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In Afghanistan, New Misgivings About an Old but Risky Practice

Marriage Between First Cousins Tied to High Rate of Congenital Disorders

By N.C. Aizenman
Washington Post Foreign Service
Sunday, April 17, 2005; Page A16

KABUL, Afghanistan -- By local standards, they were an ideal match: first cousins, raised in the same house since birth, and, within a year of their marriage, the proud parents of a plump baby boy.

But not long after their son's first birthday, Ahmad and Mazari Ayubi noticed that little Masi's head was starting to wobble. By the time he was 2, the boy was paralyzed from the neck down and mentally retarded, and Mazari began to suspect what the doctors would later confirm:

Ahmad Ayubi and his wife, Mazari, carry their daughters, ages 6 and 14 months, to a Muslim shrine to pray for a cure for the brain disorder that already killed two of their eight children. (N.c. Aizenman -- The Washington Post)

"It's because [Ahmad] and I are related that this happened," she said sadly, as she cradled the youngest of three more children born with the same disorder. "Perhaps it is better for cousins not to marry."

Such doubts are the first hairline cracks in what remains a bedrock tradition in Afghanistan. Although statistics on the prevalence of marriage between first cousins in the country are not available, anecdotal evidence from health workers, government officials and Afghan families suggests the practice is widespread and deeply ingrained.

"There is a saying in our country that a marriage between cousins is the most righteous because the engagement was made in heaven," said M. Marouf Sameh, chief of obstetrics and gynecology at Kabul's Rabia Balkhi Women's Hospital .

He estimated that at least 10 percent of his patients are married to a first cousin. Doctors at several other hospitals and clinics reported even higher rates of cousin marriage among their patients -- almost always as a result of matches arranged by their families.

Some parents want to keep their property within the family or lower the "bride price" that men must traditionally pay their in-laws.

Others say they are simply trying to find their son or daughter a good mate. Choosing a stranger is something of a gamble. Far better, goes the thinking, to pick a nephew or niece whose character you've been able to observe over years -- accepted wisdom not only in Afghanistan, but in many societies across Asia, Africa and the Middle East.

Even Sameh, whose parents did not arrange his marriage, ended up falling in love with one of his first cousins. In a society where women are traditionally prohibited from mingling with unrelated men, he explained, "those were the only girls I was allowed to spend time with." It was only after becoming a doctor, Sameh said, that he learned that couples who are closely related have a higher chance of conceiving children with birth defects and diseases such as the brain disorder affecting the Ayubi children.

Like the vast majority of children of first cousins, Sameh's own sons and daughters are healthy. But he has been alarmed at the high incidence of congenital birth defects among his patients. Sameh, who is also director of the Afghan branch of the International Planned Parenthood Federation, has recently started speaking out on radio and TV programs about the risks of inter-family marriage.

Masooda Jalal, the minister of women's affairs, said she was seeking funds to start a nationwide awareness campaign. "I'm sure if they know about the possible miserable results, future generations will be convinced to avoid this practice," she said.

The Ayubis' experience suggests otherwise.

Two of the couple's sons, including Masi, have already died, and two daughters are growing more disabled by the day. Yet Ahmad's younger brother, who shares the same house in Kabul, insists that he wants to arrange the engagement of his 10-year-old daughter to one of Ahmad's healthy sons, who is now 13.

To Mazari's dismay, Ahmad is considering the offer. "First I will try to find my son an unrelated wife who is responsible and obedient," he said. "But if I can't find one, I will have no other option."

It was the same logic that led his own mother to choose Mazari for him more than 16 years ago.

Ahmad was a gangly 20-year-old then, in love with a neighborhood girl who favored jeans and a modern hair style, and of whom his widowed mother disapproved.

"She said, 'I am getting older. [Mazari] is my niece and she will care for me better than a strange girl,' " Ahmad recalled.

Mazari had already been promised to another boy. But Ahmad's mother pleaded with Mazari's father, a truck driver who was her brother, to choose Ahmad instead.

Ahmad only learned of the plan when he came home from his job as a tinsmith one day and found Mazari's father had bought the sweets that a woman's parents traditionally give her fiance's family.

"I was furious," said Ahmad. "Then I realized that if I broke off this engagement my mother would be very sad. So I decided to accept."

Mazari, then an apple-cheeked, giggly 16-year-old, was equally distressed when her father broke the news to her. "I started crying because I didn't want the responsibility of being married yet," she said. Refusing, however, was not an option.

The fact that her intended was a relative provided some consolation. If she had been engaged to a stranger, she said, "I would have been really upset and afraid." And none of the more then 10 couples in her family who are first cousins had experienced medical problems, according to relatives.

But Mazari was not especially close to Ahmad, who was four years older and one of a gaggle of children she had grown up with in a house in Kabul shared by six families.

The pictures in their wedding album show a young man in a crisp, pinstriped suit and a teenage girl in a festive, flouncy white dress, surrounded by grinning guests. But in photo after photo, their unsmiling faces are turned away from each other.

It was just a prelude to the couple's hardest trial: watching the inexorable progress of the brain disorder that has stricken four of their eight children.

Occasionally, Mazari still complains to her father about "these troubles you have put me through."

She said he shrugs and replies that he's not to blame -- it was simply her destiny.

Ahmad, now 36, said he had learned to distance himself from each new child at the first sign of their affliction. He can't even remember what name he finally settled on for the youngest, a 14-month-old girl who has already developed the telltale head wobble.

"I try not to look at her often, because when I do I feel so much pain in my heart," he said, his eyes welling with tears.

Mazari, by contrast, has made saving her children her life's mission. At only 32, her round face has already become furrowed from the effort of reading scribbled prescription lists beyond the reach of her third-grade education. When modern medicine proved fruitless, she turned to religion, stringing amulets around her daughters' necks and taking them on an endless round of pilgrimages to Muslim shrines.

Ahmad, whose new business selling car paint has proved fairly prosperous, finances these outings without complaint. And over the years their grief has slowly brought the couple closer.

Not long ago, a specialist in Pakistan suggested that Ahmad take a second wife and start having children with her -- a practice permitted under Islamic law.

Ahmad flatly refused.

"After all the difficulties that we have borne together, I don't want another woman to come between us," he said.

He has also agreed to Mazari's request to stop having children.

The only major remaining source of tension between them is whether to marry their son to Ahmad's niece. The match was arranged by Ahmad's mother several years before her death. Ahmad's brother keeps insisting that, "even if all our grandchildren come out sick, I will not make my mother unhappy in her grave."

As the mother of the groom-to-be, Mazari technically has no say in the arrangement. But she is quietly plotting to derail it.

"If I need to, I will tell Ahmad that the girl would make a bad daughter-in-law," she confided. "I have had a hard, sad life. I don't want my son to suffer like this."

© 2005 The Washington Post Company