Consanguinity and Related Demons: Science and Racism in the Debate on Consanguinity and Birth Outcome

Abstract

The tendency to locate health inequalities in cultural or genetic differences between groups is not new (Crawford, 1977). It is particularly true in ‘explaining’ ethnic health inequalities ranging from tuberculosis to rickets, and from syphilis to obstetric outcome. In the West, black people have often been aligned with depravity, disease and death. Recently in Britain a new discourse, focused largely on the Pakistani-origin population, has emerged which combines notions of presumed genetic pathology with pathological cultures in the guise of clinical concerns about ‘unnaturally’ high rates of consanguineous marriages (i.e. marriages with blood relatives, often first cousins). As argued by Proctor and Smith (1992), consanguinity is increasingly indicted as the major explanatory factor for the higher rates of perinatal deaths and congenital malformations among the Pakistani population. That the informal culture within British obstetrics maintains a strong belief in the ‘truthfulness’ of the consanguinity hypothesis (with the rate of consanguineous marriages among Pakistanis reported to be higher than 50 per cent) (Darr and Modell, 1988; Bundey et al., 1989), in explaining their poor obstetric experience is not in doubt.¹