NHS guidance on first-cousin marriages draws criticism over health risks and cultural sensitivity

LONDON — NHS England's Genomics Education Programme released guidance on consanguineous marriage, noting that first-cousin unions are associated with a higher risk of genetic conditions and congenital anomalies, but also pointing to potential social benefits such as stronger extended family support. The document emphasizes that such marriages have historical roots in Britain, citing the 16th-century reforms during Henry VIII's reign that allowed marriages between cousins. The guidance frames the issue as a public health matter that warrants education and support rather than punitive measures.

The guidance describes several asserted benefits of cousin marriages, including stronger extended family networks and potential economic advantages from consolidated resources and inheritance. It also argues that banning the practice could stigmatise communities and cultural traditions, and therefore recommends genetic counselling, awareness-raising initiatives and public health campaigns to inform couples without banning the practice outright.

On the risk side, the document notes that while children of first cousins have an increased chance of being born with a genetic condition, the absolute increase is modest: the general population faces a 2-3 percent risk, rising to about 4-6 percent for children of first cousins in many cases. The guidance also cites broader health considerations—parental age, smoking, alcohol use and assisted reproductive technologies—as factors that influence outcomes but are not banned in the UK. It adds that the risk should be understood in context and that most children of first cousins are healthy.

The guidance also references data indicating substantial local variation in affected births, noting that up to around 20 percent of children treated for congenital problems in large UK cities such as Sheffield, Glasgow and Birmingham are of Pakistani descent, compared with 4 percent or lower in the general population. It argues that this distribution reflects demographic patterns rather than an inevitable outcome of cultural practice and underscores the cost to the NHS of treating resulting conditions, which the document describes as substantial and ongoing.

Reaction to the guidance followed shortly after its publication. Tory MP Richard Holden said that the Conservatives would legislate to ban marriage between first cousins, arguing that such unions undermine integration, women’s rights and the health of those involved. He told The Mail on Sunday that the NHS should stop accommodating what he described as oppressive cultural practices and suggested that a ban could aid broader social goals around immigration and integration. Labour and other critics have called for a more nuanced approach that respects cultural traditions while addressing health risks through education and counselling.

Dr Patrick Nash, an Oxford-based scholar with the Pharos Foundation, criticized the guidance, calling it dismaying to publish official material that promotes purported social benefits of cousin marriage without addressing linked issues such as gender discrimination, honour-related violence and long-term taxpayer costs. He described cousin marriage as a form of incest and urged a re-evaluation of the approach, arguing for stronger public health protections rather than endorsements.

The document also references historical precedent, noting that laws permitting first-cousin marriage date back to Henry VIII’s era, when he sought to marry Catherine Howard, a cousin of Anne Boleyn, as part of broader royal realignments. The NHS Genomics Education Programme did not respond to requests for comment.

Public sentiment on the issue has been mixed in recent polling, with a YouGov survey earlier this year showing about three-quarters of Britons support a ban in principle, while roughly one in ten believed the law should stay as it is. The new NHS guidance has intensified debates about how best to balance cultural awareness with public health responsibilities, and how to communicate complex genetic information in diverse communities.

As the discussion continues, health officials say the aim is to provide accurate information, access to genetic counselling, and targeted public health messaging that respects cultural contexts while highlighting potential risks and the resources available to families across the country.