Arranged marriages and consanguineous partnerships between blood relatives, such as first or second cousins, are practiced around the world and have deep cultural, religious and familial significance. Yet these traditions are often misunderstood or stigmatized in Western health care systems. This lack of understanding and support creates conversations focused exclusively on minimally elevated risks, and often alienates the communities that genetic counseling could help the most. 

As genetic counselors and health care professionals, we have a responsibility to approach this topic with cultural humility, human empathy and scientific accuracy. Consanguineous marriages are not uncommon, with globally more than 10% of all marriages being consanguineous, with rates exceeding 50% in some regions (Bittles 2012). They exist most prevalently across South Asian, Middle Eastern, North & Sub-Saharan African and Indigenous communities. 

The increased risk of autosomal recessive conditions in consanguineous unions is real but often misunderstood. When partners are closely related, there is a higher chance they share the same variant, which increases the risk of passing on a recessive genetic condition. However, the absolute risk varies and should be communicated with nuance. For example, first-cousin marriages carry an estimated 1.7 to 2.8% additional risk of birth defects beyond the general baseline risk of 2-3% (Bennett et al., 2021), resulting in an overall risk of approximately 3.7-5.8% for birth defects. 

The solution is not to shame or discourage culturally rooted practices. Instead, we as a field should provide informed, respectful and tailored counseling. Below are four key takeaways to support families more effectively: 

1. Promote Access to Preconception Genetic Counseling 

Many individuals entering arranged or consanguineous marriages are open to making informed reproductive choices, but may lack access to culturally sensitive resources. Offering preconception genetic counseling in community health settings, especially where there is access to language interpreters, can empower couples with information before a pregnancy. Screening programs for high-prevalence conditions have already shown success without undermining cultural practices (American College of Obstetricians and Gynecologists, 2017). 

2. Build Trust Through Cultural Competency 

Genetic counselors should receive training in cultural competency that included specific modules on arranged and consanguineous marriage. Without this training, even well-intentioned providers may deliver care that is perceived as judgmental or coercive. For instance, framing consanguinity only in terms of risk overlooks the emotional, familial and practical reasons such marriages occur, such as preserving family ties, language and values (Fawaz, 2022).

3. Engage Communities in Cocreating Resources 

Public health campaigns often fail when they speak to communities rather than with them. Partnering with community leaders, faith groups and cultural organizations to develop educational materials ensues that content resonates and reaches the intended audience. This also fosters community engagement, which is crucial for successful partnerships (Nouri et al., 2017). 

4. Address Misconceptions in Public Discourse 

Often, Western-based media and even academic discourse present consanguineous marriages as a problem rooted in ignorance. This can fuel xenophobia and deepen mistrust of health care systems. Genetic counselors and public health experts must push back against these narratives and ensure that communication reflects both scientific integrity and respect. 

Moving Forward With Respect 

The path forward is not about choosing between science and culture. It is about integrating both. Informed decision-making can and should coexist with tradition. By offering evidence-based, nondirective and culturally responsive counseling, we uphold the values of autonomy, dignity and inclusion. 

References 

• American College of Obstetricians and Gynecologists. (2017). Carrier screening for genetic conditions. Committee Opinion No. 691. Obstetrics & Gynecology, 129(3), e41–e55 
• Bennett, R. L., Malleda, N. R., Byers, P. H., Steiner, R. D., & Barr, K. M. (2021). Genetic counseling and screening of consanguineous couples and their offspring practice resource: Focused Revision. Journal of Genetic Counseling, 30(5), 1354–1357. 
• Bittles, A. H. (2012). Consanguinity in context. Cambridge University Press. https://doi.org/10.1017/CBO9781139015844 -Carens, J. H. (2013). The ethics of immigration. Oxford University Press. 
• Fawaz, R. I. (2022). Exploring Genetic Counselors’ Experiences, Language, and Discussion of Consanguinity in Clinical Practice: A Multinational Perspective. 
• Nouri, N., Nouri, N., Tirgar, S., Soleimani, E., Yazdani, V., Zahedi, F., & Larijani, B. (2017). Consanguineous marriages in the genetic counseling centers of Isfahan and the ethical issues of clinical consultations. Journal of Medical Ethics and History of Medicine, 10, 12. 
• Sahin, E., İnciser Paşalak, Ş., & Seven, M. (2020). Consanguineous marriage and its effect on reproductive behavior and uptake of prenatal screening. Journal of Genetic Counseling, 29(5), 849–856. https://doi.org/10.1002/jgc4.1214 
• Shenk, M. K., Towner, M. C., Voss, E. A., & Alam, N. (2016). Consanguineous Marriage, Kinship Ecology, and Market Transition. Current Anthropology. https://doi.org/10.1086/685712 
• Shetty, P. J., Kamireddy, A. P., & Hasan, Q. (2025). 11-Consanguinity in the genomic era-Requirement of focused counseling. In D. Kumar & R. Chadwick (Eds.), Genomics, Populations, and Society (pp. 227– 240). Academic Press. https://doi.org/10.1016/B978-0-323-91799-5.00018-8 
   

---