Background: Children born to blood relations (consanguineous parents), primarily cousins, have higher mortality and morbidity than children born to non-consanguineous parents. Consanguinity is low in the UK but high in some communities, including the Pakistani heritage community in Bradford. There has been a marked decrease in consanguinity in the last decade and that is likely to result in reductions in excess mortality and morbidity.
Methods: Drawing on patterns of child health reported by the Born in Bradford study, augmented with a summary of the literature on motivations for choosing consanguineous unions and on the shifting characteristics of those who make this choice, questions about marriage choice and knowledge of allied health risk were devised. They were explored in four focus groups with self-identified members of the Pakistani heritage community. Groups were divided by age and gender. Discussions were analysed using Thematic Analysis.
Results: There was agreement that rates of consanguinity were declining. Older group members were concerned this might indicate a shift from tradition and damage community cohesion. Younger participants were positive about the benefits of individual choice. They felt this could be achieved without damaging community strengths. Reasons for the fall in numbers were attributed to changes within the community, including higher numbers of people staying in education beyond school. External factors, including new immigration rules, were also considered.There was not a consensus about health risks, some older respondents were sceptical of links between marriage choice and child health and concerned about how health risks were communicated. All were concerned that marriage choice should not be used to demonise this community.
Conclusion: A commitment to sustaining community cohesion is shared by all groups. Younger people think this can be achieved despite falls in consanguinity. There are continuing challenges in communicating health risk.
Keywords: Consanguinity: childhood morbidity: Pakistani heritage: focus groups.
The “Born in Bradford” (BiB) study into children’s health and well-being started in 2007. BiB researchers found that children whose parents are blood relations, typically cousins, are more likely to have ill-health than children whose parents are not related. Marriages between blood relations are rare in the UK but are common in those of Pakistani heritage in Bradford, although there has been a decrease in these marriages in recent years. Working with Bradford Council, BiB researchers undertook group discussions with members of the Pakistani community to understand why these sorts of marriages have decreased and to explore understandings about health risks for children born to parents who are related. Discussions highlighted the importance of people staying longer in education, social change encouraging individual rather than family decision making and external factors including changes in immigration laws. There was a concern that linking worse child health with cousin marriage was too simplistic and an allied concern about how health risks are communicated. This is a small scale study in one city but it adds to wider literature seeking to understand health implications of marriage choice. Around one billion people across the world live in countries where marrying a cousin is common.
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