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NHS England's Genomics Education Programme published training guidance on 22 September, which highlighted supposed benefits of first-cousin marriage, including 'stronger extended family support systems and economic advantages', has been withdrawn within days after fierce criticism from politicians and medical experts who questioned why health authorities would promote a practice linked to doubled genetic risks in offspring.

The controversy centres on a troubling question: how did guidance extolling consanguineous marriage benefits ever reach publication when NHS-funded research has long established the elevated health dangers?

The Born in Bradford study, one of Britain's largest multi-ethnic health projects tracking over 13,500 families, found that children of first cousins face a congenital anomaly rate of 6%, compared with 3% for children of unrelated parents.

Health Secretary Demands Apology Over 'Insensitive' NHS Guidance

Health Secretary Wes Streeting told The Guardian that he learned about the guidance through media reports and immediately demanded answers. '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?' he said. Streeting called the material 'wrong' and insisted NHS England should apologise for publishing advice that should never have appeared on an official platform.

The Mail on Sunday first exposed the guidance, which acknowledged the genetic risks but downplayed them by comparing consanguinity to other risk factors such as parental age, smoking, and alcohol use during pregnancy. Critics argued this false equivalence minimised the documented dangers and risked confusing healthcare professionals who rely on NHS training materials.

Within 48 hours of publication, the guidance vanished from NHS England's website. However, NHS England defended the now-deleted post as merely 'a summary of existing scientific research and the public policy debate', claiming it did not express an official NHS position. This explanation satisfied few, given the material appeared on an official training platform aimed at midwives, GPs, and genetic counsellors.

Bradford Research Reveals Stark Health Disparities

The Born in Bradford study, published in The Lancet in 2013, tracked births at Bradford Royal Infirmary between 2007 and 2011. Researchers found that 31% of congenital anomalies in babies born to Pakistani mothers could be attributed to consanguineous unions. The study showed that children of first cousins had twice the risk of birth defects even after adjusting for deprivation, maternal education, and other socioeconomic factors.

More recent research released in February 2025 revealed wider developmental consequences. Children of first cousins in Bradford had an 11% probability of speech and language difficulties compared with 7% for children of unrelated parents. These children also averaged 4.1 primary care appointments yearly, compared with 3 for their peers.

Between 2000 and 2010, parliamentary data show that 39% of British Pakistani couples in Bradford were first cousins. That figure declined to 27% by 2019, indicating an increase in awareness of genetic risks alongside shifting cultural attitudes and immigration patterns.

Political Firestorm and Cultural Sensitivity Debate

Conservative MP Richard Holden, who has advocated for banning cousin marriage, told the Mail on Sunday that 'our NHS should stop taking the knee to damaging and oppressive cultural practices'. He argued that health authorities must prioritise medical evidence over cultural relativism, particularly when public funds are used to treat preventable genetic conditions.

Dr Patrick Nash, director of the Pharos Foundation social science research group in Oxford, called the guidance 'truly dismaying'. He described cousin marriage as a form of incest that should be banned with urgency, saying there is no balance to be struck between cultural lifestyle choices and severe public health implications.

Yet some medical professionals argue that blanket condemnation risks alienating communities. Professor Sam Oddie, a neonatologist at Bradford Teaching Hospitals, noted that blaming first-cousin marriage alone is an oversimplification. He points to endogamy, where people marry within close communities, though not necessarily blood relatives, as a compounding factor affecting genetic diversity.

Unanswered Questions About NHS Editorial Oversight

Guido Fawkes revealed that additional NHS material, still online, recommends healthcare staff 'develop cultural competence' and 'understand consanguinity from an Islamic perspective'. This raises questions about whether the withdrawn guidance reflects isolated poor judgement or systemic reluctance to confront uncomfortable public health realities.

First-cousin marriages remain legal in the UK and have been since the 16th century. They are practised in several communities, including British Pakistani and Bangladeshi populations, particularly in Bradford, Birmingham, and parts of West Yorkshire. Advocates for reform argue that health authorities should focus on genetic literacy, voluntary screening, and counselling rather than prohibition.

Streeting rejected calls for a ban but pledged investment in genomic services. Ministers have committed funding to expand genetic counselling, aiming to provide families with evidence-based information without stigmatisation. However, the episode has damaged public trust in NHS communications, with critics questioning whether fear of accusations of cultural insensitivity led officials to compromise medical messaging.

The withdrawn guidance stated that most children of first cousins are healthy, which is statistically valid. Yet the doubling of congenital anomaly risk from 3% to 6% translates to thousands of preventable cases annually. For families affected by genetic conditions requiring lifelong care, the distinction between relative and absolute risk is anything but academic.

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