The NHS has once again found itself defending the indefensible. This time, training offered to midwives appears to minimise the risks posed to children born from parents who are close relatives. The documents claim 85-90% of cousin couples “do not have affected children”, adding that “the associated genetic risks have been exaggerated”. Staff are warned, meanwhile, that “close relative marriage is often stigmatised in England”. The guidance even seems to extol the “benefits” of such unions, stating: “marriage within the family can provide financial and social security at the individual, family and wider kinship levels”.

One might reasonably ask why the NHS is listing any “benefits” of consanguineous marriages, rather than doing what a health service is supposed to do — explaining the science and assessing the risks. Cousin marriages should be stigmatised, and UK institutions must not tiptoe around the subject in the name of cultural sensitivity.

This practice has largely been imported from Pakistan, where around 50% of people marry their first cousins — the highest rate in the world. While proponents argue that it brings families closer, I’ve witnessed the harms of consanguineous marriage among my own relatives and wider community. These unions guarantee that wealth and property stay in the family, as well as allowing people to bring over a relative to the UK under a spousal visa. The bigger problem arises when generation after generation continues marrying cousins, which leads to severe illnesses.

Babies from first-cousin marriages can be born with blindness, deafness, blood disorders, heart or kidney failure, lung and liver problems, and complex neurological disorders — all of which may require long, complex and costly treatment. Framing these risks as exaggerated is not compassionate but reckless.

A decade ago, a seminal research project called Born in Bradford (BiB) showed that a staggering 62% of Pakistani-heritage women in the city were married to first or second cousins. The study, based at Bradford Royal Infirmary and tracking the lives of tens of thousands of children, was instrumental in raising awareness about genetic risk. And it worked: a new follow-up study in 2023, looking at mothers in three inner-city wards, found the figure was now less than half — 46%. This is progress, albeit at a glacial pace.

When I spoke to young British Pakistanis in Bradford in researching this topic, many were astonished that the practice continues. “People still do that? I thought it was something our grandparents’ generation did,” one student told me. The reality is that youngsters are moving on, while institutions are lagging behind.

This is not the first time the NHS has been attacked for such an approach. Last year, the health service came under fire after its Genomics Education Programme published an article entitled “Should the UK ban first-cousin marriage?” The piece sought to minimise the risks, stating that “although children of first cousins have an increased chance of being born with a genetic condition, that increase is a small one… from around two per cent to three per cent; this increases to four per cent to six per cent in children of first cousins”.

Following backlash, the article was swiftly removed. But that debacle, alongside the latest row over this guidance, exposes a deeper problem: a public health service more anxious about causing cultural offence than safeguarding children and empowering parents with clear, evidence-based advice. Think back to the nonsensical recommendations given some years ago to midwives on using “inclusive” phrases such as “chestfeeding” so that trans parents wouldn’t be offended. This latest example is particularly dangerous. When the NHS downplays genetic risks in the name of sensitivity, it doesn’t promote inclusion. It abdicates responsibility.

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Iram Ramzan is a journalist and commentator who has previously worked at the Daily Mail and the Sunday Times. She writes the Substack Off The Record With Iram.

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