NHS England has come under fire after releasing training material suggesting first-cousin marriages may carry social and economic advantages, despite acknowledging well known health risks for children of closely related couples. The online guide, part of the Genomics Education Programme, listed perceived benefits such as “stronger extended family support systems and economic advantages”.

Although the guidance did highlight increased chances of genetic disorders and developmental challenges, it also presented marriage between first cousins as a cultural practice with positive aspects in some communities. This attempt at balance has provoked strong criticism from politicians, campaigners and healthcare professionals, many of whom argue the NHS should take a more forthright stance against the practice.

The material cited evidence from the long-running Born in Bradford project, a study that examined the health of children in a region with a large British Pakistani population. Researchers found that children of first cousins were more likely to experience developmental difficulties. For instance, 11 per cent of these children were diagnosed with a speech and language problem compared with 7 per cent of children whose parents were unrelated. Just over half, 54 per cent, were recorded as reaching a good stage of development by the age of five, compared with 64 per cent in the wider group.

While the overall risk of genetic disorders is generally estimated at between 2 and 3 per cent for the general population, the figure rises to around 4 to 6 per cent for children of first-cousin couples. Despite these differences, NHS England noted that focusing solely on cousin marriage was an oversimplification and stressed the need for broader genetic literacy, voluntary testing and sensitivity to cultural practices.

That approach has been sharply condemned by some politicians. Conservative MP Richard Holden declared:

“Our NHS should stop taking the knee to damaging and oppressive cultural practices.” He went further, stating Sir Keir Starmer should “stop running scared of the misogynistic community controllers and their quislings who appear in the form of cultural relativist-obsessed sociology professors, and ban a practice the overwhelming majority, from every community in Britain, want to see ended for good.”

Campaigners have also objected to the NHS stance. Dr Patrick Nash of the Pharos Foundation described the practice in blunt terms, saying:

“Cousin marriage is incest, plain and simple, and needs to be banned with the utmost urgency – there is no ‘balance’ to be struck between this cultural lifestyle choice and the severe public health implications it incurs.”

Aneeta Prem MBE, who founded the Freedom Charity, added:

“These are preventable harms that place families and the NHS under immense pressure.”

Community voices have entered the debate too. For some families, cousin marriages are seen as traditional and a way of strengthening kinship ties, but opponents argue that cultural sensitivity must not override child welfare. The controversy highlights the challenge faced by the NHS in presenting scientific findings while engaging with diverse communities.

The backlash was so strong that the guidance has since been removed from the NHS website. An NHS England spokesperson later clarified that the document was intended as a summary of existing research and public policy discussions, not an endorsement of cousin marriage. However, the incident has reignited a national conversation about how far public bodies should go in accommodating cultural traditions when there are clear health concerns.