Aim <p>This study explored the perceptions, awareness, and lived experiences related to consanguineous marriages in district Kotli, Azad Jammu and Kashmir (AJK).</p> Subjects and methods <p>This descriptive qualitative study was carried from July to December 2024. We conducted in-depth interviews with couples who have had a consanguineous marriage and their parents, which helped in documenting awareness, knowledge of genetic risks and the cultural drivers behind this practice. Thematic analysis was undertaken to analyze the results.</p> Results <p>Consanguineous marriage is a common cultural and traditional practice that is deeply rooted in many communities. Despite its various advantages such as trust and stronger family bonds, these unions have severe implications on the health of the children born out of these unions-malformation of genetics, and maternal complications. Participants reported consanguinity as a long-standing cultural norm driven by trust, family cohesion, and social convenience. Awareness of genetic risks was minimal prior to marriage, and most participants only recognized the health implications through personal experiences. Common consequences included physical and mental disabilities in children. Coping mechanisms relied heavily on faith and family support. Parents often viewed premarital genetic testing as culturally inappropriate or unnecessary. However, younger generations expressed openness toward preventive measures. Participants recommended community awareness campaigns, involvement of religious leaders, and premarital counseling to reduce risks.</p> Conclusion <p>Consanguineous marriage remains deeply embedded in cultural traditions, often overshadowing awareness of genetic risks. Targeted interventions, including culturally sensitive education and accessible genetic counseling, are essential to promote informed decision-making and reduce adverse health outcomes.</p>