When the Womb is a Battlefield

Some mothers carry more than their children.

They carry silence, blame, and a quiet grief no one sees.

In the dusty corners of rural clinics, on prayer mats soaked with whispered prayers, and behind the closed doors of family homes, I have met women who are not just mothers they are scapegoats. Their children were born with inherited disorders, and in the absence of answers, guilt found its way to them. Not the fathers. Not the elders who arranged the marriages. Not the traditions that sealed their fate.

Pakistan’s burden of congenital disorders is significant, with nearly 6% of all births resulting in birth defects, according to the National Institute of Child Health one of the highest rates in South Asia.

The science is simple. Medical studies show that children born to first cousins are at 2 to 3 times higher risk of inheriting genetic disorders. In Pakistan, where an estimated 60–70 percent of marriages are between relatives, this is more than a number it is a quiet crisis that often unfolds in the bodies of children, and in the hearts of mothers. In Punjab specifically, the rate of cousin marriages exceeds 72% in some districts, making it the region with the highest genetic exposure risk in the country.

According to a 2020 report by the Pakistan Medical Association, more than 40% of children with genetic disorders in Pakistan are born from consanguineous (blood-relative) marriages. The World Health Organization also links cousin marriage to a higher incidence of birth defects, especially in communities with repeated intra-family unions. While the global rate of cousin marriages stands around 10%, Pakistan’s rate is six to seven times higher among the highest in the world.

Yet in most families, this risk is never discussed. When something goes wrong, people don’t ask why they ask who. And the answer is almost always her.

Her body becomes the site of blame.

Her womb, the battlefield.

Genetic counseling is almost unheard of in most of Rural Punjab. For many women, the first time they hear the word ‘inheritance’ is after their child is diagnosed. There are no pre-marital screenings, no community health workers trained to explain these risks. Silence is not just cultural it is systemic.

This is not just a story about illness. It is about how motherhood is quietly shaped by shame, by silence, by expectations that were never spoken aloud but always enforced. It is about how women, even in their pain, find ways to survive. And how that survival is often invisible just like the blame they carry.

Razia was seventeen when her nikah was decided an agreement between two families that had shared blood long before they ever shared grief. She didn’t know the boy well. But he was her cousin, and that was supposed to mean safety. Familiarity. Trust. No one mentioned risk.

When her first child was born, he seemed fine. It wasn’t until he turned one that the signs appeared. His legs didn’t support him. His speech didn’t come. By the time he was three, the doctors said it was a genetic disorder. There were no treatment plans only silence, and then blame.

“They said my blood was weak,” she told me. “My mother-in-law said I should’ve never been allowed to marry into the family.”

Razia didn’t ask for pity.
She asked for knowledge

“Why didn’t anyone tell us cousin marriage could do this?”

But asking that question was, in itself, seen as rebellion.

In a crowded pediatric unit at the District Headquarters Hospital in Mianwali a district from rural Punjab, Pakistan, Dr. Saima Noor sat beside a stack of case files, most of them handwritten and smudged with fingerprints and worry. She has worked here for over twelve years, treating children with developmental delays, congenital disabilities, and rare disorders many with no official name, only symptoms.

“We see these cases frequently,” she said. “Seizures, hearing loss, delayed milestones. Children with Thalassemia, spinal muscular atrophy (SMA), congenital deafness, metabolic disorders, and intellectual disabilities. Most of these cases are from cousin marriages.”

Pakistan records over 5,000 new cases of Thalassemia major every year, with nearly 7% of the population being carriers of the Thalassemia gene, according to the Thalassemia Federation of Pakistan. Cousin marriage significantly increases the chance of both parents carrying this gene.

She paused, then added softly, “They come in quietly, sometimes with bruises. Not from their children, from their husbands or in-laws. They’re blamed for everything. For giving birth to a ‘damaged’ child. For being the reason the family is ashamed.”

Dr. Amina Khalid, a gynecologist, echoed the same frustration.

“Genetic risks are real. But who is educating these girls before they’re married off? No one. And when the child is born with a condition, it’s the mother who is punished through silence, through blame, sometimes through violence.”

When I asked if fathers ever accompanied their wives for counseling or genetic testing, she gave a sad smile.

“They don’t even come for follow-ups. It’s always the mother carrying the child, the shame, and the responsibility for decisions she never made.”

The fathers rarely show up. Not in hospital visits. Not in blame. Not in guilt. The responsibility, like the grief, lands on the mother alone.

Shabana lives in a small village of Rural Punjab , where the fields stretch wide but the walls inside homes are tight with judgment. Her youngest daughter, Alishba, is four years old and still unable to walk or speak.

“She looks at me,” Shabana said. “Her eyes follow me everywhere. But she can’t say what she feels. I’ve learned to read her silence.”

Alishba was born after Shabana’s second cousin marriage a match arranged before she had even finished school. No one in her family had ever spoken of genetics. But after the diagnosis, the blame was immediate.

“They said I brought this upon the family. That I must have done something wrong in pregnancy. That I had hidden something from God.”

Her voice shook, but not from tears only from exhaustion.

Some families silence medical truth by calling it fate. Others tell mothers to pray harder as if prayer can erase genetics. But some women, too, pray. Not for healing, but for peace. For someone to tell them it wasn’t their fault.

When Shabana asked her husband to accompany her to a specialist in the city, he refused.

“What’s the point?” he said. “It’s already too late.”

She went anyway, borrowing money from a neighbor who also helped hold the child while Shabana sat quietly on the hospital bench.

“I don’t want pity,” she told me. “I just want someone to say this is not your fault. That would be enough.”

Caring for a child with special needs is unpaid labor. But in places like Mianwali, it is also isolating. Women stop working, stop going out, stop being seen.

A 2021 study in Lahore, Pakistan estimated that the average cost of care for a child with a genetic disorder ranges between Rs. 20,000 to Rs. 40,000 per month, depending on the condition an unbearable expense for most rural families. Grief, in these homes, has no salary but it takes everything.

In the stories of Razia and Shabana, I heard different voices, different names but the same silence. A silence so familiar it has become part of how women carry their children: wrapped around them like cloth, stitched into their bodies like second skin.

In public hospitals across Rural Punjab Pakistan, doctors report increasing cases of inherited conditions like beta-thalassemia, microcephaly, congenital blindness, and severe speech and language delays. The science is there. But the silence is louder.Nationwide, nearly 1.5 million children are living with rare inherited disorders, yet very few hospitals are equipped to offer proper diagnosis or care.

No one teaches these women about genes or bloodlines. No one explains what cousin marriage could mean for their futures. Instead, knowledge is replaced with shame, and the space for grief is taken up by blame. A recent survey by Aga Khan University found that only 17% of rural women are aware that cousin marriages increase the risk of inherited illness.

Mothers like Razia are told to pray more. Mothers like Shabana are told to stop asking questions. The burden is not only emotional it is spiritual, social, and generational. It is passed down quietly, like recipes and family secrets, until it begins to feel normal.

Some mothers told me, quietly, that they fear for their daughters. That they’ll be married into the same bloodlines, carry the same blame. That the silence will be passed down like dowry.

But it is not normal.

In hospitals, in homes, in the aching silence of late-night care, these women continue. They raise children while carrying wounds they cannot name. They love fiercely in a world that punishes them for what they could not control.

And in doing so, they show a kind of motherhood that rarely gets seen: one shaped not by softness alone, but by strength. A strength that holds everything together while silently falling apart.

This is not only a story about illness.

It is a story about how cultural expectations, silence, and shame shape a woman’s journey through motherhood long before her child is even born. A story about how some mothers are forced to carry not just life, but blame. About how their bodies are named as the cause, while the systems and traditions around them remain untouched.

And yet, in the quiet, these women endure. They bathe, feed, and hold their children with tenderness. They walk long roads to clinics. They speak less, not because they have no voice, but because no one asked to hear it.

Somewhere in this silence is a strength that goes unseen.

A love that persists, even when it is made to feel like a burden.

A motherhood that survives, not because it is free of pain, but because it chooses to continue anyway.

Written By Mahpara Zulqadar