The NHS is now training midwives to discuss what it calls the “benefits” of cousin marriage, a move that has sparked outrage among politicians, academics, and health professionals.
While the guidance acknowledges some risks to children’s health, it suggests these risks are often overstated and should be weighed against potential social and economic advantages.
Weighing Benefits Against Risks
According to the new training material, “85 to 90 per cent of cousin couples do not have affected children,” a statistic the document claims shows concerns about congenital conditions are “exaggerated” and “unwarranted.”
It encourages midwives to consider emotional, social, and financial benefits that such marriages might bring, particularly in communities where the practice is culturally common, such as among British Pakistani families.
Critics Speak Out
Critics say the NHS is endorsing a practice with real and documented dangers.
Tory MP Richard Holden, who campaigns to ban cousin marriage, called the guidance “indefensible,” arguing that the health, welfare, and societal consequences far outweigh any supposed benefits.
Professor Patrick Nash of the Pharos Foundation likened the guidance to recommending alcohol or smoking during pregnancy, saying it dangerously downplays the risks to both mother and child.
A Broader Policy Context
The guidance comes from NHS England’s Maternity Transformation Programme, which aims to halve stillbirths, maternal deaths, and serious brain injuries by 2030.
The programme emphasizes that discouraging cousin marriage is “inappropriate” and can be alienating, warning staff against stigmatizing families where the practice is common.
Cultural Sensitivity Versus Public Health
The document stresses that cousin marriage is “perfectly normal” in some cultures and encourages midwives not to shame or blame families.
It also claims Pakistani women in cousin marriages “compare favourably” to those in non-relative marriages regarding outcomes like maternal wellbeing and social stability.
Supporters say the guidance promotes culturally sensitive care.
Health Risks Cannot Be Ignored
Opponents argue that repeated close-relative marriages increase the risk of birth defects, which are well-documented and costly for the NHS.
Cities like Glasgow and Birmingham have reported that children of Pakistani descent account for up to 20 per cent of congenital condition treatments, despite making up only 4 per cent of the wider population.
These cases can cost the NHS billions over time.
Wider Social Concerns
Experts also warn that cousin marriage can reinforce social isolation.
Professor Michael Muthukrishna from the London School of Economics notes that restricting marriage within a tight community limits social integration, which can exacerbate problems like radicalization and grooming.
Normalizing the practice, he argues, does little to protect mothers or babies from health risks.
NHS Response
The NHS maintains that it fully recognizes the genetic risks of consanguineous relationships.
A spokesperson said: “Where people consider entering into them, we offer referral to genetics services so individuals understand the risks and can make informed decisions.”
The guidance, they add, is meant to provide midwives with tools to offer culturally sensitive advice, not to promote cousin marriage.
Balancing Care and Controversy
The debate highlights the difficult balance between respecting cultural practices and protecting public health.
While the NHS emphasizes sensitivity and education, critics argue the guidance risks normalizing a practice with serious medical consequences, leaving families and policymakers grappling with a complex and highly charged issue.
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