The Sunday Times

August 29th, 2010

Muslims may object, but we must ban first-cousin marriage

Imagine that you are a young British woman about to enter into a marriage arranged by your parents. It is not a love match, but you consider it acceptable and you like the boy well enough. You are looking forward to a big family wedding. Then imagine you are told by a reliable expert that every baby of this marriage would have a 1 in 10 chance of being born with a serious genetic disorder. That is a shockingly high risk, especially when the disorders in question are terrible, often with progressive damage to the body and mind of a much loved child, over which parents have to grieve helplessly for years.

The expert explains to you that the risks to your children if you marry this particular man are five times greater than those if you marry some other man. With another husband, your risk with each child would be normal, at about 2%. That is simply because the man your parents have chosen is your first cousin and you both come from a long tradition of first-cousin marriage. Surely your response — the only reasonable response — would be to ask your parents to find another husband, who is not related to you, or to find one for yourself.

Put like that, the problem seems simple. Cousin marriage is risky, particularly for groups which have practised it for generations. Closely related first cousins face greater than normal risks of having babies with serious recessive genetic disorders.

To say that is not to criticise anyone for anything. It is not to attack any particular religion or ethnic group or culture. It is merely to state a painful fact, of which people used to be unaware.

However, today this subject is political dynamite; most people don’t dare talk about it at all. That is because the people mainly affected are British Pakistani Muslims: hence the deafening, pusillanimous silence on what should be a serious public health concern.

People have always married their first cousins — Darwin did, Einstein did — and it is legal to do so here. But British Pakistani Muslims actively favour cousin marriage and traditionally have done. About 55% marry their first cousins in this country and in Bradford the number is about 75%.

The result, sadly, is what you would expect. British Pakistani couples account for about 3% of all births here, but they produce nearly a third of all British children suffering from recessive genetic disorders. The BBC reported in 2005 that Birmingham primary care trust estimated that 1 in 10 of children born to first cousins in the city either died in infancy or went on to develop a serious disability due to a genetic disorder.

Many of these problems were discussed by a young British Pakistani woman brave enough to report on this last week on Channel 4’s Dispatches programme. Tazeen Ahmad showed harrowing scenes of a young man writhing and protesting in the misery of his genetic disorder, while his exhausted mother looked after his two blind sisters.

Ahmad spoke of the disabilities and early deaths among her own uncles and aunts, as a result of cousin marriage, and made the general risks plain. What was profoundly shocking was the resistance to these known risks; she spoke to imams, community leaders and parents in a state of resentful denial. Although some younger people seemed more aware, and angry about the intense family pressure on cousins to marry, most people interviewed simply did not accept the scientific evidence. One mother said her children’s disorders were caused by the drugs given to them by the National Health Service.

Worst of all, not a single MP from a constituency with a large Pakistani population would agree to appear on television. Not one was brave enough to run the risk of being called racist or Islamophobic, which is the usual reaction against anyone prepared to talk openly about this subject. Only the redoubtable Ann Cryer, retired MP for Keighley, was courageous enough to appear, calling stoutly for an end to cousin marriage and saying that much of the Pakistani community was in denial about the risks.

It is a national disgrace that members of parliament have allowed themselves to be cowed into silence. (Phil Woolas, like Cryer, is an honourable exception; he warned of these dangers in 2008.) They owe it to their constituents and to the public to face up to and speak out about a practice that causes horrible suffering, to say nothing of the vast cost to the NHS.

Admittedly it is difficult to assess risk. It is also difficult for most of us to understand risk at all, apparently, and even for the numerate the statistics can be confusing or unreliable. Scientific argument is unfamiliar to many of us, including the cousin-mother who said cousin marriage must be safe because all her children were fine.

All this makes it much easier for people who want to ignore a problem to dismiss it as baseless. When Baroness Deech, the bioethicist and lawyer, gave a speech in March about the risks of cousin marriage, she was immediately criticised (and misrepresented) for getting her facts wrong, as people regularly do on scientific matters.

Perhaps her real mistake was to mention in the same speech some other features of cousin marriage — features that are in themselves hotly controversial, as British Muslims are no doubt anxiously aware. Deech said that, although cousin marriages were at odds with freedom of choice, romantic love and integration, they are on the rise. She believes most of them are arranged for financial reasons — to settle debts, or to provide financial support for relatives abroad, to help relatives to migrate to Britain or to provide a ready-made family for an immigrant spouse.

All these things, insofar as they are true, might help to explain the widespread determination among British Muslims to dismiss the problem. The rewards of cousin marriage are great, so perhaps the risks are best belittled or ignored. It is for this reason that I don’t think public health education will help to solve this problem.

Besides, look at the ludicrous failure of sexual health education: sexually transmitted diseases are increasing because, as people used to say in Dorset, there’s none so deaf as them that won’t hear. And comprehensive genetic screening is so far impossible. So to avoid in future the terrible and unnecessary suffering of those many children born with recessive genetic disorders, the government should be brave enough, and compassionate enough, to make first cousin marriage illegal.