Hospital staff need to stop discouraging first cousin marriages, a government-funded NHS monitoring board has said, despite the practice increasing the risk of birth defects.
The National Child Mortality Database (NCMD) has told NHS staff that “it is unacceptable to discourage close relative marriage in a blanket way” because the risk of having a child with a genetic disorder is only “slightly increased”.
It states that genetic counsellors should meet the couple and their relatives to advise them on how to “consider arranging future marriages outside of the family”.
Critics have urged health bosses to expand an investigation into separate NHS guidance, which states there is a benefit in cousin marriage, to include this NCMD document.
First cousin marriage, which is fairly common in the Pakistani community as well as other parts of the world, remains legal in Britain despite attempts to prohibit it.
Experts have warned about the possible health implications. Babies that are born to cousins are up to three times more likely to have genetic disorders. However, the document appears to challenge this notion, saying: “This is not appropriate given the level of risk since 90 per cent of children born to consanguineous families will not be affected by a genetic condition.”
• Banning cousin marriage won’t stop these relationships
The NCMD is based at the University of Bristol and has received more than £3.5 million in taxpayer funding to record and interpret data on all children who die. The guidance document was first issued in 2023.
“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,” the document said.
Richard Holden, the Conservative MP for Basildon & Billericay who is campaigning to ban cousin marriage, said: “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.”
Richard Holden, the Conservative MP for Basildon & Billericay
MATTHEW HORWOOD/GETTY IMAGES
The government recently announced that NHS England is increasing models of care for “couples at increased genetic risk due to close relative marriage”.
Zubir Ahmed, a health minister, told MPs in December: “NHS England is funding additional capacity in several professions, including midwifery, genomics associates and neonatal nurses, in nine pilot sites through the Genetic Risk Equity Project.”
However, YouGov polling from last year showed that three-quarters of Britons think first cousin marriage should not be legal, compared with 9 per cent who think the law should remain.
Michael Muthukrishna, professor of economic psychology at the London School of Economics, said last month: “When marriage is restricted to family members, communities become more isolated, limiting social integration.
“This isolation is what has allowed for over-representation of radicalisation and grooming gangs. Normalising cousin marriage doesn’t help mothers, nor babies affected by the well-documented health risks of repeated inbreeding.”
Last year it was reported that the deaths of more than two children a week in England were linked to their parents being closely related. Figures showed that up to 20 per cent of children treated for congenital problems in cities such as Glasgow and Birmingham are of Pakistani descent, compared with 4 per cent in the wider population.
A job posting from Birmingham Women’s and Children’s NHS Foundation Trust said that genetic risk equity midwives will “proactively work with women from Pakistani ethnic groups and those at greater risk from genetic related disorders, to encourage a greater level of genetic testing/awareness/literacy among families”.
The NHS said it was not classed as “official NHS guidance” and was from the government-funded monitoring board.
“The evidence is clear that having closely related parents increases the risk of inherited genetic conditions and serious illness, and while cases like this exist, the NHS must ensure support is in place for children at risk,” it said.
The NCMD said: “The purpose of the National Child Mortality Database is to collect data on deaths and share our findings to improve and save children’s lives. We do not instruct the NHS or its staff on practice, except where we either a) make recommendations for professionals to help reduce mortality in children; or b) inform those professionals who have a statutory responsibility to review child deaths of how best to submit information to our database.”