“There is no justification or excuse for this at all."
The NHS is teaching midwives about the supposed “benefits” of cousin marriage, despite long-established evidence linking the practice to higher risks of birth defects.
New guidance, reported by The Mail on Sunday, claims concerns about congenital disease linked to cousin marriage are “exaggerated” and “unwarranted”.
It argues this on the basis that “85 to 90 per cent of cousin couples do not have affected children”, compared with a national average of 98 per cent.
While acknowledging there are “risks to child health associated with close relative marriage”, the document states these should “be balanced against the potential benefits… from this marriage practice”.
It adds that marrying a relative, a practice more common in parts of the Pakistani community, can bring “economic benefits” alongside “emotional and social connections” and increased “social capital”.
The guidance also instructs midwives not to “stigmatise” predominantly South Asian or Muslim patients who have children with cousins, stating the practice is “perfectly normal” in some cultures.
The NHS has been accused of allegedly endorsing an “indefensible cultural practice”.
Richard Holden, a Conservative MP campaigning to outlaw cousin marriage, said:
“There are no benefits to marriage between first cousins, only massive downsides for health, welfare, individual rights and the cohesiveness of our society.”
Oxford-based academic and director of the Pharos Foundation research institute, Patrick Nash, compared the guidance to dangerous medical advice.
He said: “This is on a par with recommending alcohol and smoking during pregnancy for their calming effects, while brushing over the absolutely horrendous consequences for mother and child.
“There is no justification or excuse for this at all. Shame on the authors and shame on the Government for refusing to ban this indefensible cultural practice.”
The guidance was produced as part of NHS England’s Maternity Transformation Programme, which aims to halve stillbirths, neonatal and maternal deaths, and brain injuries by 2030.
It is used as part of midwife training and states that “discouraging cousin marriage is inappropriate” and would be “alienating and ineffective”.
It added: “The increased risk of genetic conditions among the offspring of close relative couples has often been exaggerated . . . leading to individuals feeling shamed and blamed.”
The document again claims that “85 to 90 per cent of cousin couples do not have affected children” and states: “Pakistani women in cousin marriages have been found to compare favourably to those in non-relative marriages”.
The guide argues that “marriage within the family can provide financial and social security at the individual, family and wider kinship levels”.
It says the risks have been “exaggerated” and that there has been an “unwarranted, narrow focus on close relative marriage”.
However, experts have warned that normalising the practice risks wider social and health consequences.
Professor of Economic Psychology at the London School of Economics, Michael Muthukrishna, said:
“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.”
It was previously reported that areas with higher levels of cousin marriage are significantly more likely to claim state benefits, which was linked to increased rates of birth defects.
In 2025, it was reported that the deaths of more than two children a week in England were linked to parents being closely related.
Figures also show that up to 20% of children treated for congenital problems in cities such as Glasgow and Birmingham are of Pakistani descent, compared with four per cent in the wider population.
Treating these conditions is estimated to cost the NHS billions of pounds.
An NHS spokesperson said: “The NHS absolutely recognises the genetic risks of consanguineous relationships, and where people consider entering into them we offer referral to genetics services so individuals understand the risks and can make informed decisions.”
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