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Susan Joy Bishai

Risk is one of the few human “universals.” Almost all individuals or communities will at some point face threats, whether “real” or “perceived.” Although risk may be a cross-cultural reality, the ways in which peoples construe and respond to risk vary widely, reflecting the diversity of societies throughout the world. In the spring of 2006, I reviewed published works dealing with a specific risk: consanguineous parents—particularly married first cousins—and their risk of miscarrying or producing children with hereditary birth defects. Three factors prompted my interest in this subject.

First, my own cultural background encourages first cousin marriage despite international medicine’s increased designation of consanguineous marriage as a less healthy (or, conversely, more “risky”) choice. Based on my own experience and, later, this annotated bibliography research, I determined that different societies perceive and navigate genetic risk in different ways and that knowledge of genetic risk factors is not always a deterrent to consanguineous marital choice. In some societies, for example, even doctors trained in the Western medical tradition may choose first cousin or other consanguineous marriages as the basis for their own families.

Second, I am interested in the ways in which people navigate threats to individual bodies—here, a couple’s potential children—based on communal or society-wide marriage traditions. Finally, recent changes in genetic medicine and technology as well as population migration patterns indicate consanguineous marriage and genetic risk may become or may need to become central issues in some communities’ reproductive health programs.

I attempted to create a cross-cultural collection of annotations and references, drawing on research based in locales as diverse as urban Britain and rural Appalachia and China. The majority of available published works, however, identified two socio-cultural environments—Pakistan and its offshoot emigrant communities and the Middle East and North Africa—as the world’s most actively and consistently “consanguineous.” My bibliography thus offers an intensive anthropologically-based introduction to first cousin marriage and genetic risk amongst persons of Pakistani and multi-ethnic and religious Middle Eastern and North African backgrounds, with brief examinations of other countries and regions provided as supplements.

Although most of the referenced authors are biological or physical anthropologists, some cultural anthropologists have undertaken studies of consanguineous marriages and parents’ approach to genetic risk. British anthropologist Alison Shaw is one of the most oft-cited and well-regarded cultural anthropologists in the area of consanguinity and genetic risk. Shaw has focused on the large British-Pakistani communities of urban Britain. This mixed immigrant and British-born population presents a prominent example of persistent first-cousin marriage within an urban and fully industrialized society and, as such, provides an ideal context for Shaw’s emphasis on culturally compatible minority health and genetic counseling services.

Another British anthropologist who successfully advocates for culturally informed genetic counseling is Nadeem Qureshi, himself of Pakistani descent. Like Shaw, Qureshi argues that clinics and practitioners cannot easily dismiss cultural and religious background and obligations when counseling Pakistani Britons on the genetic risks of cousin marriage. Both Shaw and Qureshi advise against the ever-present dangers of British and other Western health practitioners overriding or dismissing as ignorant the deeply held marriage traditions that Pakistani communities bring to their evaluation of genetic risk.

I was surprised by the relatively large amount of material devoted to studies of consanguineous marriage and its relation to genetic risk. Although studies of “incest” have garnered far more anthropological attention, increases in the availability of reproductive and genetic technologies will create more demand for genetic counseling and will cast further light on communities maintaining consanguineous marriage, prompting more anthropologists to devote studies to this subject. Consanguinity and genetic risk also speak to the increasingly multi-ethnic societies of countries throughout the world, stirring up a diverse set of issues related to cultural sensitivity, minority healthcare, and immigration policy.


Annotated Bibliography
Al-Ghazali, L.I. 1997

Consanguineous Marriages in the United Arab Emirates. Journal of Biosocial Science 29 ( 4): 491-497.

Al-Ghazali and a team of physical anthropologists and biologists examine the long-standing tradition of cousin marriage amongst Arabian Gulf populations in the United Arab Emirates. The team takes into consideration persisting preferences for cousin marriage and differing levels of education about genetic risks for children of consanguineous marriages.
United Arab Emirates—Social life and customs

Consanguinity—United Arab Emirates

Physical Anthropology—Biogenetics

Bittles, A. H. 1993

Infant and Child Mortality in Rural Egypt. Journal of Biosocial Science 25 (3): 415-416.

Bittles applies his expertise in South Asian consanguinity issues to child mortality in Upper Egypt. He compares incidences of postnatal death, finding that cultural or social preferences for consanguineous marriage often override acknowledged genetic risk of infant mortality.


Africa—Child Mortality

North & Northeast Africa—Consanguinity

Infant Mortality and Consanguinity—Egypt

Biogenetics

Bittles, A. H., A. Radha Rama Devi, H.S. Savithri, Rajeswari Sridhar,

and N. Appaji Rao. 1987

Consanguineous Marriage and Postnatal Mortality in Karnataka, South India. Man. New Series 22 (4): 736-745.

This team of team conducted a five-year study of children born to consanguineous (first cousin and uncle-niece) marriages in four southern Indian states. The researchers looked at the rates of postnatal death among 65, 492 live born pregnancies. Their statistics failed to reveal a consistent link between consanguineous marriages and postnatal infant death. The lack of evidence linking relative marriage to infant mortality was not surprising to local people for whom consanguinity is a well-regarded element of marriage.


South India

Consanguinity

Infant Mortality

Biogenetics

Darr, Aamra. 1997

Consanguineous Marriage and Genetics: a Positive Relationship. In Culture, Kinship and Genes: Towards Cross-Cultural Genetics. A. Clarke and E. Parsons, eds. Pp 83-97. New York: St. Martin's Press.

Working within a British Pakistani community and the larger British society, Darr attempts to de-stigmatize consanguineous (cousin) marriage and its presumed links to genetic birth defects and other disorders. While acknowledging the slightly higher risk for certain genetic disorders, Darr points out the ways in which pre-marital genetic counseling and other measures can help reduce this risk, allowing modern scientific techniques to co-exist with and complement consanguineous marital traditions.
Cousin marriage—Pakistanis

Consanguinity—Great Britain

Consanguinity—genetic risk

Genetic disorder

Physical Anthropology

Guha, Amina. 1990



Influence of Cultural Traditions and Social Movements on the Genetic Structure of the Boro-Kachari population. Indian Anthropological Society Journal. 25 (1): 73-81.

Guha looks at genetic risk among the Boro and Karachi peoples of the Assam region of northeastern India. She compares modern Boro and Karachi populations’ preference for cousin marriage and the ways in which social preference affects biogenetics, essentially forming and shaping the genetic character of a population. Villagers may consider common disorders an expected or natural component of their population.


Consanguinity--India--Assam.

Boro (India people)--India--Assam--Social conditions.

Kachari (India people)--India--Assam--Social conditions.

Physical Anthropology

Holy, Ladislav. 1989.

Kinship, Honour, and Solidarity: Cousin Marriage in the Middle East. Manchester, UK: Manchester University Press.

Holy is interested in how pre-industrial kinship structures—many of which originated in Arab Bedu tribal society—have proliferated in ethnic groups and countries throughout the Arabic-speaking world. Although many people in the urban Arabic-speaking world are aware of modern science’s restrictions on relative marriage, kinship ties and family honor continue to furnish the demand for cousin marriage among individuals of diverse socio-economic backgrounds.
Themes in Social Anthropology—cousin marriage.

Cross-cousin marriage—Middle East

Anthropology—sociocultural

Hussain, R. 1998

The Role of Consanguinity and Inbreeding as a Determinant of Spontaneous Abortion in Karachi, Pakistan. Annals of Human Genetics 62 (2): 147-157.

Hussein establishes the biological phenomenon of spontaneous abortion/miscarriage as higher among consanguineous (first cousin) marriages in Karachi, Pakistan than in stranger or non-consanguineous marriages, leading to increased risk for Pakistani families considering cousin marriage.


Consanguinity

Cousin marriage—Pakistan

Miscarriage

Biogenetics

Inhorn, Marcia. 2004

Middle Eastern Masculinities in the Age of New Reproductive Technologies: Male Infertility and Stigma in Egypt and Lebanon. Medical Anthropological Quarterly (18)2: 162-182.

Inhorn posits that Lebanese and Egyptian men’s rates of infertility are compounded and increased by these men’s unawareness of the many social and environmental factors contributing to male infertility. Inhorn touches on high rates of first cousin marriage in Egypt and some parts of Lebanon as one such factor that puts unwitting men at risk for infertility.
Middle East—Egypt and Lebanon

Male infertility

Cousin marriage

Biological Anthropology—Medical

Jorjani, Eisa. 1998

Demo-Genetic Structure among the Turkmen of Iran. Indian Journal of Physical Anthropology and Human Genetics 21 (2): 67-78.

Jorjani examines consanguineous (first-cousin) marriage among Turkmen in twenty villages of Eastern and Western Iran, highlighting the effects on and role of consanguinity in determining population genetics and makeup. Jorjani relies on oral interviews as well as case histories on consanguinity, touching on differences and similarities between Indian, ethnic Persian and Persian Turkmen consanguineous marriages.


Turkmen—Iran

Consanguinity

Population genetics—Iran

Physical Anthropology

Korotayev, Andrey. 2000

Parallel-cousin (FBD) Marriage, Islamation, and Arabization. Ethnology 39(4): 395-409.

Korotayev coins the term “Islamation” to describe the processes of Islamization and Arabization that have accompanied the spread of Islam from southwestern Asia to large portions of Asia, Africa, and some communities in Eastern Europe. Korotayev posits that a country or community’s inclusion in a specific eighth-century Islamic sphere of governance can strongly predict high preference for patrilateral parallel-cousin (FBD) marriage. Korotayev asserts that such stated or conventional preferences do not correspond to actual marriage practices, in which communities may consciously avoid cross-cousin marriages. Although genetic risk factors are not the primary reasons behind such cousin-averse marriages, non-Arabized Muslim populations are aware of genetic risk, and may or may not cite it as a motivation to avoid consanguineous marriage.
Cross-cousin marriage

Islam—marriage

Anthropology—ethnology

Meyer, B.F. 2005

Strategies for the Prevention of Hereditary Diseases in a Highly Consanguineous Population. Annals of Human Biology 32 (2):174-179.

Meyer offers culturally appropriate strategies for reducing the risk of genetic disorders, such as spinal muscular atrophy, in the “highly consanguineous” population of Saudi Arabia. Meyer’s ideas include culturally-themed genetic counseling and prenatal screening for this population in which first cousin marriage is and frequently practiced.


Cousin marriage—Saudi Arabia

Genetic Disorders—Saudi Arabia

Biogenetics

Nishimura, Yuko. 1998

Gender, Kinship and Property rights: Nagarattar womanhood in South India. Oxford: Oxford University Press.

Nishimura explores social pressures and property rights, largely born of kinship concerns, in South Indian women’s first cousin marriages. Most such marriages are arranged or encouraged by the relatives of bride and groom; such social pressures ensure that both families may, despite knowledge of genetic risks, choose cousin marriage.

Cross-cousin marriage—India, south

Anthropology—sociocultural

O’Brien, Elizabeth and L.B. Jorde, Bjorn Ronnlof, Johan Fellman,

and Aldur Eriksson. 1989

Consanguinity avoidance and mate choice in Sottunga, Finland. American Journal of Physical Anthropology 79 (2): 235-246.

O’Brien et. al. are interested in the converse of populations in which consanguineous marriages are socially permissible or even desirable. The team surveyed young adults of marrying age in Finland, a country in which individuals are encouraged to choose their own mates irrespective of familial approval or benefit. Finnish men and women expressed a conscious desire to avoid consanguineous marriages of any kind, including marriages to cousins three and four times removed. The authors present Finnish people’s marriage choices in contrast to local immigrant communities in which first cousin marriages are encouraged.


Mate selection--Finland--Genetic aspects

Finland—Population genetics

Marriage—Finland

Physical Anthropology



Ottenheimer, Martin. 1996

Forbidden Relatives: The American Myth of Cousin Marriage. Urbana: University of Illinois Press.



Ottenheimer compares restrictions on and views of cousin marriage in Europe and the United States, including Euro-American, native European, and non-Western immigrant perspectives. He posits that the mainstream American concern over cousin marriages is largely a myth/construction in light of American cousin marriage rates that are lower than popularly assumed. Ottenheimer also uses several chapters to review the different biogenetic arguments made for and against cousin marriage. Different social and ethnic groups employ these scientific data when making their own calculations of the risks/benefits of cousin marriage.
Cousin marriage—Europe

Cousin marriage—United States

Anthropology—Biogenetics

Qureshi, Nadeem. 1997

The Relevance of Cultural Understanding to Clinical Genetic Practice. In Culture, Kinship, and Genes: Towards Cross-Cultural Genetics. A. Clarke and E. Parsons, eds. Pp 111-119. New York: St. Martin’s Press.

Qureshi makes an anthropologically based case for culturally themed genetic counseling and practices. He takes as his prominent example the well-studied case of British-born Pakistanis for whom first cousin marriage is widely preferred and practiced. Qureshi argues that clinics and practitioners cannot ignore cultural and religious background and obligations when counseling Pakistani Britons on the genetic risks of cousin marriage.


Great Britain-Minorities

Pakistanis-Great Britain—Medical Care

Genetic Counseling—Great Britain.

Physical Anthropology

Raz, Aviad and Marcela Atar. 2005

Perceptions of Cousin Marriage Among Young Bedouin Adults in Israel. Marriage & Family Review 37 (3): 27-46.

The authors are ethnographers who observed Bedouin* Arabs of marriageable age and their reactions to the risk of genetic disorders in traditional Bedouin cousin marriages. *A minority of available recent anthropological literature uses the alternate term “Bedu,” for which some Bedu have expressed a preference. To facilitate future research, I have used “Bedouin” and “Bedu” where authors have used each and where cataloguing systems have listed each as a subject term.

Raz and Atar found that a significant percentage of young Bedouin in a specific clan (37%) favored first cousin marriage, with another large percentage (22%) reacting unfavorably toward cousin marriage but anticipating their own such marriage due to familial or social expectations. Both groups of young people demonstrated clear knowledge of the genetic risks associated with first cousin marriage yet either preferred consanguineous marriage or had resigned themselves to the practice.


Israel—Bedouins

Bedu


Consanguinity

Israel


Ethnography

Saedi-Wong, Simin. 1989

Socio-economic Epidemiology of Consanguineous Matings in the Saudi Arabian Population. Journal of Asian and African Studies 24 (3/4): 247-52.

Saedi-Wong examines the social and economic underpinnings of Saudi people’s deep-seated preferences for first cousin marriage despite widespread indications (from Western medicine and media, for example) that such unions increase offspring’s risk of genetic disorders.


Middle and Near East

Consanguineous marriage—Saudi Arabia

Cultural Anthropology

Shaw, Alison. 2000

Conflicting Models of Risk: Clinical Genetics and British Pakistanis. In Risk Revisited. Pat Caplan, Ed. Pps 85-107. London: Pluto Press.

Shaw highlights the tension between “native” British healthcare professionals’ and British-born or immigrant Pakistanis’ conflicting views on genetic risk of birth defects for children born of consanguineous (first cousin) parents. Shaw makes several recommendations including specifically tailoring genetic counseling literature and education to render them more accessible to lay and specific ethnic, particularly Pakistani, communities.


Great Britain—Asian immigrants

Pakistani immigrants

Cousin Marriage

Genetic Risk

Anthropology—Physical—Social

Simpson, Bob. 2004

Acting Ethically, Responding Culturally: Framing the New Reproductive and

Genetic Technologies in Sri Lanka. Asia Pacific Journal of Anthropology 5 (3): 227-243.

Simpson is interested in the roles of reproductive and genetic technology in developing countries whose social practices, such as first cousin marriage, seem to pose strong ethical opposition to such technological innovations. Simpson explores the “relativization” of modern bioethics in relation to such cultural norms. He dissects the usage of the term “culturally appropriate” in the Sri Lankan medical/reproductive health community.
Sri Lanka

Reproductive technology

Genetics

Cousin Marriage

Anthropology—sociocultural

Tincher, Robert B. 1980

Night Comes to the Chromosomes: Inbreeding and Population Genetics

in Southern Appalachia. Central Issues in Anthropology 2 (1): 27- 49.

Tincher compares data on rates of cousin marriage and isonymy (marriage between people of the same surname) in the Appalachian region of the United States with recorded incidents of genetic disorder. He calls into question the “conventional” or prevailing view that Appalachian inbreeding is responsible for perceived genetic disabilities and low levels of intelligence, or that such unions have resulted in “widespread deleterious effects.”
Appalachia—United States

Consanguinous marriage

Genetic Disorder

Cultural Anthropology



Zhaoxiong, Qin. 2001

Rethinking Cousin Marriage in Rural China. Ethnology 40 (4): 347-361.

Zhaoxiong examines cross-cousin marriage in a rural Chinese village of central China’s Hubei Province. The author offers varying reasons for the acceptability of such marriages and villagers’ views of “outsider marriages” as less acceptable to local communities (this negative view of outsider marriage is common throughout cousin-marrying societies). Zhaoxiong identifies as central to rural Chinese villagers’ identity their emphasis on patrilineal descent through first cousin marriage.
China—Hubei Province

Central China—villages

Rural China

Cross-cousin marriage

Cultural Anthropology

Child Labor in Cultural Context

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