Genetic risk awareness does not influence avoidance of consanguineous marriage: Social and family influences in Kabul, Afghanistan

Consanguineous marriage (CM) is associated with increased risk of inherited disorders and represents an important focus for genetic counseling in many regions. Prevention strategies often assume that increased awareness of genetic risk leads to behavior change; however, evidence from collectivist contexts remains limited. This study examined whether genetic risk awareness influences CM practices in Kabul, Afghanistan, and explored social and familial factors shaping marital decision-making. A cross-sectional study was conducted in Kabul between March and June 2025 among 610 adults recruited through nonprobability sampling across five urban zones. A structured questionnaire assessed marital consanguinity, awareness of genetic risks, sociodemographic characteristics, and social influences on marriage decisions. Descriptive statistics, chi-square analyses and independent t-test were performed. Among married participants, 34.5% reported CM, and 39.5% reported parental consanguinity. Awareness of CM (63.4%) and its genetic risks (74.7%) was relatively high; however, awareness was not associated with avoidance of CM (p > 0.05), with over one-third of informed individuals still entering consanguineous unions. Higher education was strongly associated with awareness but was also associated with a greater prevalence of CM. Key determinants included emotional attachment, family-arranged marriage, trust within kinship networks, familial pressure, and fatalistic beliefs regarding destiny. Knowledge alone may be insufficient to influence CM decisions. Genetic counseling approaches in collectivist settings may benefit from family-centered and culturally responsive strategies that address social norms and shared decision-making processes beyond individual risk awareness.