The National Health Service (NHS) in England has provoked significant public outcry following the release of new guidelines advising midwives to support cousin marriages. This guidance claims that concerns regarding birth defects from such unions are overstated, arguing that between 85 to 90 percent of children born to cousin couples do not have congenital issues. This stands in stark contrast to the national average, where approximately 98 percent of children are unaffected.
The document asserts that while there are acknowledged risks associated with marriages between close relatives, these should be considered alongside the potential benefits, including economic advantages and enhanced social ties. The guidance emphasizes that staff should avoid stigmatizing couples from cultures, particularly within the Pakistani community, where cousin marriage is common.
Critics, including Richard Holden, a Conservative MP advocating for a ban on cousin marriage, argue that the guidance overlooks the substantial health risks involved. Holden stated, “There are no benefits to marriage between first cousins, only massive downsides for health, welfare, individual rights and the cohesiveness of our society.”
In response to the backlash, experts have voiced their concerns regarding the implications of normalizing cousin marriages. Patrick Nash, a professor at the University of Oxford, compared the guidance to recommending harmful behaviors during pregnancy, emphasizing the dire consequences for both mother and child. “There is no justification or excuse for this at all,” he remarked.
The guidance was part of the NHS’s Maternity Transformation Programme, which aims to reduce stillbirths and maternal deaths by 2030. The document stresses that discouraging cousin marriage is inappropriate and could alienate communities, suggesting that the associated genetic risks have been exaggerated. It claims that Pakistani women in cousin marriages have health outcomes that compare favorably to those in non-relative marriages.
Despite these assertions, public health concerns persist. Michael Muthukrishna, a professor of Economic Psychology at the London School of Economics, noted that restricting marriage to family members can lead to isolation within communities, which may increase vulnerabilities to issues such as radicalization.
The NHS has faced scrutiny for its stance on cousin marriage, especially given data indicating that areas with higher rates of such marriages also report more cases of congenital problems. Previous investigations have revealed that over two children per week in England die as a result of their parents being closely related. Health figures show that up to 20 percent of children treated for congenital issues in cities like Glasgow and Birmingham are of Pakistani descent, compared to just 4 percent in the general population. This situation places a significant financial burden on the NHS, costing billions each year.
An NHS spokesperson acknowledged the genetic risks associated with consanguineous relationships and indicated that individuals considering such marriages are referred to genetics services to understand the potential health implications.
As the debate continues, the NHS must navigate the complex intersection of cultural practices and health risks, seeking a balance that respects individual rights while prioritizing the well-being of children and families.
