Five Years Too Late: Why Every Nigerian Must Know Their Genotype Before Falling in Love

Amina was twenty-three when she met Daniel at a church programme in Yola. He was steady, kind, and serious about her from the first month. By the second year, their families had begun quiet conversations. By the fifth, a wedding date had been pencilled into the calendar.

Nobody asked about genotype.

It was not carelessness. It was simply the way things had always been done in both families. Love was confirmed. Character was examined. Bride price was negotiated. Genotype did not come up. The test came only because Amina’s elder sister, recently returned from a health seminar in Abuja, insisted. She purchased two test kits from a pharmacy in Jimeta and sat with the couple one Sunday afternoon until they agreed.

Amina was AS. Daniel was SS.

The wedding date was quietly removed from the calendar. Five years of love, of shared plans, of families already intertwined, collapsed into a single afternoon. Amina told this reporter she did not speak for two days after the result. Daniel said he already knew his genotype but had told himself it would somehow work out.

“I thought love was enough,” he said. “Nobody told me it was not.”

What Two Letters Can Cost a Family

Before a couple exchanges vows, two letters of the alphabet can determine the health of every child they will ever have.

Haemoglobin genotype is the genetic code that governs how the body produces red blood cells. In Nigeria, the most common genotypes are AA, AS, AC, SC, and SS. Each letter represents one copy of the haemoglobin gene inherited from each parent. The combination a person carries shapes not only their own health but also the health of their children and grandchildren.

AA is the normal genotype. A person with AA has two healthy haemoglobin genes and faces no sickle cell risk. AS means the person carries one normal gene and one sickle gene. They are generally healthy but are carriers who can pass the sickle gene to their children. SS means both copies of the gene are sickle genes. This is sickle cell disease, a lifelong, debilitating, and, in many Nigerian households, fatal condition.

According to a 2025 study published in Frontiers in Health Services, approximately 150,000 Nigerian babies are born with sickle cell disease every year. The Center for Policy Impact in Global Health reports that nearly half of those children die before their fifth birthday. Those who survive face a life expectancy that hovers around 21 years in Nigeria, against 54 years in high-income countries where management resources exist.

The Nigeria Sickle Cell Foundation, citing WHO data, has stated that Nigeria accounts for 75 per cent of all infant sickle cell cases across Africa, making it the most sickle cell-endemic country in the world. A further 50 million Nigerians carry the sickle cell trait without presenting the disease themselves, meaning one in every four Nigerians is a silent carrier passing the gene forward.

The Combinations That Put Children at Risk

Nigerian genetic counsellors identify several pairings as medically inadvisable. The most dangerous is SS marrying SS. Every child born to two SS parents will inherit sickle cell disease. There are no exceptions.

AS marrying AS produces a one-in-four chance of an SS child with every pregnancy. Over multiple children, those odds compound. A family of four from this pairing can statistically expect one SS child. AS marrying SS raises that risk to one in two. Half of all children from such a union may be born with full sickle cell disease.

The pairing many couples overlook is AA marrying SS. Because no child born to this union will have sickle cell disease, some families consider it safe. Medical experts disagree firmly. Every child of an AA and SS parent will be AS, a carrier of the sickle gene. When those children grow up and start families of their own, the gene they inherited moves silently into the next generation and the generation after that.

“You may protect your children,” one Lagos-based haematologist told this reporter. “But you are guaranteeing that your grandchildren face the same risk all over again.”

Genetic counsellors across Nigeria identify only two pairings that carry no long-term sickle cell risk. AA marrying AA produces all AA children. No sickle gene enters the family line. AA marrying AS produces children who are either AA or AS. No child will have sickle cell disease, though some will be carriers. Every other combination, including AA with SS, carries a generational cost that compounds silently over time.

A Test That Costs Less Than a Bride Price

Amina’s and Daniel’s story is not unusual. Across Nigeria, couples invest years of emotional energy, family resources, and social commitment into relationships before the question of genotype is ever raised. By the time the result arrives, the cost of walking away has become enormous.

Genotype testing at most government hospitals and private laboratories across Nigeria costs between N500 and N2,000. The test takes less than an hour. The result is permanent.

“We spend hundreds of thousands on introduction ceremonies,” one genetic counsellor based in Maiduguri told this reporter. “We cannot find five hundred naira to do a test that changes everything.”

The management of sickle cell disease, by contrast, carries a monthly cost ranging from N70,000 to N1 million, covering hospital admissions, blood transfusions, hydroxyurea medication, physiotherapy, and chronic pain management. Most Nigerian families cannot sustain that cost across a child’s lifetime. Prevention, through a test that costs less than a plate of food, remains the most accessible tool available.

Anambra State has passed legislation making genotype knowledge mandatory before marriage. A similar bill currently sits before the National Assembly. Some churches across Nigeria have made genotype tests compulsory for intending couples before wedding counselling proceeds. These are steps in the right direction. They remain the exception, not the standard.

What Communities and Families Must Do Differently

Doctors urge every Nigerian of marriageable age to know their genotype before entering a serious relationship. Not when feelings have deepened. Not after the introduction. Before.

Testing is available at government hospitals, private laboratories, and most primary healthcare centres across the country. The cost is low. The information is permanent. It does not expire, and it does not change.

Couples who discover an incompatible pairing are encouraged to seek genetic counselling before making final decisions. Options exist, including assisted reproductive technology with embryo screening, though access and cost remain barriers for most Nigerians. The first step, however, is simply knowing.

Religious and cultural pressure to proceed with incompatible marriages despite known risk remains one of the most significant challenges medical professionals report. The argument that “God will provide a healthy child” is one that genetic counsellors hear regularly and one that the data does not support. Biology does not negotiate with faith on this particular question.

The sickle cell crisis in Nigeria is not a mystery. Its cause is documented, its prevention is cheap, and its burden is entirely concentrated in families who were never told early enough to ask a simple question.

Amina said she wished someone had told her in secondary school. She wished her parents had known to ask. She wished Daniel had said something in the first month instead of the fifth year.

“Test early,” she said. “Before you even start to feel anything. Because once you feel it, the test becomes the hardest thing you will ever do.”

She is right. The conversation you have before love takes hold may be the most important one your children never have to face.