NHS told not to discourage first cousin marriage as genetic risk debate intensifies
NHS guidance fuels first cousin marriage debate
A renewed debate over first cousin marriage in the UK has emerged after a government-funded NHS monitoring board advised healthcare professionals not to “discourage close relative marriage in a blanket way.”
The guidance, issued by the National Child Mortality Database (NCMD) and first published in 2023, states that while there is a genetic risk associated with cousin marriage, it is described as “slightly increased.” The document reportedly urges healthcare staff to provide balanced, non-stigmatising and non-directive information when advising families.
The issue has quickly become politically charged, with some MPs calling for an outright ban, while others argue that education, not prohibition, is the appropriate response.
What the NHS Guidance Says About Genetic Risk
The NCMD, based at the University of Bristol and funded with more than £3.5 million in taxpayer money, collects and analyzes data on child deaths across England. According to reports, its document stresses that it is “unacceptable to discourage close relative marriage in a blanket way.”
Research cited in broader discussions shows that children born to first cousins carry about a 6% probability of inheriting a recessive genetic disorder, compared to roughly 3% in the general population. While the risk is statistically doubled, experts note that the overall likelihood remains relatively low in absolute terms.
The guidance also recommends that genetic counsellors engage families in discussions about future marriages outside the family, but in a way that avoids stigma or coercion.
The NCMD clarified that it does not dictate NHS practice but provides recommendations aimed at reducing child mortality and improving data collection.
Bradford NHS Trust Hires Specialist Nurse for Close Relative Marriages
The debate intensified after Bradford Teaching Hospitals NHS Foundation Trust advertised a role for a “close relative marriage neonatal nurse/midwife.”
The nurse’s responsibilities include:
- Supporting families where parents are closely related
- Addressing neonatal wellbeing in the context of genetic risks
- Initiating sensitive discussions about recessive disorders
The role highlights how some NHS trusts are focusing on clinical management and early intervention, particularly in communities where cousin marriage is more prevalent.
A 2021 study found that around 55% of British Pakistanis are married to first cousins, though cousin marriages account for roughly 3% of all UK marriages overall.
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Is First Cousin Marriage Legal in the UK?
Yes. First cousin marriage remains legal in the United Kingdom. While marriages between siblings are prohibited, there are no laws banning cousins from marrying.
However, calls to change the law have grown louder in recent years. In 2024, Conservative MP Richard Holden introduced a Private Members’ Bill seeking to outlaw first cousin marriage, arguing it posed public health concerns. The proposal was debated but did not progress.
Downing Street has previously stated it has no plans to ban cousin marriage.
Political Backlash and Cultural Sensitivity
Critics of the NHS guidance argue that it downplays genetic risks and fails to address broader social concerns. Supporters counter that banning cousin marriage may not reduce health risks and could instead drive the practice underground.
Independent MP Iqbal Mohamed suggested that raising awareness through education programmes would be more effective than legislation.
Health experts generally emphasize the importance of genetic screening, counselling, and informed choice, rather than cultural condemnation.
The Broader Public Health Context
Studies, including research from the “Born in Bradford” programme, indicate that children of closely related parents may require more primary care appointments and face elevated risks of certain recessive conditions, such as cystic fibrosis or sickle cell disease.
Medical professionals stress that risk assessment depends on multiple factors, including family medical history, genetic diversity, and access to healthcare services.
The debate ultimately centers on how the NHS balances public health data, cultural sensitivity, and individual liberty in a diverse society.
FAQ
Is first cousin marriage legal in the UK?
Yes. First cousin marriage is legal in the UK. There are no laws prohibiting cousins from marrying.
What are the genetic risks of first cousin marriage?
Children of first cousins have about a 6% chance of inheriting a recessive genetic disorder, compared to around 3% in the general population.
Why is the NHS advising staff not to discourage cousin marriage?
The National Child Mortality Database guidance says advice should be balanced and non-stigmatising, noting the increased genetic risk is statistically modest.
Has the UK government tried to ban cousin marriage?
A Private Members’ Bill was introduced in 2024 proposing a ban, but it did not pass. The government has stated it has no plans to outlaw the practice.
Why is cousin marriage more common in some communities?
Cousin marriage is culturally traditional in certain communities, including parts of South Asia and the Middle East.
What is consanguinity?
Consanguinity refers to unions between individuals who are closely related by blood, such as first cousins.
Does cousin marriage always lead to birth defects?
No. While the risk of recessive disorders is higher compared to unrelated parents, the majority of children born to first cousins are healthy.
What role does genetic counselling play?
Genetic counselling helps families understand inherited risks and make informed decisions regarding marriage and childbearing.