CINXE.COM

<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML+RDFa 1.0//EN" "http://www.w3.org/MarkUp/DTD/xhtml-rdfa-1.dtd">     <html xml:lang="en" lang="en" dir="ltr" >    <head profile="http://www.w3.org/1999/xhtml/vocab"> <meta charset="utf-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <link rel=”apple-touch-icon-precomposed” href=”/sites/default/themes/bmj/the_bmj/img/icon.png”/> <meta http-equiv="X-UA-Compatible" content="IE=edge">  <link rel="dns-prefetch" href="//static.polldaddy.com" /> <link rel="dns-prefetch" href="//ajax.googleapis.com" /> <link rel="dns-prefetch" href="//crossmark-cdn.crossref.org" /> <link rel="dns-prefetch" href="//d1bxh8uas1mnw7.cloudfront.net" /> <link rel="dns-prefetch" href="//www.google.com" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://www.bmj.com/sites/default/themes/bmj/the_bmj/favicon.ico" type="image/vnd.microsoft.icon" /> <link href="//netdna.bootstrapcdn.com/font-awesome/4.0.3/css/font-awesome.css" rel="stylesheet" media="all" type="text/css" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/387/bmj.q2181.full.pdf" /> <meta name="type" content="article" /> <meta name="category" content="discussion" /> <meta name="HW.identifier" content="/bmj/387/bmj.q2181.atom" /> <meta name="HW.pisa" content="bmj;387/nov05_1/q2181" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /> <meta name="DC.Identifier" content="10.1136/bmj.q2181" /> <meta name="DC.Date" content="2024-11-05" /> <meta name="DC.Publisher" content="British Medical Journal Publishing Group" /> <meta name="DC.Rights" content="Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="The tradition of marrying close family members is rapidly declining in Pakistan, with rising awareness of genetic disorders. Sonia Sarkar reports Syed Hashim Haider, a 29 year old software engineer in Lahore, not only married out of his family but also out of his Islamic sect. This is unusual in Pakistan, which has one of the highest rates of cousin marriage globally—65%.1 But a new generation of Pakistanis is moving away from consanguineous marriages, with families’ increasing awareness of the severe health challenges that have roots in such a match. These include stillbirths, low birthweight, increased mortality, congenital malformations, spinal muscular atrophy, thalassaemia, sensorineural hearing loss, and cystic fibrosis.2 Haider’s parents are cousins, but he says that his family had already started a “positive” trend of marrying out of the family when his older brothers chose their own non-familial partners. “Many people get married to their cousins because of undue parental pressure, but I feel privileged that I did not feel any such pressure,” says Haider. He has seen many cousin marriages in his extended family—–usually forced arranged marriages. “The problems within such forced marriages aggravate faster when a child is born with a genetic disorder,” he says. “A blame game starts within these marriages over the carrier of the gene that led to the disease.” Consanguineous marriages in Pakistan fell from 67.9% in 2006-07 to 63.6% in 2018, with more educated and financially independent women and men able to marry for love rather than family obligation. One 2022 study reported that women with higher education were much less likely to be in cousin marriages than women with no formal education.3 And women residing in urban areas were 33% less likely to be in cousin marriages than their rural counterparts. But Salman Kirmani, chair …" /> <meta name="DC.Contributor" content="Sonia Sarkar" /> <meta name="article:published_time" content="2024-11-05" /> <meta name="article:section" content="Feature" /> <meta name="citation_title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /> <meta name="citation_abstract" lang="en" scheme="teaser" content="<p>The tradition of marrying close family members is rapidly declining in Pakistan, with rising awareness of genetic disorders. <b>Sonia Sarkar</b> reports</p>" /> <meta name="citation_journal_title" content="BMJ" /> <meta name="citation_publisher" content="British Medical Journal Publishing Group" /> <meta name="citation_publication_date" content="2024/11/05" /> <meta name="citation_mjid" content="bmj;387/nov05_1/q2181" /> <meta name="citation_id" content="387/nov05_1/q2181" /> <meta name="citation_public_url" content="https://www.bmj.com/content/387/bmj.q2181" /> <meta name="citation_abstract_html_url" content="https://www.bmj.com/content/387/bmj.q2181.abstract" /> <meta name="citation_full_html_url" content="https://www.bmj.com/content/387/bmj.q2181.full" /> <meta name="citation_pdf_url" content="https://www.bmj.com/content/bmj/387/bmj.q2181.full.pdf" /> <meta name="citation_issn" content="1756-1833" /> <meta name="citation_journal_abbrev" content="BMJ" /> <meta name="citation_doi" content="10.1136/bmj.q2181" /> <meta name="citation_pmid" content="39500532" /> <meta name="citation_volume" content="387" /> <meta name="citation_article_type" content="Discussion" /> <meta name="citation_section" content="Feature" /> <meta name="citation_author" content="Sonia Sarkar" /> <meta name="citation_author_institution" content="Delhi" /> <meta name="citation_reference" content="citation_journal_title=BMC Womens Health;citation_author=S. Iqbal;citation_author=R. Zakar;citation_author=F. Fischer;citation_author=MZ. Zakar;citation_title=Consanguineous marriages and their association with women’s reproductive health and fertility behavior in Pakistan: secondary data analysis from Demographic and Health Surveys, 1990-2018;citation_pages=118;citation_volume=22;citation_year=2022;citation_pmid=35421973;citation_doi=10.1186/s12905-022-01704-2" /> <meta name="citation_reference" content="citation_journal_title=Int J Community Med Public Health;citation_author=MA. Ullah;citation_author=AM. Husseni;citation_author=SU. Mahmood;citation_title=Consanguineous marriages and their detrimental outcomes in Pakistan: an urgent need for appropriate measures;citation_pages=1-3;citation_volume=5;citation_year=2018;citation_doi=10.18203/2394-6040.ijcmph20175757" /> <meta name="citation_reference" content="Bashir S, Nazir S. Marriage market in Pakistan consanguinity, educational assortative mating, and fertility. Pakistan Institute of Development Economics. 2022. https://file.pide.org.pk/uploads/wp-0212-marriage-market-in-pakistan-consanguinity-educational-assortative-mating-and-fertility.pdf" /> <meta name="citation_reference" content="citation_journal_title=BMC Pregnancy Childbirth;citation_author=A. Hanif;citation_author=F. Akbar;citation_author=S. Kirmani;citation_title=Experience in prenatal genetic testing and reproductive decision-making for monogenic disorders from a single tertiary care genetics clinic in a low-middle income country;citation_pages=431;citation_volume=23;citation_year=2023;citation_pmid=37301973;citation_doi=10.1186/s12884-023-05698-z" /> <meta name="citation_reference" content="citation_journal_title=Gene;citation_author=E. Rao;citation_author=S. Kumar Chandraker;citation_author=M. Misha Singh;citation_author=R. Kumar;citation_title=Global distribution of β-thalassemia mutations: An update;citation_pages=148022;citation_volume=896;citation_year=2024;citation_pmid=38007159;citation_doi=10.1016/j.gene.2023.148022" /> <meta name="citation_reference" content="citation_journal_title=J Pediatr Nurs;citation_author=IU. Rehman;citation_author=TM. Khan;citation_author=A. Bukhsh;citation_title=Challenges of having a child with thalassemia in Pakistan: a phenomenological study;citation_pages=e179-86;citation_volume=72;citation_year=2023;citation_pmid=37414623;citation_doi=10.1016/j.pedn.2023.06.026" /> <meta name="citation_reference" content="citation_journal_title=Popul Dev Rev;citation_title=Intensive kinship, development, and demography: why Pakistan has the highest rates of cousin marriage in the world;citation_author=MK. Shenk;citation_author=S. Naz;citation_author=T. Chaudhry" /> <meta name="citation_reference" content="Pakistan GDP. Worldometer. https://www.worldometers.info/gdp/pakistan-gdp/" /> <meta name="citation_reference" content="World Bank Group. Rural transformation of Pakistan: pathways for growth. Sep 2023. https://documents1.worldbank.org/curated/en/099020224011526037/pdf/P1756671ad821e0431b847134d623fa93e6.pdf?_gl=1*1rivrqh*_gcl_au*ODUwMjkxMjM3LjE3MjU3ODA1NDM" /> <meta name="citation_reference" content="Call to discourage first-cousin marriages. Scotsman. 29 Mar 2010. https://www.scotsman.com/news/call-to-discourage-first-cousin-marriages-2442750" /> <meta name="citation_reference" content="citation_journal_title=Hum Hered;citation_author=A. Shaw;citation_title=Drivers of cousin marriage among British Pakistanis;citation_pages=26-36;citation_volume=77;citation_year=2014;citation_pmid=25060267;citation_doi=10.1159/000358011" /> <meta name="twitter:title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:description" content="The tradition of marrying close family members is rapidly declining in Pakistan, with rising awareness of genetic disorders. Sonia Sarkar reports Syed Hashim Haider, a 29 year old software engineer in Lahore, not only married out of his family but also out of his Islamic sect. This is unusual in Pakistan, which has one of the highest rates of cousin marriage globally—65%.1 But a new generation of Pakistanis is moving away from consanguineous marriages, with families’ increasing awareness of the severe health challenges that have roots in such a match. These include stillbirths, low birthweight, increased mortality, congenital malformations, spinal muscular atrophy, thalassaemia, sensorineural hearing loss, and cystic fibrosis.2 Haider’s parents are cousins, but he says that his family had already started a “positive” trend of marrying out of the family when his older brothers chose their own non-familial partners. “Many people get married to their cousins because of undue parental pressure, but I feel privileged that I did not feel any such pressure,” says Haider. He has seen many cousin marriages in his extended family—–usually forced arranged marriages. “The problems within such forced marriages aggravate faster when a child is born with a genetic disorder,” he says. “A blame game starts within these marriages over the carrier of the gene that led to the disease.” Consanguineous marriages in Pakistan fell from 67.9% in 2006-07 to 63.6% in 2018, with more educated and financially independent women and men able to marry for love rather than family obligation. One 2022 study reported that women with higher education were much less likely to be in cousin marriages than women with no formal education.3 And women residing in urban areas were 33% less likely to be in cousin marriages than their rural counterparts. But Salman Kirmani, chair …" /> <meta name="og-title" property="og:title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /> <meta name="og-url" property="og:url" content="https://www.bmj.com/content/387/bmj.q2181" /> <meta name="og-site-name" property="og:site_name" content="The BMJ" /> <meta name="og-description" property="og:description" content="The tradition of marrying close family members is rapidly declining in Pakistan, with rising awareness of genetic disorders. Sonia Sarkar reports Syed Hashim Haider, a 29 year old software engineer in Lahore, not only married out of his family but also out of his Islamic sect. This is unusual in Pakistan, which has one of the highest rates of cousin marriage globally—65%.1 But a new generation of Pakistanis is moving away from consanguineous marriages, with families’ increasing awareness of the severe health challenges that have roots in such a match. These include stillbirths, low birthweight, increased mortality, congenital malformations, spinal muscular atrophy, thalassaemia, sensorineural hearing loss, and cystic fibrosis.2 Haider’s parents are cousins, but he says that his family had already started a “positive” trend of marrying out of the family when his older brothers chose their own non-familial partners. “Many people get married to their cousins because of undue parental pressure, but I feel privileged that I did not feel any such pressure,” says Haider. He has seen many cousin marriages in his extended family—–usually forced arranged marriages. “The problems within such forced marriages aggravate faster when a child is born with a genetic disorder,” he says. “A blame game starts within these marriages over the carrier of the gene that led to the disease.” Consanguineous marriages in Pakistan fell from 67.9% in 2006-07 to 63.6% in 2018, with more educated and financially independent women and men able to marry for love rather than family obligation. One 2022 study reported that women with higher education were much less likely to be in cousin marriages than women with no formal education.3 And women residing in urban areas were 33% less likely to be in cousin marriages than their rural counterparts. But Salman Kirmani, chair …" /> <meta name="og-type" property="og:type" content="article" /> <meta name="og:image" property="og:image" content="https://www.bmj.com/sites/default/files/highwire/bmj/387/8449.cover-source.jpg"/> <meta name="twitter:card" content="summary_large_image"><meta name="twitter:image" property="twitter:image" content="https://www.bmj.com/sites/default/files/sites/defautl/files/attachments/bmj-article/2024/11/pakistani_wedding.png"><meta name="twitter:title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /><link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/387/bmj.q2181.full.txt" /> <script>window.dataLayer = window.dataLayer || [];window.dataLayer.push({"page":{"hwTitle":"Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders","hwUrl":"https://www.bmj.com/content/387/bmj.q2181","hwPath":"/content/387/bmj.q2181","hwType":"journal page"},"user":{"hwMemberID":"","hwLoggedIntoInstitutionID":"","hwLoggedIntoInstitution":"","hwAccessUsageTerms":"guest","hwRegisteredUser":"no","hwHasFullTextAccess":"no","hwEntitled":"no","mail":"e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855"},"content":{"hwIssueDate":"2024-11-05","hwIssueDateTime":"2024-11-05 10:36:20","hwPublicationDate":"2024-11-05","hwPublicationDateTime":"2024-11-05 10:36:20","hwNlmArticleType":"discussion","hwDOI":"10.1136/bmj.q2181","hwAuthors":"Sonia Sarkar","hwContributors":"","hwIsEarlyRelease":"no","hwEissn":"1756-1833","hwPissn":"","hwVolume":"387","hwIssue":"","hwArticleType":"Feature","hwTabView":"main_tab","hwViewType":"","hwAccessType":"Paywall","hwOpenAccess":"no","hwFreeAccess":"no","hwTaxonomy":"","hwCorpusCode":"bmj","hwType":"article","hwSubtitle":null,"hwOverline":null,"hwPisaId":"bmj;387/nov05_1/q2181","hwFirstPage":null,"hwLastPage":null,"hwIsLatestVersion":"yes","hwIsCurrentIssue":"no","hwIsOpenIssue":"no","hwHasFullText":"yes","hwHasPDF":"yes","hwParentTitle":"BMJ: 387","hwElectronicPubDate":"2024-11-05","hwElectronicPubDateTime":"2024-11-05 10:36:20"}}); //--><!]]></script> <meta name="generator" content="Drupal 7 (http://drupal.org)" /> <link rel="canonical" href="https://www.bmj.com/content/387/bmj.q2181" /> <link rel="shortlink" href="https://www.bmj.com/node/1102937" /> <meta name="twitter:card" content="summary" /> <meta name="twitter:url" content="https://www.bmj.com/content/387/bmj.q2181" /> <meta name="twitter:title" content="Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders" /> <title>Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders | The BMJ</title>   <link type="text/css" rel="stylesheet" href="https://www.bmj.com/sites/default/files/advagg_css/css__FiHqHoPUdv6CHw5dUEIfFV7jpYTgBb1JUncssjaxHyo__1sncCi_mkZlnZk1lpMbS0Ko6gldf3d0A0WKzvsoV5h4__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.css" media="all" /> <link type="text/css" rel="stylesheet" href="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.css" media="all" /> <link type="text/css" rel="stylesheet" href="https://www.bmj.com/sites/default/files/advagg_css/css__Z9fgw99JqFKGwDuQuLtZOeq23E9uc0mK4qxQe7ZDZo8__ToVWhf1nLySNMRN6kHdMWHAxZT2jAPLuldI3WqOcr0g__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.css" media="all" /> <link type="text/css" rel="stylesheet" href="https://www.bmj.com/sites/default/files/advagg_css/css__hcEfBsSfdZ2na-rT9Jhk7K2mHyy5KBdPKm6ia_F7MYU__4716zpuGoj4DfVIEENbeOWgAOX_pf_t16EI4fvJGo7A__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.css" media="print" /> <link type="text/css" rel="stylesheet" href="https://www.bmj.com/sites/default/files/advagg_css/css__b-tWEqg3_twqP_ufdNXyA5V14StJgBdiIxG1UIi0LYc__3z5eyFP7TvyPE6DkwNj3xM94b3mZNfr4lSWEChDxsvU__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.css" media="screen" /> <link type="text/css" rel="stylesheet" href="https://www.bmj.com/sites/default/files/advagg_css/css__-BkZ71IF4pBXmZfP4vYyswWdIhuaKktrUUQ4i2vtUVo__0i_0YcYkMECNn0z7FdhNoJ8gLWleqnTtjnHRAmLijvc__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.css" media="all" /> <link href="/sites/default/themes/bmj/the_bmj/css/fonts.css" rel="stylesheet" media="all" type="text/css"> <style media="screen" type="text/css"> .page-news #latest-blogs h2.pane-title, .bootstrap-threecol-4-4-4 #latest-blogs h2.pane-title { width: 153px !important; } #navigation-wrapper #navigation .main-navigation .menu.nav>li.last { display: block !important; } </style>  <script src="https://cdn.cookielaw.org/consent/tcf.stub.js"" type="text/javascript" charset="UTF-8"></script>  <script src="https://cookie-cdn.cookiepro.com/scripttemplates/otSDKStub.js" type="text/javascript" charset="UTF-8" data-domain-script="565e50dd-f6e9-46d6-91cd-5c40a270264f"></script> <script type="text/javascript"> function OnetrustAdsConsent(){ if(googletag.apiReady){ //console.log("GoogleTag API ready") googletag.pubads().disableInitialLoad(); if(OptanonActiveGroups.match(/,4,/)){ googletag.pubads().setRequestNonPersonalizedAds(0); //googletag.pubads().refresh(); } else{ googletag.pubads().setRequestNonPersonalizedAds(1); // googletag.pubads().refresh(); } } else{ OnetrustAdsConsent(); } } function OptanonWrapper() { OnetrustAdsConsent(); } </script>  <script src="https://www.bmj.com/sites/default/files/advagg_js/js__wQYYWLUWErxls_q7a6fk-aoyATq9qiA4xZWj_nuQWIY__idPe4msTM3VewG9y-TVQn9f3_mIGnqFi2cuHIkTOFDs__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__0YTPIamlhRKP1C291geHzRxybsKbjQDTlsgtfmRDp-k___nGVJm_2vQH-OlkAZ4KJWyWRqF2DVgEgc5PAkG2TT7s__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.google.com/recaptcha/api.js?hl=en&render=explicit&onload=drupalRecaptchaOnload"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__PgTqDXPxlq-HyomloHpN-WrBe9DkY3SNs9BDw85yP4I__rTeO0iPp3oLbE6MHxqppxss6-RxXMLj5_Q8F0SjcF1g__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__UUwMbpErCBHAQQqH_Cxzi20oSmMoxcbKeYV6qoD70qc__skFUSUohWkyaYdPjJ2LSEF0xKVUuQTqmOxG-9og_468__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__7tN13Z_jEtWpAlHc4vWZWrFePCNhuslRS59mkCehpG8__hIhm4v2jj35Ek3jyTBAduhmH_HOFYDYH-VH1JBUELWg__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script>var _prum=[['id', '612e3f1b1733500011000061'], ['mark', 'firstbyte', (new Date()).getTime()]]; (function() { var s=document.getElementsByTagName('script')[0], p=document.createElement('script'); p.async='async'; p.src='//rum-static.pingdom.net/prum.min.js';s.parentNode.insertBefore(p,s);})();</script> <script>if(typeof window.MathJax === "undefined") window.MathJax = { menuSettings: { zoom: "Click" } };</script> <script async="async" src="https://scholar.google.com/scholar_js/casa.js"></script> <script>jQuery.extend(Drupal.settings,{"basePath":"\/","pathPrefix":"","ajaxPageState":{"theme":"the_bmj","theme_token":"IsKTQ1wT5cumsqCO6cywbmjUlVGj9Hm6y5aNWrF0sII"},"colorbox":{"opacity":"0.85","current":"{current} of {total}","previous":"\u00ab Prev","next":"Next \u00bb","close":"Close","maxWidth":"98%","maxHeight":"98%","fixed":true,"mobiledetect":true,"mobiledevicewidth":"480px"},"highwire":{"nid":"1102937","apath":"\/bmj\/387\/bmj.q2181.atom","pisa":"bmj;387\/nov05_1\/q2181","ac":{"\/bmj\/387\/bmj.q2181.atom":{"access":{"full":false,"extract":true},"pisa_id":"","apath":"\/bmj\/387\/bmj.q2181.atom","jcode":"bmj"},"bmj;387\/nov05_1\/q2181":{"access":{"full":false},"pisa_id":"bmj;387\/nov05_1\/q2181","apath":"","jcode":"bmj"}},"processed":["highwire_math"],"markup":[{"requested":"long","variant":"extract","view":"extract","pisa":"bmj;387\/nov05_1\/q2181"}],"trendmd":{"trendmd-suggestions":"{\u0022element\u0022:\u0022#trendmd-suggestions\u0022,\u0022track_id\u0022:\u002224814\u0022}"},"dataLayer":"{\u0022page\u0022:{\u0022hwTitle\u0022:\u0022Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders\u0022,\u0022hwUrl\u0022:\u0022https:\\\/\\\/www.bmj.com\\\/content\\\/387\\\/bmj.q2181\u0022,\u0022hwPath\u0022:\u0022\\\/content\\\/387\\\/bmj.q2181\u0022,\u0022hwType\u0022:\u0022journal page\u0022},\u0022user\u0022:{\u0022hwMemberID\u0022:\u0022\u0022,\u0022hwLoggedIntoInstitutionID\u0022:\u0022\u0022,\u0022hwLoggedIntoInstitution\u0022:\u0022\u0022,\u0022hwAccessUsageTerms\u0022:\u0022guest\u0022,\u0022hwRegisteredUser\u0022:\u0022no\u0022,\u0022hwHasFullTextAccess\u0022:\u0022no\u0022,\u0022hwEntitled\u0022:\u0022no\u0022,\u0022mail\u0022:\u0022e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855\u0022},\u0022content\u0022:{\u0022hwIssueDate\u0022:\u00222024-11-05\u0022,\u0022hwIssueDateTime\u0022:\u00222024-11-05 10:36:20\u0022,\u0022hwPublicationDate\u0022:\u00222024-11-05\u0022,\u0022hwPublicationDateTime\u0022:\u00222024-11-05 10:36:20\u0022,\u0022hwNlmArticleType\u0022:\u0022discussion\u0022,\u0022hwDOI\u0022:\u002210.1136\\\/bmj.q2181\u0022,\u0022hwAuthors\u0022:\u0022Sonia Sarkar\u0022,\u0022hwContributors\u0022:\u0022\u0022,\u0022hwIsEarlyRelease\u0022:\u0022no\u0022,\u0022hwEissn\u0022:\u00221756-1833\u0022,\u0022hwPissn\u0022:\u0022\u0022,\u0022hwVolume\u0022:\u0022387\u0022,\u0022hwIssue\u0022:\u0022\u0022,\u0022hwArticleType\u0022:\u0022Feature\u0022,\u0022hwTabView\u0022:\u0022main_tab\u0022,\u0022hwViewType\u0022:\u0022\u0022,\u0022hwAccessType\u0022:\u0022Paywall\u0022,\u0022hwOpenAccess\u0022:\u0022no\u0022,\u0022hwFreeAccess\u0022:\u0022no\u0022,\u0022hwTaxonomy\u0022:\u0022\u0022,\u0022hwCorpusCode\u0022:\u0022bmj\u0022,\u0022hwType\u0022:\u0022article\u0022,\u0022hwSubtitle\u0022:null,\u0022hwOverline\u0022:null,\u0022hwPisaId\u0022:\u0022bmj;387\\\/nov05_1\\\/q2181\u0022,\u0022hwFirstPage\u0022:null,\u0022hwLastPage\u0022:null,\u0022hwIsLatestVersion\u0022:\u0022yes\u0022,\u0022hwIsCurrentIssue\u0022:\u0022no\u0022,\u0022hwIsOpenIssue\u0022:\u0022no\u0022,\u0022hwHasFullText\u0022:\u0022yes\u0022,\u0022hwHasPDF\u0022:\u0022yes\u0022,\u0022hwParentTitle\u0022:\u0022BMJ: 387\u0022,\u0022hwElectronicPubDate\u0022:\u00222024-11-05\u0022,\u0022hwElectronicPubDateTime\u0022:\u00222024-11-05 10:36:20\u0022}}"},"jnl_bmj_infographic":{"infographic_tab":false},"custom_search":{"form_target":"_self","solr":1},"panel_ajax_tab":{"path":"sites\/all\/modules\/contrib\/panels_ajax_tab"},"instances":"{\u0022highwire_abstract_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:20,\u0022height\u0022:20,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-abstract-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-abstract-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022right center\u0022,\u0022my\u0022:\u0022left center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022shift\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter click \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_author_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-author-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-author-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022top center\u0022,\u0022my\u0022:\u0022bottom center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_reflinks_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022mimic\u0022:\u0022top center\u0022,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-ref-link-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-ref-link-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022bottom left\u0022,\u0022my\u0022:\u0022top left\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022flip\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}}}","qtipDebug":"{\u0022leaveElement\u0022:0}","urlIsAjaxTrusted":{"\/login":true,"\/content\/387\/bmj.q2181?tab=article-alert":true,"\/content\/387\/bmj.q2181":true},"ws_fl":{"width":100,"height":21},"jnl_bmj":{"container_id_share":"article-share-modal","container_id_response":"article-response-modal"},"orcidLogo":{"svg":"\/sites\/default\/themes\/bmj\/the_bmj\/img\/vector_iD_icon.svg"},"bootstrap":{"anchorsFix":"1","anchorsSmoothScrolling":"1","popoverEnabled":"1","popoverOptions":{"animation":1,"html":0,"placement":"right","selector":"","trigger":"click","title":"","content":"","delay":0,"container":"body"},"tooltipEnabled":"1","tooltipOptions":{"animation":1,"html":0,"placement":"auto left","selector":"","trigger":"hover focus","delay":0,"container":"body"}}});</script> <script type="text/javascript"> window.dataLayer = window.dataLayer || []; </script>  <script type="text/javascript">var DC = { Date : "", subject : "" };var ga_article_category = "Feature";var ga_article_page_type = "discussion";var ga_article_pub_year = "2024";var ga_customer_number = "";var ga_user_type = "";DC.Date = "2024-11-05";DC.subject = "";</script>   <style>.async-hide { opacity: 0 !important} </style> <script>(function(a,s,y,n,c,h,i,d,e){s.className+=' '+y;h.start=1*new Date; h.end=i=function(){s.className=s.className.replace(RegExp(' ?'+y),'')}; (a[n]=a[n]||[]).hide=h;setTimeout(function(){i();h.end=null},c);h.timeout=c;})(window,document.documentElement,'async-hide','dataLayer',4000,{'GTM-NF7HCLL':true});</script>   <script>var googletag = window.googletag || {cmd: []};</script> <script async src="//securepubads.g.doubleclick.net/tag/js/gpt.js"></script> <script> var topBottomSizes = [ [970,250],[970,90],[728,90],[468,60],[300,50],[320,100] ]; var mpuSizes = [ [300,250],[300,600],[600,600], ]; //googletag.cmd.push(function() { googletag.display('div-gpt-ad-7326006-1'); }); googletag.cmd.push(function() { googletag.defineSlot('/21798771943/BMJ.com_HomePage_TOPBanner', topBottomSizes,'div-gpt-ad-7326006-1').addService(googletag.pubads()).setTargeting("pgid", "pubgrade_lib_disabled"); googletag.defineSlot('/21798771943/BMJ.com_HomePage_MPU1', mpuSizes, 'div-gpt-ad-7326006-2').addService(googletag.pubads()); googletag.defineSlot('/21798771943/BMJ.com_HomePage_MPU2', mpuSizes, 'div-gpt-ad-7326006-3').addService(googletag.pubads()); googletag.defineSlot('/21798771943/BMJ.com_HomePage_BOTTOM', topBottomSizes, 'div-gpt-ad-7326006-4').addService(googletag.pubads()); googletag.pubads().setTargeting('url', window.parent.location.pathname); // Some examples of ways to enable below. Normally, only one of these // methods should be used. // A) Enable with defaults. //googletag.pubads().enableLazyLoad({ //fetchMarginPercent: 0, // Fetch slots within 1 viewports. //renderMarginPercent: 0, // Render slots within 1 viewports. //mobileScaling: 2.0 // Double the above values on mobile. //}); googletag.enableServices(); }); </script> <script> let cookies = parseCookies(); let bmj_uuid = cookies.bmj_uuid; let bmj_ppid = cookies.bmj_ppid; window.dataLayer = window.dataLayer || []; function checkUserLoginStatus(dataLayer) { const userMail = dataLayer.find((item) => item.user)?.user?.mail; if (!userMail) { return false; } return userMail !== anonMailId; } const anonMailId = 'e3b0c44298fc1c149afbf4c8996fb92427ae41e4649b934ca495991b7852b855'; let nonAnonMailId = ((dataLayer.find(item => item.user)?.user)?.mail) === anonMailId ? null : (dataLayer.find(item => item.user)?.user)?.mail; let userId = ((dataLayer.find(item => item.user)?.user)?.['data-ics']) ?? ((dataLayer.find(item => item.user)?.user)?.mail && nonAnonMailId) ?? bmj_ppid ?? bmj_uuid; document.cookie = 'bmj_ppid=' + userId + '; domain=.bmj.com; path=/; max-age=31622400; SameSite=None; Secure'; googletag.cmd.push(function() { googletag.pubads().setPublisherProvidedId(userId); googletag.pubads().setTargeting("islogged", checkUserLoginStatus(dataLayer) ? "true" : "false"); googletag.enableServices(); }); window.dataLayer.push({ 'bmj_uuid': bmj_uuid }); </script> </head>   <script type="text/javascript">(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-NF7HCLL');</script>  </head>  <body class="html not-front not-logged-in no-sidebars page-node page-node- page-node-1102937 node-type-highwire-article 1 Feature" >  <noscript><iframe src="//www.googletagmanager.com/ns.html?id=GTM-NF7HCLL" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript>  <div id="skip-link"> <a href="#main-content" class="element-invisible element-focusable">Skip to main content</a> </div> <div id="wrapper-outer"> <div id="wrapper"> <header> <div class="bmj-disclaimer"> <p>Intended for healthcare professionals</p> </div> <div class="ad-leaderboard"> <div id='div-gpt-ad-7326006-1'> <script> googletag.cmd.push(function() { googletag.display('div-gpt-ad-7326006-1'); }); </script> </div> </div>   <div id="top-nav" role="navigation" class="navbar navbar-static-top"> <div class="container"> <div id="userbar-status"> <ul id="status"> <li class="user-status-link user-status-subscribe phone-menu-item"> <a href="/us/subscribe">Subscribe</a> </li> <li class="user-status-myaccount phone-menu-item"> <div class="btn-group has-submenu"> <a class="btn dropdown-toggle" aria-expanded="false" aria-haspopup="true" data-toggle="dropdown" href="#" > My Account <span class="caret" aria-expanded="true"></span> </a> <ul class="jnl-bmj-user-my-account dropdown-menu"><li class="0 first last"><a href="//myaccount.bmj.com/myaccount/account/hw-registration.html">My email alerts</a></li> </ul></div> </li> <li class="user-status-bma phone-menu-item"> <a href="//bmjverification.bma.org.uk/validate/userdetails?url=https://www.bmj.com/content/387/bmj.q2181?sso=">BMA member login</a> </li> <div class="btn-group has-submenu"> <a class="btn dropdown-toggle" aria-expanded="false" aria-haspopup="true" data-toggle="dropdown" href="#" > Login <span class="caret" aria-expanded="true"></span> </a> <ul class="jnl-bmj-user-signin-popup dropdown-menu"><li class="0 first last"><span><form action="/login" method="post" id="jnl-bmj-user-login-form--2" accept-charset="UTF-8"><div><input type="hidden" name="form_build_id" value="form-_7MvUHc0pIllQheDv9QNtBUXfjeykj26rho7xUIEBXk" /> <input type="hidden" name="form_id" value="jnl_bmj_user_login_form" /> <div class="form-type-textfield form-item-name form-item form-group"> <label for="article-p-name">Username <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="text" id="article-p-name" name="name" value="" size="15" maxlength="60" /> </div> <div class="form-type-password form-item-pass form-item form-group"> <label for="article-p-pass">Password <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="password" id="article-p-pass" name="pass" size="15" maxlength="128" /> </div> <div class="link"><div id="edit-forgot--2" class="form-type-item form-item form-group"> <label for="edit-forgot--2"><a href="https://www.bmj.com/user/password" title="Retrieve your credentials.">Forgot your log in details?</a> </label> </div> </div><div class="link"><div id="edit-activate--2" class="form-type-item form-item form-group"> <label for="edit-activate--2"><a href="//journals.bmj.com/cgi/activate/basic">Need to activate</a> </label> </div> </div><input class="btn form-submit" type="submit" id="edit-submit--10" name="op" value="Login" /><div id="edit-message--4" class="form-type-item form-item form-group"> </div> <hr /><div id="edit-bma-members--2" class="form-type-item form-item form-group"> <label for="edit-bma-members--2"><a href="//bmjverification.bma.org.uk/validate/userdetails?url=https%3A//www.bmj.com/content/387/bmj.q2181%3Fsso%3D" title="Log in here if you are a BMA member.">BMA Member Log In</a> </label> </div> <div id="edit-athens--2" class="form-type-item form-item form-group"> <label for="edit-athens--2"><a href="https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&subcode=bmjjournals&hw-shib-return-uri=https%253A%252F%252Fwww.bmj.com%252Fcontent%252F387%252Fbmj.q2181">Log in via OpenAthens</a> </label> </div> <div id="edit-shibboleth--2" class="form-type-item form-item form-group"> <label for="edit-shibboleth--2"><a href="/login/shibboleth?uri=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F387%2Fbmj.q2181&subcode=bmjjournals&env=prod">Log in via your institution</a> </label> </div> </div></form></span></li> </ul></div> </ul> <div id="userbar"> <div class="region region-userbar"> <section id="block-panels-mini-jnl-bmj-country-portal-switcher" class="block block-panels-mini clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_bmj_country_portal_switcher"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-country-switcher" > <div class="pane-content"> <span class="country-label">Edition: </span> <div class="btn-group has-submenu"> <a class="btn dropdown-toggle" aria-expanded="false" aria-haspopup="true" data-toggle="dropdown" href="#" id=country-switcher> US <span class="caret" aria-expanded="true"></span> </a> <ul class="jnl-bmj-country-portal-country-switcher dropdown-menu"><li class="0 first"><a href="/bmj_countries/switch/uk?destination=node/1102937">UK</a></li> <li class="1"><a href="/bmj_countries/switch/india?destination=node/1102937">South Asia</a></li> <li class="2 last"><a href="/bmj_countries/switch/international?destination=node/1102937">International</a></li> </ul></div> </div> </div> </div> </div> </div> </section>  </div> </div> <div id="cmp-link"> <div class="pane-content"> <span class="country-label"><a href="/company?int_source=tbmj&int_medium=header&int_campaign=URLswitch">Our company</a></span> </div> </div> </div> </div> </div>  <div id="main-nav" data-spy="affix" data-offset-top="125"> <div class="primary-navigation-bar"> <div id="navigation-wrapper"> <div class="container">  <a href="#" id="btn-nav" class=""> <span class="sr-only">Toggle navigation</span> </a>  <a class="logo navbar-btn pull-left" href="/" title="Home">  <div class="bmj-logo">The BMJ logo</div> </a> <div class="ie6-site-map"><a href="/sitemap">Site map</a></div>  <div class="main-nav-search"> <div id="search">  <a href="#" class="dropdown-toggle" data-toggle="dropdown" title="Search"><div class="search"><em class="fa fa-search" alt="Search"></em><span class="search-label">Search</span></div></a> <div class="dropdown-menu"> <div class="header-search-form container"> <div class="searchbar"> <div class="region region-search-block"> <section id="block-search-form" class="block block-search clearfix"> <form class="search-form form-search content-search" action="/content/387/bmj.q2181" method="post" id="search-block-form" accept-charset="UTF-8"><div><div> <h2 class="element-invisible">Search form</h2> <div class="input-group"><input title="Enter the terms you wish to search for." class="container-inline input-append form-control form-text" placeholder="Search The BMJ" type="text" id="edit-search-block-form--2" name="search_block_form" value="" size="15" maxlength="128" /><span class="input-group-btn"><button type="submit" class="btn btn-default">Search</button></span></div><button class="element-invisible btn btn-primary btn btn-primary form-button" type="submit" id="edit-submit--5" name="op" value="Search">Search</button><input type="hidden" name="form_build_id" value="form-IKB0SDWy-ERyEC557OaP1J8ZnCJbkGA1eV-yt8l0_h0" /> <input type="hidden" name="form_id" value="search_block_form" /> <input type="hidden" name="custom_search_paths" value="search/advanced/[key]" /> </div> </div></form> </section>  </div> </div> <div class="advanced-search"> <ul class="list-inline"> <li><a href="/search/advanced" title="Advanced search">Advanced search</a></li> <li><a href="/rapid-responses" title="Search responses">Search responses</a></li> <li><a href="//blogs.bmj.com/bmj/" title="Search blogs">Search blogs</a></li> </ul> </div> </div> </div> </div> </div>  <a href="#" id="toggle-mobile-top-nav"> <span class="fa fa-cog"></span> <span class="sr-only">Toggle top menu</span> </a>  <div id="navigation" class="navigation">  <div class="main-navigation"> <nav role="navigation"> <ul class="menu nav navbar-nav"><li class="first leaf"><a href="/coronavirus">covid-19</a></li> <li class="expanded dropdown"><a href="/us/research" data-target="#" class="dropdown-toggle" data-toggle="dropdown">Research</a><ul class="dropdown-menu"><li class="first leaf"><a href="/us/research">At a glance</a></li> <li class="leaf"><a href="/us/research/research">Research papers</a></li> <li class="leaf"><a href="/us/research/research%20methods%20%26amp%3B%20reporting">Research methods and reporting</a></li> <li class="leaf"><a href="/us/research/minerva">Minerva</a></li> <li class="last leaf"><a href="/us/research/research%20news">Research news</a></li> </ul></li> <li class="expanded dropdown"><a href="/us/education" data-target="#" class="dropdown-toggle" data-toggle="dropdown">Education</a><ul class="dropdown-menu"><li class="first leaf"><a href="/us/education">At a glance</a></li> <li class="leaf"><a href="/us/education/clinical%20review">Clinical reviews</a></li> <li class="leaf"><a href="/us/education/practice">Practice</a></li> <li class="leaf"><a href="/us/education/minerva">Minerva</a></li> <li class="leaf"><a href="/us/education/endgames">Endgames</a></li> <li class="leaf"><a href="/specialties/state-art">State of the art</a></li> <li class="leaf"><a href="/specialties/what-your-patient-thinking">What your patient is thinking</a></li> <li class="leaf"><a href="/rapid-recommendations">Rapid recommendations</a></li> <li class="last leaf"><a href="/student">Student</a></li> </ul></li> <li class="expanded dropdown"><a href="/us/news" data-target="#" class="dropdown-toggle" data-toggle="dropdown">News & Views</a><ul class="dropdown-menu"><li class="first leaf"><a href="/us/news">At a glance</a></li> <li class="leaf"><a href="/us/news/news?category=News">News</a></li> <li class="leaf"><a href="/us/news/feature">Features</a></li> <li class="leaf"><a href="/us/news/editorial">Editorials</a></li> <li class="leaf"><a href="/us/news/analysis">Analysis</a></li> <li class="leaf"><a href="/us/news/observations">Observations</a></li> <li class="leaf"><a href="/news/opinion">Opinion</a></li> <li class="leaf"><a href="/us/news/head%20to%20head">Head to head</a></li> <li class="leaf"><a href="/us/news/editor%27s%20choice">Editor's choice</a></li> <li class="leaf"><a href="/us/news/letter">Letters</a></li> <li class="leaf"><a href="/us/news/obituary">Obituaries</a></li> <li class="leaf"><a href="/us/news/views%20%26amp%3B%20reviews">Views and reviews</a></li> <li class="leaf"><a href="/careers-articles">Careers</a></li> <li class="last leaf"><a href="/rapid-responses">Rapid responses</a></li> </ul></li> <li class="expanded dropdown"><a href="/campaigns" data-target="#" class="dropdown-toggle" data-toggle="dropdown">Campaigns</a><ul class="dropdown-menu"><li class="first leaf"><a href="/campaigns">At a glance</a></li> <li class="leaf"><a href="/better-evidence">Better evidence</a></li> <li class="leaf"><a href="/campaign/climate-emergency">Climate change</a></li> <li class="leaf"><a href="/divestment">Divestment from fossil fuels</a></li> <li class="leaf"><a href="/campaign/patient-partnership">Patient and public partnership</a></li> <li class="last leaf"><a href="/too-much-medicine">Too much medicine</a></li> </ul></li> <li class="last expanded dropdown"><a href="/careers" data-target="#" class="dropdown-toggle" data-toggle="dropdown">Jobs</a><ul class="dropdown-menu"><li class="first leaf"><a href="/careers">Doctor Jobs UK</a></li> <li class="leaf"><a href="/careers/jobs/hospital/">Hospital Jobs UK</a></li> <li class="leaf"><a href="/careers/jobs/general-practice/">GP Jobs UK</a></li> <li class="last leaf"><a href="/careers/jobs/international/">International Jobs</a></li> </ul></li> </ul>  <div class="second-navigation"> <ul class="secondary-nav" id=""> <li class="even"><a href="/archive" class="">Archive</a></li> <li class="odd"><a href="/about-bmj/resources-authors" class="">For authors</a></li> <li class="odd last"><a href="http://hosted.bmj.com" class="">Hosted</a></li> </ul> </div> </nav> </div> </div> </div> </div> </div> </div> </header> <div class="main-container container" id="page">   <div class="row"> <section class="col-sm-12" > <ol class="breadcrumb"><li class="first"><a href="/us/news">News & Views</a></li> <li>Young Pakistanis are...</li> <li class="active last">Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders</li> </ol> <a id="main-content"></a> <div class="region region-content"> <section id="block-system-main" class="block block-system clearfix"> <div class="panel-display" > <div class="hero"> <div class="hero-wrapper"> <div class="hero-content" style="position: relative; left: 0px; top: 35.5px;"> </div>  </div>  </div>  <div class="row"> <div class="left-content col-xs-12 col-sm-8 col-md-8 col-lg-8"> <article> <div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1102937" data-node-nid="1102937" id="node-1102937--2982164300" data-pisa="bmj;387/nov05_1/q2181" data-pisa-master="bmj;bmj.q2181" data-apath="/bmj/387/bmj.q2181.atom"><cite class='highwire-cite highwire-citation-bmj-article-top'> <span class='highwire-cite-article-type'>Feature</span> <span class='bmj-series-title'>Consanguineous marriage</span> <h1 class="highwire-cite-title" id="page-title">Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders</h1> <span class='highwire-cite-journal'>BMJ</span> <span class='highwire-cite-published-year'>2024</span>; <span class='highwire-cite-volume-issue'>387</span> <span class='highwire-cite-doi'> doi: <a href="https://doi.org/10.1136/bmj.q2181">https://doi.org/10.1136/bmj.q2181</a></span> <span class='highwire-cite-date'>(Published 05 November 2024)</span> <span class='highwire-cite-article-as'> Cite this as: <span class="italic">BMJ</span> 2024;387:q2181 </span> </cite> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <ul class="tabs inline panels-ajax-tab"><li class="first"><a title="Article Tab - Article" href="/content/387/bmj.q2181" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="" data-url-enabled="1"><span>Article</span></a><a title="Article Tab - Article" href="/panels_ajax_tab/jnl_bmj_tab_art/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li><a title="Article Tab - Related Articles" href="/content/387/bmj.q2181/related" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_related_art" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="related" data-url-enabled="1"><span>Related content</span></a><a title="Article Tab - Related Articles" href="/panels_ajax_tab/jnl_bmj_tab_related_art/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li><a title="Article Tab - Info & Metrics" href="/content/387/bmj.q2181/article-info" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_info" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="article-info" data-url-enabled="1"><span>Metrics</span></a><a title="Article Tab - Info & Metrics" href="/panels_ajax_tab/jnl_bmj_tab_info/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li><a title="BMJ Article Related Rapid Responses" href="/content/387/bmj.q2181/rapid-responses" class="panels-ajax-tab-tab" data-panel-name="bmj_related_rapid_responses" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="rapid-responses" data-url-enabled="1"><span>Responses</span></a><a title="BMJ Article Related Rapid Responses" href="/panels_ajax_tab/bmj_related_rapid_responses/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li><a title="Article Tab - Peer review" href="/content/387/bmj.q2181/peer-review" class="panels-ajax-tab-tab" data-panel-name="jnl_bmj_tab_peer_review" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="peer-review" data-url-enabled="1"><span>Peer review</span></a><a title="Article Tab - Peer review" href="/panels_ajax_tab/jnl_bmj_tab_peer_review/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> <li class="last"><a title="BMJ Rapid Responses Form" href="/content/387/bmj.q2181/submit-a-rapid-response" class="panels-ajax-tab-tab" data-panel-name="bmj_rapid_responses_form" data-target-id="highwire_article_tabs" data-entity-context="node:1102937" data-trigger="submit-a-rapid-response" data-url-enabled="1"><i class="fa fa-edit"></i></a><a title="BMJ Rapid Responses Form" href="/panels_ajax_tab/bmj_rapid_responses_form/node:1102937/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li> </ul> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_bmj_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.bmj.com/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_bmj_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article extract-view"><span class="highwire-journal-article-marker-start"></span><div class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="last" id="contrib-1"><span class="name">Sonia Sarkar</span><span class="contrib-role">, freelance journalist</span></li></ol><ol class="affiliation-list"><li class="aff"><address>Delhi</address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1"><span class="em-link"><span class="em-addr">26.sarkar{at}gmail.com</span></span></li></ol></div><div class="teaser"><p id="p-1">The tradition of marrying close family members is rapidly declining in Pakistan, with rising awareness of genetic disorders. <strong>Sonia Sarkar</strong> reports</p></div><p id="p-2">Syed Hashim Haider, a 29 year old software engineer in Lahore, not only married out of his family but also out of his Islamic sect. This is unusual in Pakistan, which has one of the highest rates of cousin marriage globally—65%.<span class="xref-bibr">1</span></p><p id="p-3">But a new generation of Pakistanis is moving away from consanguineous marriages, with families’ increasing awareness of the severe health challenges that have roots in such a match. These include stillbirths, low birthweight, increased mortality, congenital malformations, spinal muscular atrophy, thalassaemia, sensorineural hearing loss, and cystic fibrosis.<span class="xref-bibr">2</span></p><p id="p-4">Haider’s parents are cousins, but he says that his family had already started a “positive” trend of marrying out of the family when his older brothers chose their own non-familial partners. “Many people get married to their cousins because of undue parental pressure, but I feel privileged that I did not feel any such pressure,” says Haider. He has seen many cousin marriages in his extended family—–usually forced arranged marriages. “The problems within such forced marriages aggravate faster when a child is born with a genetic disorder,” he says. “A blame game starts within these marriages over the carrier of the gene that led to the disease.”</p><p id="p-5">Consanguineous marriages in Pakistan fell from 67.9% in 2006-07 to 63.6% in 2018, with more educated and financially independent women and men able to marry for love rather than family obligation. One 2022 study reported that women with higher education were much less likely to be in cousin marriages than women with no formal education.<span class="xref-bibr">3</span> And women residing in urban areas were 33% less likely to be in cousin marriages than their rural counterparts.</p><p id="p-6">But Salman Kirmani, chair … </p><span class="highwire-journal-article-marker-end"></span></div><span id="related-urls"></span></div><a href="https://www.bmj.com/content/387/bmj.q2181.full" class="hw-link hw-link-article-full-text">View Full Text</a></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-bmj-article-purchase-subscribe" > <div class="pane-content"> <div class="panel-display row bootstrap-twocol-6-6" id="mini-panel-bmj_article_purchase_subscribe"> <div class="panel-panel col-left col-xs-6 col-sm-6 col-md-6 col-lg-6"> <div class="panel-pane pane-highwire-opportunity-challenge" id="challenge-pane" > <h2 class="pane-title"> Log in </h2> <div class="pane-content"> <div class='opportunity-challenge-login'><h3>Log in using your username and password</h3><form action="/login" method="post" id="jnl-bmj-user-login-form" accept-charset="UTF-8"><div><div class="article-page-other-links"> <p class="bma-login"><a href="//bmjverification.bma.org.uk/validate/userdetails?url=https%3A//www.bmj.com/content/387/bmj.q2181%3Fsso%3D" title="Log in here if you are a BMA member." class="btn btn-primary btn-lg btn-block existing-subs-btn">BMA Member Log In</a></p> <div class="article-page-sign-in"> <p>If you have a subscription to The BMJ, log in:</p> <input type="hidden" name="form_build_id" value="form-Hz5hXujm0jZ6QAI2HwSpL2DTcnTXRcEHy0zJBlIr3OY" /> <input type="hidden" name="form_id" value="jnl_bmj_user_login_form" /> <div class="form-type-textfield form-item-name form-item form-group"> <label for="article-b-name">Username <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="text" id="article-b-name" name="name" value="" size="15" maxlength="60" /> </div> <div class="form-type-password form-item-pass form-item form-group"> <label for="article-b-pass">Password <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="password" id="article-b-pass" name="pass" size="15" maxlength="128" /> </div> <div class="article-page-forgot-activate"> <div class="link"><div id="edit-forgot" class="form-type-item form-item form-group"> <label for="edit-forgot"><a href="https://www.bmj.com/user/password" title="Retrieve your credentials.">Forgot your log in details?</a> </label> </div> </div> </div> <input class="btn form-submit" type="submit" id="edit-submit" name="op" value="Login" /> </div> <ul> <li><div class="link"><div id="edit-activate" class="form-type-item form-item form-group"> <label for="edit-activate"><a href="//journals.bmj.com/cgi/activate/basic">Need to activate</a> </label> </div> </div></li> <li><a class="btn" href="/login/shibboleth?uri=https%3A%2F%2Fwww.bmj.com%2Fcontent%2F387%2Fbmj.q2181&subcode=bmjjournals&env=prod">Log in via institution</a></li> <li><a href="https://openathens-sp.highwire.org/session/init?entityID=https%3A//idp.eduserv.org.uk/openathens&subcode=bmjjournals&hw-shib-return-uri=https%253A%252F%252Fwww.bmj.com%252Fcontent%252F387%252Fbmj.q2181" class="btn">Log in via OpenAthens</a></li> </ul> </div> </div></form></div><div class='opportunity-challenge-institution'><h3>Log in through your institution</h3></div> </div> </div> </div> <div class="panel-panel col-right col-xs-6 col-sm-6 col-md-6 col-lg-6"> <div class="panel-pane pane-snippet pane-subscribe-panel-for-article-page" > <div class="pane-content"> <div class="subscribe-panel-for-article-page" id="subscribe-panel-for-article-page"> <div class="snippet-content"> <div class="panel-pane pane-custom pane-1" id="article-subscribe-top"> <h2>Subscribe from £184 *</h2> <p>Subscribe and get access to all BMJ articles, and much more.</p> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmj-article-subs" > <div class="pane-content"> <p class="bma-subscribe"><a href="/us/subscribe" class="btn btn-primary btn-block">Subscribe</a></p><p class="small">* For online subscription</p> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet pane-subscribe-panel-2-for-article-page" > <div class="pane-content"> <div class="subscribe-panel-2-for-article-page" id="subscribe-panel-2-for-article-page"> <div class="snippet-content"> <div class="panel-pane pane-custom pane-1" id="article-subscribe-bottom"> <div class="buy-article"> <p><strong>Access this article for 1 day for:<br>£50 / $60/ €56</strong> (<a href="/company/eu-vat-rates/">excludes VAT</a>)</p> <p>You can download a PDF version for your personal record.</p> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmj-purchase-link" > <div class="pane-content"> <p><a href="/highwire/payment/ppv/1102937">Buy this article</a> </p> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-trendmd" > <div class="pane-content"> <div id="trendmd-suggestions"></div> </div> </div> </article> </div> <div class="right-nav col-xs-12 col-sm-4 col-md-4 col-lg-4"> <aside> <div class="panel-pane pane-service-links" > <div class="pane-content"> <div class="service-links"><ul><li class="first"><a href="http://twitter.com/share?url=https%3A//www.bmj.com/content/387/bmj.q2181&count=horizontal&via=&text=Young%20Pakistanis%20are%20moving%20away%20from%20cousin%20marriage%20owing%20to%20the%20risk%20of%20genetic%20disorders&counturl=https%3A//www.bmj.com/content/387/bmj.q2181" class="twitter-share-button service-links-twitter-widget" id="twitter_widget" title="Tweet This" rel="nofollow"><span class="element-invisible">Tweet Widget</span></a></li> <li class="last"><a href="http://www.facebook.com/plugins/like.php?href=https%3A//www.bmj.com/content/387/bmj.q2181&layout=button_count&show_faces=false&action=like&colorscheme=light&width=100&height=21&font=&locale=" id="facebook_like" title="I Like it" class="service-links-facebook-like" rel="nofollow"><span class="element-invisible">Facebook Like</span></a></li> </ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet" > <div class="pane-content"> <div class="oas-ad-middle-1" id="oas-ad-middle-1"> <div class="snippet-content"> <div id="div-gpt-ad-7326006-2"><script> googletag.cmd.push(function() { googletag.display('div-gpt-ad-7326006-2'); }); </script></div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmj-article-buttons" > <h2 class="pane-title"> Article tools </h2> <div class="pane-content"> <a href="/content/387/bmj.q2181.full.pdf" title="PDF" class="pdf-link"><span class="icon"><em class="bmj-icon blue-icon fa fa-file-text"></em>PDF</span></a><a href="/content/387/bmj.q2181/rapid-responses" class="citation-rr-link"><em class="bmj-icon blue-icon fa fa-comment"></em>0 responses</a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-bmj-art-tools" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_bmj_art_tools"> <div class="panel-panel panel-col"> <div><ul><li class="first"><div class="panel-pane pane-custom pane-1" > <div class="pane-content"> <p><i class="bmj-icon fa fa-edit"></i><a href="/content/387/bmj.q2181/submit-a-rapid-response">Respond to this article</a></p> </div> </div> </li> <li><div class="panel-pane pane-bmj-variant-link" > <div class="pane-content"> <i class="bmj-icon fa fa-print"></i><a href="/content/387/bmj.q2181.full-text.print" data-font-icon="fa fa-print">Print</a> </div> </div> </li> <li><div class="panel-pane pane-bmj-minipanel-model-link pane-jnl-bmj-article-page-alerts" > <div class="pane-content"> <div class='minipanel-model-wrapper'><div class='minipanel-model-link-link'><i class="bmj-icon fa fa-bullhorn"></i><a href="/#mini-panel-jnl-bmj-article-page-alerts-1" data-toggle="collapse" role="button" data-font-icon="fa fa-bullhorn">Alerts & updates</a></div><div id="mini-panel-jnl-bmj-article-page-alerts-1" class="panel-collapse collapse"><div class="minipanel-header"><h4 class="minipanel-label">Article alerts</h4><div class="short-description"><div class="alerts-marketing">Please note: your email address is provided to the journal, which may use this information for marketing purposes.</div></div></div><div class="minipanel-body"><div class="panel-display row bootstrap-onecol" id="mini-panel-jnl_bmj_article_page_alerts"> <div class="panel-panel col-xs-12 col-sm-12 col-md-12 col-lg-12"> <div class="panel-pane pane-custom pane-2" > <div class="pane-content"> <h4 class="minipanel-label">Log in or register:</h4> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-alerts-login-form" > <div class="pane-content"> <form action="/content/387/bmj.q2181?tab=article-alert" method="post" id="user-login-form" accept-charset="UTF-8"><div><div class="form-type-textfield form-item-name form-item form-group"> <label for="edit-name">Username <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="text" id="edit-name" name="name" value="" size="15" maxlength="60" /> </div> <div class="form-type-password form-item-pass form-item form-group"> <label for="edit-pass">Password <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="password" id="edit-pass" name="pass" size="15" maxlength="128" /> </div> <input type="hidden" name="form_build_id" value="form-aS240UM4-PEddAoGaesW6nd8qJ795UQByJ5awFKs5Ns" /> <input type="hidden" name="form_id" value="highwire_alerts_user_login" /> <input class="btn form-submit" type="submit" id="edit-submit--2" name="op" value="Log in" /></div></form> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-3" id="register-for-alerts" > <div class="pane-content"> <p><a class="btn register-button" href="//myaccount.bmj.com/myaccount/registration.html?regService=bmj-registration&fwdUrl=https://www.bmj.com/content/387/bmj.q2181?tab=article-alert&itemId=pr1906">Register for alerts</a><br /> <div class="alerts-email"><i class="fa fa-info-circle"></i> If you have registered for alerts, you should use your registered email address as your username</div> </div> </div> </div> </div> </div></div></div> </div> </div> </li> <li><div class="panel-pane pane-bmj-minipanel-model-link pane-article-page-citation-download" > <div class="pane-content"> <div class='minipanel-model-wrapper'><div class='minipanel-model-link-link'><i class="bmj-icon fa fa-globe"></i><a href="/#mini-panel-article-page-citation-download-1" data-toggle="collapse" role="button" data-font-icon="fa fa-globe">Citation tools</a></div><div id="mini-panel-article-page-citation-download-1" class="panel-collapse collapse"><div class="minipanel-header"><h4 class="minipanel-label">Download this article to citation manager</h4></div><div class="minipanel-body"><div class="panel-display row bootstrap-onecol" id="mini-panel-article_page_citation_download"> <div class="panel-panel col-xs-12 col-sm-12 col-md-12 col-lg-12"> <div class="panel-pane pane-bmj-citation-export" > <div class="pane-content"> <div> <div class="highwire-citation-info"> <div class="highwire-article-citation highwire-citation-type-highwire-article node1102937" data-node-nid="1102937" id="node-1102937--2320042833" data-pisa="bmj;387/nov05_1/q2181" data-pisa-master="bmj;bmj.q2181" data-apath="/bmj/387/bmj.q2181.atom"><div id="jnl_bmj_custom_authors" style="display: none;"><span data-delta="0"><span class="nlm-given-names">Sonia</span> <span class="nlm-surname">Sarkar</span> <span class="nlm-role">freelance journalist</span></span></div> <div class="highwire-cite highwire-cite-highwire-article highwire-citation-bmj-article-citation-export clearfix" > <span class="highwire-cite-authors" ><!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN" "http://www.w3.org/TR/REC-html40/loose.dtd"> <html><body><span data-delta="0"><span class="nlm-surname">Sarkar</span> <span class="nlm-given-names">S</span></span>. </body></html> </span> <span class="highwire-cite-title article-title">Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders</span> <span class="highwire-cite-metadata" ><span class="highwire-cite-metadata-journal highwire-cite-metadata">BMJ </span><span class="highwire-cite-metadata-date highwire-cite-metadata">2024; </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">387 </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">:q2181 </span></span> <span class="article-doi" >doi:10.1136/bmj.q2181</span> </div> </div> </div> <div class="highwire-citation-formats"> <div class="highwire-citation-formats-links"> <span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.spage&rft.epage&rft.atitle=Young%20Pakistanis%20are%20moving%20away%20from%20cousin%20marriage%20owing%20to%20the%20risk%20of%20genetic%20disorders&rft.volume=387&rft.issue&rft.date=2024-11-05%2010%3A36%3A20&rft.stitle&rft.jtitle=BMJ&rft.au=Sarkar%2C+Sonia"></span><h3></h3><ul class="bmj-citation-links"><li class="first">BibTeX (win & mac)<a href="/highwire/citation/1102937/bibtext" class="citation-link btn btn-primary pull-right">Download</a></li> <li>EndNote (tagged)<a href="/highwire/citation/1102937/endnote-tagged" class="citation-link btn btn-primary pull-right">Download</a></li> <li>EndNote 8 (xml)<a href="/highwire/citation/1102937/endnote-8-xml" class="citation-link btn btn-primary pull-right">Download</a></li> <li>RefWorks Tagged (win & mac)<a href="/highwire/citation/1102937/refworks-tagged" class="citation-link btn btn-primary pull-right">Download</a></li> <li>RIS (win only)<a href="/highwire/citation/1102937/ris" class="citation-link btn btn-primary pull-right">Download</a></li> <li class="last">Medlars<a href="/highwire/citation/1102937/medlars" class="citation-link btn btn-primary pull-right">Download</a></li> </ul> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet" > <h2 class="pane-title"> Help </h2> <div class="pane-content"> <div class="jnl-bmj-citation-download-help" id="jnl-bmj-citation-download-help"> <div class="snippet-content"> <div class="citation-help"> <p class="citation-manager">If you are unable to import citations, please contact technical support for your product directly (links go to external sites):</p> <ul> <li><a href="http://www.endnote.com/support/ensupport.asp">EndNote</a></li> <li><a href="http://www.procite.com/support/pcsupport.asp">ProCite</a></li> <li><a href="http://www.refman.com/support/rmsupport.asp">Reference Manager</a></li> <li><a href= "http://www.refworks.com/content/products/content.asp">RefWorks</a></li> <li><a href="http://www.zotero.org/support">Zotero</a></li> </ul> </div> </div> </div> </div> </div> </div> </div> </div></div></div> </div> </div> </li> <li class="last"><div class="panel-pane pane-bmj-permission-link" > <div class="pane-content"> <i class="bmj-icon icon-copyright"></i><a href="https://s100.copyright.com/AppDispatchServlet?publisherName=BMJ&publication=bmj&title=Young%20Pakistanis%20are%20moving%20away%20from%20cousin%20marriage%20owing%20to%20the%20risk%20of%20genetic%20disorders&publicationDate=11/05/2024&author=Sonia%20Sarkar&contentID=10.1136/bmj.q2181&volumeNum=387&issueNum=&startPage=&endPage=&copyright=BMJ%20Publishing%20Group%20Ltd&oa=n&orderBeanReset=1&link_type=PERMISSIONDIRECT&atom=/bmj/387/bmj.q2181.atom" rel="external" class="bmj-permission-link request-permissions" target="_blank" data-font-icon="icon-copyright">Request permissions</a> </div> </div> </li> </ul></div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-bmj-article-share-modal" > <div class="pane-content"> <div class="panel-display row bootstrap-onecol" id="mini-panel-bmj_article_share_modal"> <div class="panel-panel col-xs-12 col-sm-12 col-md-12 col-lg-12"> <div class="panel-pane pane-bmj-article-links" > <div class="pane-content"> <div class="bmj-article-links minipanel-model-wrapper"><ul class="links"><li><div class="minipanel-model-link-link"><i class="bmj-icon fa fa-user"></i><a data-font-icon="fa fa-bullhorn" role="button" data-toggle="collapse" href="/#mini-panel-jnl-bmj-article-page-citation" class="collapsed">Author citation</a></div></li></ul><div style="height: 0px;" id="mini-panel-jnl-bmj-article-page-citation" class="panel-collapse collapse"><ul class="links"><li class="0 first last"><a href="//www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&term=Sarkar%20Sonia%5Bau%5D&dispmax=50" target="_blank">Articles by Sonia Sarkar</a></li> </ul></div></div><div class="bmj-article-links"><ul class="links"><li class="0 first last"><a href="//portfolio.bmj.com/portfolio/add-to-portfolio.html?t=Young%20Pakistanis%20are%20moving%20away%20from%20cousin%20marriage%20owing%20to%20the%20risk%20of%20genetic%20disorders&u=https%3A//www.bmj.com/content/387/bmj.q2181" target="_blank" id="add-to-bmj-portfolio" class="bmj-portfolio" rel="nofollow">Add article to BMJ Portfolio</a></li> </ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmj-minipanel-model-link pane-jnl-bmj-article-button-email-to" > <div class="pane-content"> <div class='minipanel-model-wrapper'><div class='minipanel-model-link-link'><i class="bmj-icon icon-email"></i><a href="/#mini-panel-jnl-bmj-article-button-email-to-1" data-toggle="collapse" role="button" data-font-icon="icon-email">Email to a friend</a></div><div id="mini-panel-jnl-bmj-article-button-email-to-1" class="panel-collapse collapse"><div class="minipanel-header"><h4 class="minipanel-label">Forward this page</h4></div><div class="minipanel-body"><div class="panel-display row bootstrap-onecol" id="mini-panel-jnl_bmj_article_button_email_to"> <div class="panel-panel col-xs-12 col-sm-12 col-md-12 col-lg-12"> <div class="panel-pane pane-block pane-forward-form" > <div class="pane-content"> <form action="/content/387/bmj.q2181" method="post" id="forward-form" accept-charset="UTF-8"><div><div id="edit-instructions" class="form-type-item form-item form-group"> <p>Thank you for your interest in spreading the word about The BMJ.</p><p>NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.</p> </div> <div class="form-type-textfield form-item-name form-item form-group"> <label for="edit-name--2">Username <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="text" id="edit-name--2" name="name" value="" size="58" maxlength="256" /> </div> <div class="form-type-textfield form-item-email form-item form-group"> <label for="edit-email">Your Email <span class="form-required" title="This field is required.">*</span></label> <input class="form-control form-text required" type="text" id="edit-email" name="email" value="" size="58" maxlength="256" /> </div> <div class="form-type-textarea form-item-recipients form-item form-group"> <label for="edit-recipients">Send To <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper"><textarea class="form-control form-textarea required" id="edit-recipients" name="recipients" cols="50" rows="3"></textarea></div> </div> <div id="edit-page" class="form-type-item form-item form-group"> <label for="edit-page">You are going to email the following </label> <a href="/content/387/bmj.q2181" class="active">Young Pakistanis are moving away from cousin marriage owing to the risk of genetic disorders</a> </div> <div class="form-type-textarea form-item-message form-item form-group"> <label for="edit-message--3">Your Personal Message </label> <div class="form-textarea-wrapper"><textarea class="form-control form-textarea" id="edit-message--3" name="message" cols="50" rows="3"></textarea></div> </div> <input type="hidden" name="path" value="node/1102937" /> <input type="hidden" name="path_cid" value="" /> <input type="hidden" name="forward_footer" value=" " /> <input type="hidden" name="form_build_id" value="form-Lv3cugl0mHlgw29GWsv0JRaWZ_9H_RvC7q0ZotD5gXc" /> <input type="hidden" name="form_id" value="forward_form" /> <fieldset class="captcha panel panel-default form-wrapper"> <legend class="panel-heading"> <div class="panel-title fieldset-legend"> CAPTCHA </div> </legend> <div class="panel-body"> <p class="help-block"> This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. </p> <input type="hidden" name="captcha_sid" value="358666769" /> <input type="hidden" name="captcha_token" value="06470676efd5a6363749c560d2950e42" /> <input type="hidden" name="captcha_response" value="Google no captcha" /> <div class="g-recaptcha" data-sitekey="6LfnJVIUAAAAAE-bUOMg0MJGki4lqSvDmhJp19fN" data-theme="light" data-type="image"></div> </div> </fieldset> <input class="btn form-submit" type="submit" id="edit-submit--3" name="op" value="Send" /></div></form> </div> </div> </div> </div> </div></div></div> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet" > <div class="pane-content"> <div class="altmertrics" id="altmertrics"> <div class="snippet-content">  <div id="altmetric"></div>  </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet" > <div class="pane-content"> <div class="oas-ad-middle-2" id="oas-ad-middle-2"> <div class="snippet-content"> <div id="div-gpt-ad-7326006-3"><script> googletag.cmd.push(function() { googletag.display('div-gpt-ad-7326006-3'); }); </script></div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-4" > <div class="pane-content"> <p><a data-target="crossmark"><img src="https://crossmark-cdn.crossref.org/widget/v2.0/logos/CROSSMARK_Color_horizontal.svg" width="150" /></a></p> <div id="crossmark-dialog" style="display: none;" title="Crossmark"> <iframe id="crossmark-dialog-frame" frameborder="0"></iframe></div>  </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet pane-poll-international" id="poll-widget" > <h2 class="pane-title"> This week's poll </h2> <div class="pane-content"> <div class="poll-international" id="poll-international"> <div class="snippet-content"> <p><a class="anchor" id="this-weeks-poll"></a></p> <div id="PDI_container58250" class="PDS_Poll"></div> <div id="PD_superContainer"></div> <div class="poll-related"> <p><a href="https://www.bmj.com/content/385/bmj.q1429">Read</a> related article</p> <p><a href="/about-bmj/poll-archive">See</a> previous polls</p> </div> </div> </div> </div> </div> </aside> </div> </div>  <div class="row"> <div class="panel-panel page-bottom col-md-12 col-lg-12"> <div class="panel-pane pane-highwire-back-to-top" > <div class="pane-content"> <a href="#page" class="back-to-top"><span class="icon-chevron-up"></span> Back to top</a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet pane-oas-ad-bottom" > <div class="pane-content"> <div class="oas-ad-bottom" id="oas-ad-bottom"> <div class="snippet-content"> <div id="div-gpt-ad-7326006-4"><script> googletag.cmd.push(function() { googletag.display('div-gpt-ad-7326006-4'); }); </script></div> </div> </div> </div> </div> </div> </div>  </div>  </section>  </div> </section> </div> </div>  <div class="footer-wrapper"> <div class="container"> <footer id="footer"> <div class="region region-footer"> <section id="block-panels-mini-bmj-footer" class="block block-panels-mini clearfix"> <div class="panel-display bootstrap-footer" id="mini-panel-bmj_footer"> <div class="footer-top-row"> <div id="footer-social-media" class="footer-column panel-panel col-xs-12 col-sm-3 col-md-3 col-lg-3"> <div class="panel-pane pane-block pane-menu-block-2" > <h2 class="pane-title"> Follow us on </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-2 menu-name-menu-footer parent-mlid-1298 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-1299"><a href="http://twitter.com/bmj_latest" target="_blank">Twitter</a></li> <li class="leaf menu-mlid-1301"><a href="https://www.facebook.com/bmjdotcom" target="_blank">Facebook</a></li> <li class="leaf menu-mlid-1300"><a href="http://youtube.com/user/BMJmedia" target="_blank">YouTube</a></li> <li class="last leaf menu-mlid-1302"><a href="http://feeds.bmj.com/bmj/recent">RSS</a></li> </ul></div> </div> </div> </div> <div class="footer-content col-xs-12 col-sm-9 col-md-9 col-lg-9"> <div id="footer-top-row" class="row"> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-3" > <h2 class="pane-title"> Content links </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-3 menu-name-menu-footer parent-mlid-1303 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-125058"><a href="http://www.bmj.com/collections">Collections</a></li> <li class="leaf menu-mlid-125036"><a href="http://www.bmj.com/health-in-south-asia">Health in South Asia</a></li> <li class="leaf menu-mlid-125034"><a href="http://www.bmj.com/content/women%E2%80%99s-children%E2%80%99s-and-adolescents%E2%80%99-health-0">Women’s, children’s & adolescents’ health</a></li> <li class="leaf menu-mlid-17959"><a href="http://www.bmj.com/freezikaresources">Zika virus</a></li> <li class="leaf menu-mlid-1305"><a href="/us/research">Research</a></li> <li class="leaf menu-mlid-1306"><a href="/us/education">Education</a></li> <li class="leaf menu-mlid-6506"><a href="/us/news">News and views</a></li> <li class="leaf menu-mlid-1310"><a href="http://blogs.bmj.com/bmj/">BMJ Opinion</a></li> <li class="leaf menu-mlid-7612"><a href="/rapid-responses">Rapid responses</a></li> <li class="last leaf menu-mlid-1309"><a href="/archive">Archive</a></li> </ul></div> </div> </div> </div> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-4" > <h2 class="pane-title"> About us </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-4 menu-name-menu-footer parent-mlid-1314 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-6487"><a href="/about-bmj">About us</a></li> <li class="leaf menu-mlid-1316"><a href="/about-bmj/editorial-staff">Editorial staff</a></li> <li class="leaf menu-mlid-1317"><a href="/about-bmj/editorial-staff/bmj-united-states">BMJ in the USA</a></li> <li class="leaf menu-mlid-127585"><a href="/health-in-latin-america">BMJ in Latin America</a></li> <li class="leaf menu-mlid-1318"><a href="/about-bmj/editorial-staff/bmj-south-asia">BMJ in South Asia</a></li> <li class="leaf menu-mlid-1319"><a href="/about-bmj/advisory-panels">Advisers</a></li> <li class="leaf menu-mlid-1320"><a href="/about-bmj/resources-authors/forms-policies-and-checklists">Policies</a></li> <li class="last leaf menu-mlid-1323"><a href="http://mc.manuscriptcentral.com/bmj">Submit your paper</a></li> </ul></div> </div> </div> </div> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-5" > <h2 class="pane-title"> Resources </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-5 menu-name-menu-footer parent-mlid-1324 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-1325"><a href="/about-bmj/resources-authors">Authors</a></li> <li class="leaf menu-mlid-1326"><a href="/about-bmj/resources-reviewers">Reviewers</a></li> <li class="leaf menu-mlid-1327"><a href="/about-bmj/resources-bma-members">BMA members</a></li> <li class="leaf menu-mlid-1329"><a href="/about-bmj/resources-readers">Readers</a></li> <li class="leaf menu-mlid-1328"><a href="/about-bmj/resources-subscribers">Subscribers</a></li> <li class="leaf menu-mlid-1330"><a href="/about-bmj/resources-advertisers-and-sponsors">Advertisers and sponsors</a></li> <li class="leaf menu-mlid-1331"><a href="/about-bmj/resources-media">Media</a></li> <li class="last leaf menu-mlid-7610"><a href="https://recruiter.bmj.com/">Recruiters</a></li> </ul></div> </div> </div> </div> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-6" > <h2 class="pane-title"> Explore BMJ </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-6 menu-name-menu-footer parent-mlid-1332 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-7613"><a href="https://www.bmj.com/company/?int_source=tbmj&int_medium=footer&int_campaign=URLswitch">Our company</a></li> <li class="leaf menu-mlid-7421"><a href="https://jobs.bmj.com/">BMJ Careers</a></li> <li class="leaf menu-mlid-7423"><a href="http://learning.bmj.com/">BMJ Learning</a></li> <li class="leaf menu-mlid-7424"><a href="http://masterclasses.bmj.com">BMJ Masterclasses</a></li> <li class="leaf menu-mlid-7425"><a href="http://journals.bmj.com">BMJ Journals</a></li> <li class="leaf menu-mlid-7422"><a href="/student">BMJ Student</a></li> <li class="leaf menu-mlid-7426"><a href="http://www.bmj.com/about-bmj/resources-readers">Academic edition of The BMJ</a></li> <li class="leaf menu-mlid-7427"><a href="http://bestpractice.bmj.com/">BMJ Best Practice</a></li> <li class="last leaf menu-mlid-17958"><a href="http://thebmjawards.bmj.com/home">The BMJ Awards</a></li> </ul></div> </div> </div> </div> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-7" > <h2 class="pane-title"> My account </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-7 menu-name-menu-footer parent-mlid-1343 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-1344"><a href="http://myaccount.bmj.com/myaccount/account/hw-registration.html">Email alerts</a></li> <li class="last leaf menu-mlid-1345"><a href="http://journals.bmj.com/cgi/activate">Activate subscription</a></li> </ul></div> </div> </div> </div> <div class="footer-column panel-panel col-xs-6 col-sm-4 col-md-4 col-lg-4"> <div class="panel-pane pane-block pane-menu-block-8" > <h2 class="pane-title"> Information </h2> <div class="pane-content"> <div class="menu-block-wrapper menu-block-8 menu-name-menu-footer parent-mlid-1346 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-1347"><a href="/about-bmj/contact-us">Contact us</a></li> <li class="last leaf menu-mlid-1321"><a href="/about-bmj/complaints-procedure">Complaints</a></li> </ul></div> </div> </div> </div> </div> </div> </div> <div id="footer-bottom-row" class="row"> <div class="panel-panel col-xs-12 col-sm-12 col-md-12 col-lg-12"> <div class="panel-pane pane-block pane-menu-block-9 hidden-phone" > <div class="pane-content"> <div class="menu-block-wrapper menu-block-9 menu-name-menu-footer parent-mlid-1349 menu-level-1"> <ul class="menu nav"><li class="first leaf menu-mlid-125888"><a id="ot-sdk-btn" class="ot-sdk-show-settings" clickable="false">Cookie settings</a></li> <li class="leaf menu-mlid-1350"><a href="https://www.bmj.com/company/your-privacy/cookies-policy/">Cookie Policy</a></li> <li class="leaf menu-mlid-125299"><a href="https://www.bmj.com/company/your-privacy/">Privacy policy</a></li> <li class="leaf menu-mlid-1351"><a href="http://www.bmj.com/company/legal-information/">Website T&Cs</a></li> <li class="leaf menu-mlid-1352"><a href="http://group.bmj.com/group/about/revenue-sources">Revenue Sources</a></li> <li class="leaf menu-mlid-1353"><a href="http://home.highwire.org/">HighWire Press</a></li> <li class="last leaf menu-mlid-8093"><a href="/sitemap">Sitemap</a></li> </ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-bmj-copy-right" > <div class="pane-content"> <div class="copyright">Copyright © 2024 BMJ Publishing Group Ltd</div> </div> </div> </div> </div> </div> </section>  </div> </footer>  </div> </div> </div>  </div>  <script src="https://www.bmj.com/sites/default/files/advagg_js/js__uW7NyUocxI-7E_sL-GP7L5FYvHrfi0D8UkwaFa_jFUQ__ITpTmydBN18ujP4Nq9igNKs2_uPvSa_MMIGZilNH7xo__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__L2RNsEq1_BwrvVr4-XqL6HCM3TrId8FewyOD-ifl56Y__xFUWwD-CmrvIMpj7PKKOzG6M0u5x4a4YsfZcc7fa3qg__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__ADNpAJRqEZQTdJr17qFcuXkfatW9ULGGExiAh_zWtxs__Xan4DQzBMVgws81Yi1i-_1Amp0wkg5IKAA2fCWPVSwI__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__wteGLiD1wamodYGt1CPf350dgG_dnSPaybjTJJ4V8O0__tHSi0oVxXVY1K8dKSadgniknKfq0JO39EkwFnl-Qx3k__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script src="https://static.polldaddy.com/w/58250.js"></script> <script src="https://ajax.googleapis.com/ajax/libs/jqueryui/1.8.7/jquery-ui.min.js"></script> <script src="https://crossmark-cdn.crossref.org/widget/v2.0/widget.js"></script> <script src="https://d1bxh8uas1mnw7.cloudfront.net/assets/embed.js"></script> <script src="https://www.bmj.com/sites/default/files/advagg_js/js__SFoHIUTheqo0e4hxRINC0gFp_rO4LFMUUrC70xvOwtY__h5zRuwNt-m_fFPTyMKF2APwK7ArnJ2U3S4dW5Cp_p_o__a7Jq5VSqcMKMeR_gboGw1x4AC4g6SRpO1Geb_4xJjYc.js"></script> <script> setTimeout(function(){var a=document.createElement("script"); var b=document.getElementsByTagName("script")[0]; a.src=document.location.protocol+"//dnn506yrbagrg.cloudfront.net/pages/scripts/0014/4896.js?"+Math.floor(new Date().getTime()/3600000); a.async=true;a.type="text/javascript";b.parentNode.insertBefore(a,b)}, 1);</script> <script>jQuery(".page-search .pane-quick-search-results .search-snippet").text(function (_, old){ return old.replace(/\S+@\S+\.\S+/, "");});</script> <script type="text/javascript"> /* <![CDATA[ */ var google_conversion_id = 973817434; var google_custom_params = window.google_tag_params; var google_remarketing_only = true; /* ]]> */ </script> <script type="text/javascript" src="//www.googleadservices.com/pagead/conversion.js"> </script> <noscript> <div style="display:inline;"> <img height="1" width="1" style="border-style:none;" alt="" src="//googleads.g.doubleclick.net/pagead/viewthroughconversion/973817434/?value=0&guid=ON&script=0"/> </div> </noscript> <script async src="https://cdn.pbgrd.com/core-bmj.js"></script> </body> </html>