocent children who have to bear the brunt of such parental decisions. It is a social problem that needs to be addressed keeping the welfare of the children who have to grow in such an environment. Science can study such genetic disorders. It is society's responsibility to keep the welfare of the children in mind when promoting or criticizing such forms of marriage. Marriage is an institution built on solid values. We need to bring in science to sharpen the system of marriage with scientific temper and societal harmony.
Competing interests: No competing interests