The National Health Service (NHS) in the United Kingdom has found itself at the center of a heated debate after a government-funded monitoring board instructed medical professionals to stop issuing blanket discouragements against first-cousin marriages. This directive, issued by the National Child Mortality Database (NCMD) based at the University of Bristol, has sparked controversy across the country, particularly as it intersects with questions of public health, cultural practices, and the rights of minority communities.
On February 11, 2026, the NCMD formally advised NHS staff that it is "unacceptable to discourage close relative marriages in a blanket way." According to the NCMD, the risk for parents in such unions to have children with genetic disorders is only "slightly increased." The guidance, first issued in 2023, emphasized the need for any community-level action to be "balanced, non-stigmatising and non-directive." The NCMD, which has received more than £3.5 million in taxpayer funding to collect and interpret data on child deaths, clarified that its role is to share findings to improve and save children’s lives, not to dictate NHS practice except where recommendations are made to reduce child mortality.
First-cousin marriages are legal throughout the UK and are more prevalent in British-Pakistani communities compared to the white British population. Despite their legality, the practice has long been the subject of warnings from medical experts about the increased risk of birth defects and genetic disorders. As reported by The Telegraph, "Action at community level may help people to understand and act on [our] advice; but this is only acceptable if information is balanced, non-stigmatising and non-directive."
The NCMD’s new approach is rooted in a nuanced interpretation of the genetic risks. The body states that, while there is a higher risk for children of consanguineous couples, it is not as pronounced as previously portrayed. "Ninety percent of children born to consanguineous families will not be affected by a genetic condition," the NCMD guidance asserts. Peer-reviewed research published in BMC Medical Genetics supports this, finding that children of first cousins face a 2% to 4% higher risk of congenital and genetic disorders compared to the general population. The overall risk rises from about 2-3% in the general population to 4-7% among first cousin couples. However, researchers also stress that the vast majority of children born to related parents are healthy—and that risk can vary widely between families.
Yet, not everyone is convinced by the NCMD’s measured stance. Richard Holden, now the shadow transport secretary and previously a backbench MP, has been a vocal critic. In 2024, he introduced a private members’ bill to ban first-cousin marriages, arguing, "Our NHS should stop taking the knee to damaging and oppressive cultural practices. This guidance turns basic public health into public harm. First cousin marriage carries far higher genetic risk, as well as damaging individual liberty and societal cohesion. Pretending otherwise helps no one, least of all the children born with avoidable conditions and those trapped in heavy-handed patriarchal power structures they can’t leave for fear of total ostracism."
Other critics have cited data showing that children from first cousin marriages are more likely to inherit recessive disorders and suffer from speech and language difficulties. According to a Bradford study referenced in The Telegraph, only 54% of these children reach a "good stage of development." Data analysis also revealed that 73 babies under one year died or suffered serious health issues because their parents were close relatives, accounting for about 3.7% of all child deaths analyzed.
The debate has also drawn international comparisons. Norway banned cousin marriage in 2025, and Sweden is set to implement its own ban in 2027. In the United States, most states prohibit the practice. Robert Jenrick, the shadow justice secretary, remarked, "The practice of first-cousin marriage was banned in Norway last year, and is also banned across most US states. It’s time the UK came in line by outlawing this practice." Yet, the UK government has shown little interest in following suit, instead opting for policies focused on genetic counseling and public health outreach.
Reflecting this shift, the NHS recently advertised a full-time nursing role titled "Neonatal Nurse – Close Relative Marriage" at Manchester University NHS Foundation Trust, one of the country’s largest NHS trusts. The role, which has since closed, was designed to support families through "informed reproductive decision-making," encourage genetic testing and awareness, and help implement a national strategy at the local hospital level. The job posting emphasized the need for culturally sensitive, empowering conversations about recessive genetic disorders and listed fluency in Urdu as a desirable skill—underscoring the NHS’s focus on outreach to British Pakistani communities.
An NHS spokesperson stated that the role was part of a limited pilot, not a broad policy shift: "This role is part of a small pilot which will test whether nurses with specialist training in these complications could help save and improve the lives of more vulnerable babies—targeted in an area where close-relative marriage is prevalent." The NHS also offers referrals to specialist genetics services to help individuals and families in close-relative marriages understand their risks and make informed decisions about care.
Emma Schubart, a research fellow at the Henry Jackson Society, warned that such outreach risks normalizing a practice with significant genetic risks. "The NHS's creation of specialized nursing roles risks normalizing a practice that significantly elevates genetic risks, including a doubled likelihood of serious birth defects and heightened susceptibility to common diseases like type 2 diabetes," Schubart told Fox News Digital. She pointed to statistics indicating that British Pakistanis face 3–6 times the average UK risk of type 2 diabetes, with 5–18% of cases directly attributable to inbreeding, translating to thousands of additional diabetes cases and putting further strain on the NHS.
Despite the controversy, the NCMD insists its guidance is not meant to undermine the importance of genetic counseling or public health. Rather, it aims to ensure that information is delivered in a way that is respectful, non-stigmatizing, and empowering for families. "The purpose of the National Child Mortality Database is to collect data on deaths and share our findings to improve and save children’s lives," the NCMD stated. "We do not instruct the NHS or its staff on practice, except where we either a) make recommendations for professionals to help reduce mortality in children; or b) inform those professionals who have a statutory responsibility to review child deaths of how best to submit information to our database."
Polling shows that public opinion is largely against first-cousin marriage, with a YouGov survey last year indicating that three-quarters of Britons believe it should not be legal. Still, the government’s current approach reflects a balancing act—one that strives to respect cultural diversity while addressing public health concerns through education, outreach, and genetic counseling rather than outright prohibition.
As this debate unfolds, the UK continues to grapple with the complex intersection of law, medicine, culture, and individual rights—an issue that shows no signs of easy resolution.