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Ground Report | New Delhi: Cousin marriage in Pakistan; Ghafoor Hussain Shah, a resident of Pakistan-administered Kashmir, is a father of eight and a teacher by profession. According to family tradition in Pakistan, Shah is expected to arrange marriages for his children within his extended family. Shah, 56, is well aware of the potential risk of genetic diseases in children from marriages in close families. She married her cousin in 1987 and they have three children with various ailments.
Shah told DW that one of his sons did not grow normally. One of their daughters has difficulty speaking and the other has difficulty hearing. According to Shah, he regrets that his three children did not get an education. "I am always worried about them," he said. Who will take care of my wife and me after I pass away? ”
Ghafoor Hussain Shah says that despite the dangers of genetic diseases, there is a lot of social pressure to marry cousins. Anyone who refuses to marry into their children's family is in danger of being evicted. Shah also had to marry one of his sons and two daughters to close relatives. Shah's family suffers from blood disorders, learning disabilities, blindness and deafness. Doctors say family marriages could be the cause.
According to a 2017 report on genetic variation in Pakistan, the 'contradictory structure' of the country's population, including blood relations, contributes to the spread of genetic disorders. The report introduces a 'genetic mutation database', which identifies and tracks a variety of mutations and the defects they cause. According to the database, more than 1000 mutations have been reported in 130 different genetic disorders found in Pakistan.
A pediatrician specializing in genetic disorders, Huma Arshad Cheema, geneticist, told DW that there is a huge burden of 'genetic disorders' in Pakistan due to 'breeding'. "Certain disorders can be linked to specific castes and tribes, where marriages within the family are common," he said.
One of the most common genetic diseases currently seen in Pakistan is thalassemia, in which red blood cells cannot absorb oxygen.
Siraj-ud-Daulah, a health expert from Karachi said, the practice of cousin marriage in Pakistan can be linked to Islamic religious beliefs. "I asked the scholars to help raise awareness about genetic diseases and to tell people how family marriages are contributing to the increase in genetic diseases," he told DW. According to Siraj al-Dawla, the clerics with whom he spoke flatly denied the allegations, claiming that such marriages were in accordance with Islamic law.
According to doctors, more needs to be done to change the mindset of people in Pakistan about the risk of having children with close family members.
The most common disorder in the offspring of cousins was a genetic form of severe mental retardation. Overall, Dr Bande found that 48% of serious problems in Pakistani children are due to 'some, possible or probable illness'. That compares with only 3.6% for all other ethnic groups.
Dr Bunde estimates that if people of Pakistani descent stop marrying, there will be a 60 per cent reduction in deaths and serious illnesses among young children within a generation. He believes that the first step towards this would be to make better use of the genetic counselling of those in the Pakistani community who may be at risk. She argues that counselling should be available "before pregnancy, as well as in the prenatal clinic and when a baby has a problem that may have a genetic cause."
Many doctors also need better information about the risks of cousin marriage. The Health Promotion Research Trust, which funded Dr Bundy's work, has produced a booklet outlining their findings for GPs in Birmingham. There are also plans to distribute booklets in outpatient departments at Birmingham Hospital. In addition, Dr Bunde hopes that the local health authority will provide funds for a Muslim genetic counsellor to visit families in their own homes.
Dr Hussain Maqbool, a public health medicine consultant in Birmingham, agrees that education about risks needs to be addressed sensitively, perhaps first by contacting community leaders. "People are reluctant to raise this issue. We need to involve the community itself so that they do not feel threatened or attacked because of their cultural practices".
In March 2020, the Punjab government formed a task force aimed at preventing genetic diseases. The Children's Hospital in Lahore is now offering free genetic screening services in collaboration with international organizations.
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