The choice is yours
It is said that chances of the multiplication of diseases in the offspring are doubled if parents are first cousins. You! probes the social and medical repercussions of marriages between cousins and tries to present the religious, scientific and cultural perspectives regarding such unions
By Lubna Khalid
Riba developed mild swelling on her face. Without getting unduly alarmed her mother Samra, took her to the nearby doctor, who gave the one-and-a-half-year old child an anti allergic and told Samra not to worry. But the swelling refused to subside even after three days. Mildly apprehensive, Samra took Riba to a different doctor, who thought that it was a kidney infection, and prescribed some tests. Samra took the child to SIUT, Karachi, where doctors ruled out kidney infection. The parents were, by then, extremely worried as Riba developed high fever as well. Riba was their firstborn after two miscarriages and three years of marriage. They decided to take her to Aga Khan Hospital, Karachi. A battery of investigative tests, failed to give a clue to her mysterious ailment, and her condition steadily kept worsening. After a few days, she was lost to her parents forever. The stricken parents gradually came to terms with their grief. The arrival of their second daughter Sana also helped. When Sana was one-and-a-half- year old, the couple was blessed with their third daughter, Sidra. When Sidra was barely a year old, Sana developed fever. The parents immediately took her to Aga Khan. This time also, history repeated itself in a terrible way. The tests conducted on the child could not give a clue to her strange sickness. Doctors tried to treat the symptoms, but were not able to diagnose the problem. Shortly before little Sana succumbed to the deadly disease, her younger sister, who had been running a slight temperature, was diagnosed with a rare type of leukemia. For Samra and her husband Zubair, it was the beginning of a terrible ordeal. While performing the last rites of Sana, they were also mourning the impending death of their last daughter Sidra. The doctors finally came to the conclusion that the three girls had been attacked mortally by a genetic disorder. Samra and Zubair happen to be first cousins, with a history of repeated intermarriages in their family.
In the same family, there was another similar case. Rana and Ahmed, after losing their daughter in Canada came to Pakistan. However, their remaining child, a son, also developed fever and was rushed to Aga Khan. The doctor at Aga Khan referred the case to the Hospital for Sick Children, Toronto, where the couple had lost its daughter. They were immediately recalled to Canada where the bone marrow transplant was done. The child is responding slowly to the treatment, but is definitely on the mend.
Such cases make one wonder whether cousins should marry or not. In our culture, proposals from the family are preferred. Very often, matrimonial matches are fixed during the childhood period. There are many issues which compel people to seek a partner for their offspring from their family, foremost amongst them being the bradari system, the social and cultural mores that are common in the family, plus the concept that “why marry a stranger?”
Dr Tahir Shamsi, of Bismillah Taqi Hospital, Gulshan-e-Iqbal, Karachi, trained from England in blood diseases, is the pioneer in the bone marrow transplant (B.M.T) in Karachi. When asked whether first cousins ought to marry or not, he said, “Why not? There is no harm if there is no previous history of genetic or hereditary disorders.”
Dr Soofia Nusrat Khan of Islamabad disagreed with Dr Tahir Shamsi. According to her, chances of the multiplication of diseases in the offspring are doubled if the parents are first cousins. For example, A and B are first cousins, having the same grandparents. In case, either of the grandparents is diabetic, the risk of A and B’s child being a diabetic will be doubled. If the child manages to escape the disease, he is lucky.
Scientists say there are at least 5,000 diseases caused by inherited mutations called recessive genes. Possessing a single copy of the mutation is often harmless, but if a copy is inherited from each parent, the result can be death or chronic disease. Because first cousins share a pair of grandparents, the chances are greater that each will pass a copy of a “bad gene” to their child, triggering the disorder.
Is the risk worth taking?
Hereditary disorders like hypertension, arthritis, thyroid etc are enhanced if there have been inter marriages in the previous generations.
What can be done to avoid it?
Dr Tahir Shamsi said that pre natal diagnosis of any of the rare disorders is extremely difficult. These disorders crop up and attack out of the blue. Pre natal tests for some of these diseases are only available in Canada. But for common disorders like Thalassemia, tests are available. Unfortunately, due to lack of awareness, people don’t bother with the blood tests.
“Blood tests for screening Thalassemia and the Down’s Syndrome should be made mandatory by the government,” opined Dr Shamsi. “But the most important thing is to develop awareness among people - that’s the first step.” Thalassemia is the most common genetically transferred disease. About 5 people out of hundred are carriers (people who carry germs, but are not affected). So in families having a history of Thalassemia, the risk of transferring this terrible disease to the next generation will be higher if there are inter marriages and this risk will be there each time the couple conceives.
According to Dr Tahir Shamsi, in Greece, Cyprus and Italy, Thalassemia has been eradicated due to the mandatory blood tests before marriage. Iran and Saudi Arabia too have made the tests mandatory. “People should realise the magnitude of the problem, and it should be taken as seriously as polio or population control. Information about it should be made a part of the syllabus at school and college levels. Posters warning people about the danger of transmitting it to the future generations should be put up prominently in public places,” suggested Dr Shamsi.
First cousins’ marriages, besides medical problems, may culminate in other problems, too. For instance, in some families, there is the problem of stunted growth. If cousins marry in this situation, their offspring are bound to be short. But if they marry outside the family where their spouses are tall, there is a fair chance that the child will either take after the tall parent or achieve the average height of both the parents. Similarly, families having problems like sallow complexion, premature grayness, or baldness should make it a point to put an end to cousin marriages.
However, the above listed problems are not so grave, although they are common. Some of the rare problems emanating from repeated inter marriages in family can be horrifying; children can be born with half legs, very small hands/feet, defected neural tube, in which the spinal column is exposed at birth, or worse still they may be born without a stomach wall! The children without stomach wall cannot survive for long. At the most, they live only for few weeks.
According to Dr Saima Rehan: “Rickets (a disease in which bones grow fragile), is often genetically transmitted and rarely respond to therapy.” She believes that if both parents are cousins and have a family history of a genetic disorder, their offspring is definitely at risk.
According to the Islamic point of view, Muslims are advised to increase families by marrying outside. This ensures a better bloodline. In Hinduism, a marriage between first cousins is strictly prohibited. Jewish and Christian traditions discourage cousin marriages. The Roman Catholic Church requires cousins to get special permission before they marry.
The communities that do not allow cross marriages develop very individualistic physical traits and are prone to certain diseases prevalent amongst them, whereas those who are born of a union of diverse backgrounds are better endowed physically, often demonstrating the best features of their parents.
Besides the possible medical problems, First cousin marriages can cast a strain on the fabric of the existing family structure. Rifts between mother-in-law and daughter-in-law can divide houses and families, creating severe damage in the relationships between brothers and sisters. Cousin marriages have been widespread in rural societies, where they serve to keep money and property within families. The practice is still popular in much of the Muslim world, including Saudi Arabia and Pakistan.
In contrast to the above views, Robin Bennett, a leading genetic counsellor who has carried research work in North America, Africa, Asia and the Middle East, believes that marriage between first cousins is far less likely to produce abnormal children than is commonly believed. According to research scientists, doctors and genetics counselors should take family disease histories and offer ordinary genetic services such as fetal and newborn disease testing.
It is estimated that 20 per cent of all couples worldwide are first cousins. It is also estimated that 80 per cent of all marriages historically have been between first cousins! Therefore, it can be safely surmised that if cousins have histories of genetically transmitted diseases, they should go for at least the available blood tests. However, if there are no medical problems in the family, there is nothing medically wrong with cousin marriage. The choice is yours.