Health Secretary Wes Streeting has called for an apology after NHS guidance suggested first-cousin marriages could offer “benefits” despite the known doubled risk of birth defects, declaring the advice “high risk and unsafe” and questioning why it was ever published.
The controversial material, which appeared on NHS England’s Genomics Education Programme website, claimed banning the practice would “stigmatise certain communities and cultural traditions” and suggested first-cousin marriages were linked to “stronger extended family support systems and economic advantages.”
Mr Streeting told LBC radio on Tuesday he was shocked when he discovered the guidance, which has now been removed following a public outcry first highlighted in the Mail on Sunday.
The first I heard of this was when I saw that report, I asked immediately, ‘What on earth is going on here and what are they playing at?'” the Health Secretary said. “The advice has been taken down but why was it ever there in the first place?”
‘Medical Science is Clear’
Mr Streeting was unequivocal in his condemnation of the guidance, stating: “The medical science and evidence is clear. First-cousin marriages are high risk and unsafe, we see the genetic defects it causes, the harm that it causes. That’s why that advice should never have been published.”
When pressed on whether he believed an apology should be issued, he replied: “Yeah, I do think that.”
The NHS guidance had suggested that rather than considering a ban, authorities should instead offer “genetic counselling, awareness-raising initiatives and public health campaigns” to help families make informed decisions “without stigmatising certain communities and cultural traditions.
Bradford Study Reveals Stark Statistics
The controversy comes as research from the long-running Born in Bradford study continues to highlight significant health risks associated with first-cousin marriages, particularly within the Pakistani community.
The landmark study, which followed 13,500 babies born at Bradford Royal Infirmary between 2007 and 2011, found that children from first-cousin marriages face a doubled risk of congenital anomalies, rising from 3 per cent to 6 per cent when compared to the general population.
Crucially, the research revealed that whilst Pakistani babies account for only 3.4 per cent of births nationwide, they represent 30 per cent of recessive gene disorders. In Bradford specifically, the study found that 60 per cent of couples of Pakistani heritage were related by blood, with 37 per cent in first-cousin marriages, compared to less than 1 per cent amongst white British couples.
The research also documented that children from first-cousin marriages are more likely to have speech and language difficulties, less likely to reach a “good stage of development” and have more GP practice appointments than their peers.
Political Push for Ban
Conservative MP Richard Holden has introduced the Marriage (Prohibited Degrees of Relationship) Bill, which would ban first-cousin marriages in the UK, following similar legislation recently enacted in Norway and planned in Sweden.
Mr Holden argued that the practice should be “banned on the basis of health risk alone,” highlighting that the tradition had been illegal in England for 1,000 years until Henry VIII changed the law in 1540 to marry his cousin, Catherine Howard.
“First-cousin marriage should be banned on the basis of health risk alone,” Mr Holden stated in Parliament. “We ban incest for good reasons. We recognise the power imbalances inherent to sexual relationships between teachers and pupils, doctors and patients… We legislate to protect the vulnerable, so why are we silent here?”
However, Downing Street has indicated that the Government has no current plans to ban the practice, with Justice Minister Alex Davies-Jones stating the Government will take time to “properly consider our marriage law” before announcing a public position.
Cultural Sensitivities and Political Debate
The debate has exposed deep divisions over how to balance public health concerns with cultural sensitivities. Labour blocked Mr Holden’s bill from progressing beyond its initial reading in January 2025, with some MPs arguing that a ban would unfairly target certain communities.
Independent MP Iqbal Mohamed, representing Dewsbury and Batley, opposed the ban, claiming first-cousin marriage is seen as “very positive” by many and helps “build family bonds.” He warned that prohibition would be “unenforceable” and urged MPs to “step into the shoes of those who are perhaps not from the same culture.”
The issue has become increasingly politicised, with Conservative Chairman Richard Holden accusing Labour of “taking the knee to damaging and oppressive cultural practices” and suggesting the party was “deaf to sensible demands” due to fears of offending certain communities or losing votes.
Declining Trends but Persistent Concerns
Recent parliamentary discussions have noted some positive developments. The Born in Bradford study found that first-cousin marriages amongst British Pakistani couples in Bradford decreased by 27 per cent between 2010 and 2019, dropping from 39 per cent to around 28 per cent.
Researchers attribute this decline to increased awareness of health risks, young people staying in education longer, and changing family values within communities.
Professor Sam Oddie, a neonatologist and researcher at Bradford Teaching Hospitals, suggested in 2025 that genetic issues amongst British Pakistanis in Bradford may result from endogamy (marrying within closed kinship networks) rather than cousin marriage alone, noting similar patterns affect other genetically isolated populations such as British Jews and the Amish.
Health Service Response
The removal of the controversial NHS guidance has raised questions about oversight and editorial standards within the health service’s educational programmes. Critics have called it an example of the NHS “taking the knee” to political correctness at the expense of public health messaging.
Conservative MP Claire Coutinho pointed out the inconsistency, noting: “The NHS puts conditions on IVF by age, BMI and history of conception” but was suggesting cultural considerations should override genetic health risks for cousin marriages.
Further controversy emerged when it was revealed that another NHS document, published by the National Institute for Health Research and still online, recommends healthcare staff should “develop cultural competence in service delivery and cultural awareness training that focus on breaking down stereotypes and understanding consanguinity from an Islamic perspective.”
International Context
The UK’s approach contrasts with several other nations. Norway banned first-cousin marriages in 2023, Sweden plans to implement a ban by mid-2026, and Denmark is considering similar legislation. All Arab countries in the Persian Gulf currently require advance genetic screening for prospective married couples.
Research published in the Journal of Genetic Counseling estimates the average risk of birth defects in children born to first cousins at 1.1-2.0 percentage points above the baseline risk of 3 per cent for non-cousin couples – roughly equivalent to the risk for any woman giving birth over age 40.
As the debate continues, the fundamental tension remains between respecting cultural traditions and addressing documented public health risks, with the NHS caught in the crossfire over how to communicate sensitive health information without appearing discriminatory.
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Image Credit:
Secretary of State for Science, Innovation and Technology — photo by UK Government / No 10 Downing Street, licensed under CC BY 3.0
