IN Pakistan, the practice of inter-cousin marriages is deeply embedded in cultural traditions, seen as a way to strengthen familial ties and uphold societal norms.

Despite societal changes over the past three decades, data from Gallup Pakistan reveals a persistent trend: nearly half of Pakistani women aged 15-49 in 2017-18 reported being married to their first cousins, a statistic that has remained virtually unchanged since 1990-91. This practice is particularly prevalent in rural areas and among less-educated communities.

However, alongside these cultural benefits come significant health risks, primarily related to genetic disorders such as thalassaemia and Hepatitis C. Children born from inter-cousin marriages are at a higher risk of inheriting these conditions due to the genetic similarity between the parents. This issue underscores a complex interplay between tradition and public health, where deeply held customs clash with modern medical knowledge.

To address these health risks, the Khyber Pakhtunkhwa government introduced Preventive Health Act in 2009. This legislation mandates genetic testing for thalassaemia and Hepatitis C before marriage registration. It is meant to reduce the incidence of genetic disorders among children born from such unions. Despite its noble intentions, the Act faces significant implementation challenges.

Advocate Mehwish Muhib Kakakhel says effective implementation of the law requires robust education and accessible testing facilities. She terms awareness gaps among marriage registrars and economic constraints in rural communities as major barriers. Without widespread understanding and compliance, the law’s potential impact remains limited.

Ayaz, an employee at a major private hospital in Peshawar, offers a personal perspective on the challenges of inter-cousin marriages. Married to his first cousin, he and his wife embraced their union to honour family traditions. However, they were unaware of the potential health complications their children would face.

“When we married, we didn’t foresee health issues,” he says. All of their children suffer from thalassaemia minor, necessitating regular medical care and treatments.

Dr Mohammad Ali Gandapur, paediatric gastroenterologist at the same hospital, underscores importance of genetic testing in such scenarios. “Genetic testing is crucial to identify and manage potential health risks early,” he says.

He advocates for comprehensive testing and informed decision-making before cousin marriages, empowering couples with essential medical knowledge to make informed choices about their future and family planning.

Zahoor Khan, serving as both an oath commissioner and Nikah registrar, sheds light on the practical challenges of implementing Preventive Health Act. “The Act cannot be fully realised due to absence of genetic testing requirements in Nikah registration papers and systems,” he says. He stresses the need for integrating health tests into digital registration systems to enhance compliance and effectiveness.

Ayaz’s story and insights from experts highlight the urgent need for increased awareness about health risks associated with inter-cousin marriages in Pakistan. Effective public education campaigns and accessible testing facilities are crucial to protect public health while respecting cultural traditions. Strengthening implementation of Preventive Health Act through these measures will empower couples to make informed decisions about marriage and family planning, bridging tradition with modern medical knowledge.

This narrative underscores a broader societal challenge and a call to action: to balance cultural practices with public health imperatives, ensuring a healthier future for generations to come. By addressing these challenges proactively, Pakistan can navigate the complexities of tradition and health with sensitivity and foresight.

Published in Dawn, August 12th, 2024