Genotype: Your first love letter to your future child

The number of people living with sickle cell disease globally was put at 7.74 million in a 2021 estimate, with an estimated 515,000 new births. Sadly, sub-Saharan Africa has the highest burden of this disease, as estimates suggest that 75% of all patients and 70% of births with sickle cell disease occur in this region. Sickle cell disease is also found in parts of West Asia, India, and Southern Europe, as well as among people of African descent living in other places, and the disease contributes substantially to childhood mortality, particularly in regions with limited access to care.

Nigeria has the highest burden of sickle cell disease worldwide, with an estimated 2–3% of the population affected. This includes an annual birth of about 150,000 newborns with sickle cell disease and a high carrier rate of the sickle cell gene at around 20 to 30% of the population. Unfortunately, half of the children with this disease may die before age five, and those who survive have a life expectancy of about 21 years.

Now, there is one critical piece of information many couples often overlook in the whirlwind of wedding preparations. It is this simple, three-letter code that determines the fate of their future family, and this code is the genotype, a biological reality that demands attention long before the vows are exchanged.

We often talk endlessly about financial compatibility, emotional maturity, and shared values, but when it comes to marriage, no compatibility test is more vital than the one written in your blood. And ignoring your genotype is not a romantic risk; it is a profound and preventable tragedy. This information is, therefore, a call to maturity, a plea for prospective couples to put aside fleeting emotions and embrace the personal responsibility that can save their future child from a lifetime of suffering. Knowing your code is the most responsible act of love you will ever commit to or show your future child.

To help you make an informed choice, you must first understand the language of your blood. Your haemoglobin genotype, inherited from your parents, dictates the type of blood cells you have. The major players in this conversation are the various haemoglobin types associated with sickle cell disease. The AA genotype is the ideal, carrying only normal haemoglobin. The AS genotype, often called the sickle cell trait, means you are a carrier. You are typically healthy, but you possess the gene that can cause problems if paired with a similar gene.

The SS genotype signifies the presence of sickle cell disease itself. It is a debilitating, chronic illness. AC is another carrier type, and SC is a form of sickle cell disease. The compatibility issue emerges when two carriers decide to merge their bloodlines. A person with an AA genotype can marry anyone without fearing that their children will have the full-blown disease. The child will either be AA or, at worst, an AS carrier. The real danger zone, and where personal responsibility is most tested, is the union of two carriers, particularly AS and AS.

When an AS marries an AS, they face a cold, hard biological fact: a 25% chance with every single pregnancy that their child will inherit the devastating SS genotype. Imagine standing at a crossroads where a one-in-four chance means a lifetime of pain for your baby. Similarly, an AS and an AC couple face a 25% risk of having a child with the SC genotype, another form of sickle cell disease.

The truth is that the consequences of ignoring this fact are often catastrophic. For the child, life with sickle cell disease equals a cycle of excruciating pain crises, chronic organ damage, severe anaemia, and a constant, lifelong dependency on medical care that brutally impacts both quality of life and longevity. It is a burden of suffering that no parent should intentionally choose or inflict.

For the couple, the consequences do not just drain their finances; the marriage itself becomes a casualty of relentless caregiving, stress, and guilt. The emotional toll of watching a child suffer, the endless hospital visits, and the financial drain of treatment can put a strain on even the strongest bond. Many beautiful, deep-seated love stories have been sacrificed at the altar of this preventable biological gamble. Although modern medicine offers complex, expensive, and often ethically challenging solutions like “in vitro fertilisation” (IVF) with pre-implantation genetic diagnosis that screens embryos, these options are inaccessible to many and still do not erase the fundamental risk.

In cultures that often elevate the feeling of “love” and spirituality above all else, we must be mature enough to accept that love is not a cure for biology. Neither is spirituality (in many cases). And this is where wisdom and personal responsibility become the highest form of commitment. It starts by knowing your genotype, which is a piece of information as basic as your blood group, and discussing it openly and honestly with a potential partner early in your relationship. Do not wait until the wedding date is set. A partner who respects you will appreciate your honesty and maturity. If you and your partner are incompatible (if you are both AS, for example), the most loving, selfless decision you can make is to protect the generation that has no voice at the point you are falling head over heels in love.

The honest and responsible path often involves choosing a compatible partner, committing to adoption, or living a child-free life. Choosing a partner with your mind as well as your heart is not a sign of weak love or lack of spirituality; it is the ultimate expression of strength, maturity, and foresight.

Today, you have before you the knowledge to break or help break an undesirable cycle of suffering. It is the power to choose a future of health and stability. You can hold tightly to a romance that intentionally flirts with the 25% gamble, or you can embrace the mature, powerful love that elevates the well-being of a potential child above your own desires.

Ultimately, genotype compatibility is a gift of knowledge that empowers everyone to build a foundation of health, free from preventable tragedy, not a hurdle designed to frustrate one’s love life or marriage. So, go ahead and take the test, have the conversation (or encourage it), and make the responsible choice that will ensure you live and enjoy your married life. It is all for your love, for your future, and most importantly, for the child who deserves a life free from the shackles of sickle cell disease.

Ojenagbon, a health communication expert and certified management trainer and consultant, lives in Lagos.