In a move that has ignited debate across the United Kingdom, the National Health Service (NHS) has been instructed to cease issuing blanket advice discouraging marriages between first cousins—a practice more prevalent in some British-Pakistani and Bangladeshi communities than among white British families. This directive, issued by the National Child Mortality Database (NCMD) based at the University of Bristol, has prompted both support and criticism from medical professionals, politicians, and advocacy groups.
The NCMD, a government-funded body with over £3.5 million in taxpayer funding, clarified in its 2023 guidance that parents who are first cousins face only a "slightly increased" risk of having children with genetic disorders. The guidance emphasized, "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." As reported by multiple outlets, including Fox News Digital and GB News, the new approach underscores the importance of culturally sensitive, informative outreach rather than outright discouragement or stigmatization.
First cousin marriages remain legal throughout the UK, with no laws prohibiting such unions or the birth of children from these relationships. Nevertheless, the practice has historically attracted concern due to a perceived higher risk of birth defects and genetic disorders. According to a peer-reviewed study published in BMC Medical Genetics, children born to consanguineous couples—most commonly first cousins—face an increased risk of congenital and genetic disorders, particularly autosomal recessive diseases. The study estimated this heightened risk at 2% to 4% above that of the general population. However, researchers noted that "the vast majority of children born to related parents are healthy," and that genetic risk can vary widely between families.
Despite these reassurances, the NCMD’s updated guidance has not gone unchallenged. Richard Holden, the Conservative shadow transport secretary and former backbench MP who proposed a ban on first-cousin marriages in 2024 (a proposal that was ultimately blocked), has been a vocal critic. Speaking to The Times, Holden declared, "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."
Holden’s concerns are echoed by some health researchers and advocacy groups. Emma Schubart, a research fellow at the Henry Jackson Society, warned in a statement to Fox News Digital that 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 pointed to data indicating that among British Pakistanis—where consanguinity rates remain high—individuals face three to six times the average UK risk of type 2 diabetes, with 5–18% of cases directly attributable to inbreeding. "This translates to thousands of additional diabetes cases nationwide, placing undue strain on an already overburdened NHS," she added.
Amid this controversy, the NHS has taken steps to address both the medical and cultural complexities of close-relative marriages. On February 10, 2026, the NHS advertised a full-time nursing role titled "Neonatal Nurse – Close Relative Marriage" through Manchester University NHS Foundation Trust, one of the country’s largest health trusts. The job description outlined responsibilities such as supporting families through "informed reproductive decision-making," encouraging genetic testing and awareness, and helping implement a national strategy at the local hospital level. The posting noted that the nurse would "proactively work with at-risk families practicing close relative marriage to encourage a greater level of genetic testing and/or genetic awareness/literacy among families where consanguineous related disorders are present."
Interestingly, the job posting listed fluency in Urdu—a language widely spoken among Pakistani communities in the UK—as a desirable skill, further signaling the NHS’s intent to provide culturally sensitive support. The role was part of a limited pilot program and has since closed, but it highlighted the NHS’s ongoing efforts to reduce health inequalities in infant and child mortality and morbidity, particularly in communities where cousin marriage is more common.
According to an NHS spokesperson, the position was "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 spokesperson emphasized that the NHS offers referrals to specialist genetics services to help individuals and families in close-relative marriages understand potential risks and make informed decisions about their care. "Having closely related parents can increase the risk of inherited genetic conditions and serious illness," the spokesperson told Fox News Digital. However, the NHS remains committed to an approach that is "culturally sensitive and empowering," rather than stigmatizing.
While close-relative marriage is rare in most Western countries, it remains more common in parts of the Middle East and South Asia and within some immigrant communities in the UK. According to GB News, cousin marriage is notably more prevalent among British-Pakistani and Bangladeshi heritage families. The NCMD guidance and the NHS pilot program reflect a broader shift in public health strategy: moving away from blanket prohibitions and toward nuanced, community-engaged education and support.
Still, the debate shows no signs of abating. Critics like Holden and Schubart argue that downplaying the risks or normalizing the practice could lead to more children suffering from avoidable conditions and further strain on the NHS. Supporters of the new approach, meanwhile, insist that stigmatization and blanket discouragement have proven ineffective and counterproductive, and that informed, respectful engagement is the best way forward.
As the NHS continues to navigate these complex social, cultural, and medical dynamics, the question remains: how best to balance the rights of individuals to make their own choices with the responsibility of public health authorities to protect vulnerable children and reduce health inequalities? For now, the NHS’s strategy is one of careful outreach, cultural sensitivity, and an unwavering commitment to evidence-based care—while the wider debate over cousin marriage and genetic risk continues to unfold across Britain.