NHS Instructed to Cease Blanket Advice Against First-Cousin Marriages
The National Health Service has received formal guidance instructing medical professionals to stop providing blanket advice against marriages between first cousins. This significant policy shift comes from the National Child Mortality Database (NCMD), a government-funded monitoring body that records and interprets data on child deaths across the United Kingdom.
Revised Risk Assessment and Guidance
The NCMD has informed healthcare workers that parents who are first cousins now face only a "slightly increased" risk of having children with genetic disorders, a substantial revision from previous warnings about significantly higher percentages of birth defects. The guidance specifically states: "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."
This document, originally issued in 2023, represents a notable change in how healthcare providers should approach discussions about consanguineous marriages. The NCMD, which is based at the University of Bristol and has received more than £3.5 million in taxpayer funding, plays a crucial role in monitoring child mortality patterns across England.
Legal Status and Community Context
First cousin marriages remain completely legal throughout the United Kingdom, with no laws prohibiting cousins from marrying or having children together. Legally, these relationships are not considered part of the prohibited categories for marriage, placing them in the same legal standing as any other marital union between consenting adults.
Statistical analysis reveals that these unions are being practiced more frequently within the British-Pakistani community compared to white British parents, highlighting important cultural and demographic considerations in healthcare delivery. This demographic reality has prompted discussions about how medical advice should be framed to be both effective and culturally sensitive.
Political Controversy and Opposition
The guidance has not been without controversy. In 2024, then backbench MP Richard Holden, who now serves as shadow transport secretary, proposed a ban on first-cousin marriages. Mr Holden told The Times newspaper: "Our NHS should stop taking the knee to damaging and oppressive cultural practices. This guidance turns basic public health into public harm."
He further argued: "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."
This political opposition highlights the ongoing debate between public health considerations, individual liberties, and cultural practices within diverse British communities.
Balancing Public Health and Cultural Sensitivity
The new guidance represents a delicate balancing act for the NHS and healthcare professionals nationwide. Medical practitioners must now navigate:
- Providing accurate genetic risk information without stigmatising specific communities
- Respecting legal marital choices while ensuring prospective parents understand potential health implications
- Delivering healthcare advice that is both medically sound and culturally appropriate
- Addressing genetic counseling needs within diverse population groups
This development marks a significant shift in how the healthcare system approaches genetic counseling and community health education, moving away from blanket prohibitions toward more nuanced, individualized approaches that consider both medical evidence and social context.
