First cousin marriage guidance issued this week by a government-funded NHS monitoring body has prompted renewed scrutiny of how hospitals advise families about genetic risk. The document urges staff not to discourage close relative marriage “in a blanket way”, saying the risk of inherited disorders is only slightly increased.
The advice comes from the National Child Mortality Database, a programme based at the University of Bristol that collects data on child deaths across England. The document, first circulated in 2023, states that it is “unacceptable to discourage close relative marriage in a blanket way” and calls for counselling to be balanced and non-directive.
It suggests genetic counsellors should meet couples and, where appropriate, extended family members to discuss future marriage arrangements outside the family. Community-level engagement, it adds, is only appropriate if information is presented in a balanced and non-stigmatising manner.
The guidance has drawn criticism from some MPs, who have urged health ministers to widen an existing review of NHS advice on cousin marriage to include the new document.
First cousin marriage remains legal in the UK, although medical bodies have long noted that children of first cousins face a higher statistical risk of certain inherited conditions. National data on congenital anomalies and child mortality is compiled by the National Child Mortality Database, which is funded by NHS England to analyse patterns and recommend improvements in child health outcomes.
Richard Holden, the shadow transport secretary, said the issue should be addressed on public health grounds. He previously introduced proposals to outlaw cousin marriage, arguing that children of first cousins are at greater risk of birth defects. Downing Street said at the time that it had no plans to change the law.
The debate intensified last week after Bradford Teaching Hospitals NHS Foundation Trust advertised for a “close relative marriage neonatal nurse/midwife”. The role description stated that the successful candidate would support families where parents are close relatives, including cousins, uncles and aunts.
In a statement, the National Child Mortality Database said its purpose is to collect data on child deaths and share findings to improve and save children’s lives. It said it does not instruct NHS staff on practice beyond making recommendations to reduce mortality or advising professionals responsible for reviewing child deaths.
Ministers have faced periodic calls in recent years to consider legislative change. For now, first cousin marriage remains lawful, and NHS bodies continue to emphasise genetic counselling rather than prohibition.
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