Official figures from the National Child Mortality Database (NCMD) have highlighted a concerning trend: more infant deaths in the UK are linked to marriages between close relatives, specifically cousins, than to substance abuse during pregnancy. The data for 2023/24 indicates that 72 infant deaths or cases of ill health among babies younger than one year are associated with cousin marriages. In comparison, 27 deaths were attributed to substance abuse during pregnancy. Furthermore, the impact extends beyond infancy, with a further 55 deaths recorded among children aged one to 17 linked to close relative marriages.

Close relative marriages, particularly prevalent in the South Asian community, remain legal in the UK despite being connected to an increased risk of genetic disorders, including conditions such as cystic fibrosis. These new findings come in the wake of controversy surrounding guidance issued by NHS England's Genomics Education Programme. The guidance sought to contextualise the risks, suggesting that while first-cousin marriages do increase the likelihood of children being born with genetic conditions or congenital anomalies, other factors—including parental age, smoking, alcohol use, and assisted reproductive technologies—also contribute to such risks. The NHS guidance also pointed to the benefits of cousin marriages, such as stronger extended family support systems and economic advantages like consolidated resources and inheritance. It argued that banning the practice could stigmatise certain cultural communities, recommending instead the promotion of genetic counselling and public health campaigns.

However, Health Secretary Wes Streeting has called for an apology from the NHS for publishing these guidelines. In political commentary, Tory shadow justice secretary Robert Jenrick spoke to the Daily Telegraph about the issue, suggesting the government had neglected the problem due to sensitivities around immigration and cultural practices. Jenrick noted that cousin marriage is banned in countries such as Norway and many US states and advocated for similar legislation in the UK, citing the practice’s "dangerous and damaging implications," particularly for vulnerable girls and women. Public opinion appears largely supportive of such a ban, with a YouGov poll earlier this year showing three-quarters of Britons backing the prohibition, while only 9% wish the current legal position to remain unchanged.

The broader context of child mortality in England and Wales shows low birth weight as the most common cause of death among children under one year. Data from the Office for National Statistics (ONS) across multiple reports has consistently highlighted that extremely low birthweight babies face the highest mortality rates. Maternal factors such as age and marital status also influence infant mortality rates significantly. Notably, beyond infancy, marriages within families remain the second highest contributing factor to deaths among children aged one to 17 years, surpassed only by parental or guardian mental health conditions.

Research emphasizes the heightened risks associated with cousin marriages. A study conducted in Bradford, West Yorkshire, involving 11,300 babies, found that first-cousin unions more than double the risk of congenital defects such as heart and lung abnormalities, cleft palates, and polydactyly (extra fingers). While the national incidence of congenital defects is approximately 166 per 10,000 births, this nearly doubles to about 306 per 10,000 in Bradford, a region with a significant South Asian population.

The implications of consanguineous marriages are also evident in local statistics. For example, in Luton, about one fifth of infant deaths are attributed to hereditary genetic conditions linked to cousin marriage. Each year, approximately 18 children under one year die in Luton, with about four deaths associated with these conditions, contributing to a local infant mortality rate higher than the national average. This led the local council to establish a review group to investigate and address the health risks posed by the practice.

While substance abuse remains a significant public health concern, especially relating to drug poisoning deaths broadly recorded at historically high levels (over 5,400 deaths in 2023 across England and Wales), its direct link to infant mortality appears lower compared to deaths linked to close relative marriages, based on the NCMD data.

The debate around cousin marriage in the UK reflects a complex intersection of cultural traditions, public health concerns, and political sensitivities. As public opinion leans heavily towards banning the practice, authorities face the challenge of balancing cultural respect with safeguarding child health, focusing on awareness and prevention through genetic counselling and targeted health campaigns.

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  • Paragraph 7 – [7]Official figures from the National Child Mortality Database (NCMD) have drawn attention to a pressing child health issue in the UK: more infant deaths are linked to marriages between close relatives, specifically cousins, than to substance abuse during pregnancy. The data reveal that in 2023/24, 72 infant deaths, as well as cases of ill health in babies younger than one year, were associated with cousin marriages. In contrast, 27 deaths were linked to substance abuse during pregnancy. Beyond infancy, cousin marriages were also connected to the deaths of 55 children aged one to 17 years.

Consanguineous marriages remain particularly common in the South Asian community in the UK and, though legal, have long been associated with an increased risk of genetic disorders, including cystic fibrosis. This new data arrives amid controversy sparked by recently published NHS England Genomics Education Programme guidance, which emphasised that while first-cousin marriage carries higher odds of genetic conditions or congenital anomalies, multiple other factors—such as parental age, smoking, alcohol use, and assisted reproductive technologies—also contribute to such risks. The NHS guidance highlighted potential benefits of cousin marriage, including stronger extended family support systems and economic advantages by consolidating resources and inheritance. It argued against banning the practice to avoid stigmatizing communities, instead recommending genetic counselling, public health campaigns, and awareness-raising initiatives.

However, the Health Secretary Wes Streeting has publicly called on the NHS to apologise for issuing these guidelines. Commenting to The Daily Telegraph, Tory shadow justice secretary Robert Jenrick urged the UK to follow countries like Norway—which banned first-cousin marriage last year—and many US states by outlawing the practice. Jenrick described cousin marriage as having "dangerous and damaging implications," particularly for vulnerable girls and women. Supporting this position, a YouGov poll conducted earlier this year found that three-quarters of Britons favour a ban, while only 9% support the status quo.

The broader context of child mortality shows low birth weight remains the leading cause of death for infants under one. Office for National Statistics (ONS) reports consistently show that extremely low birthweight babies have the highest mortality rates. Maternal age and marital status are also significant factors influencing infant mortality rates in England and Wales. Additionally, data indicate that close relative marriages are the second highest contributing factor to deaths in children aged one to 17 years, after parental or guardian mental health conditions.

Research illustrates the heightened risks of first-cousin marriage. A study from Bradford, West Yorkshire—an area with a significant South Asian population—found that children of first cousins have more than double the risk of congenital defects, including heart and lung abnormalities, cleft palates, and extra fingers. While the national average rate of congenital defects is about 166 per 10,000 births, in Bradford this rises to approximately 306 per 10,000 births.

At a local level, the issue is starkly visible in places like Luton, where about one-fifth of infant deaths result from hereditary genetic conditions linked to cousin marriage. Each year, around 18 infants die in Luton, with approximately four deaths attributable to these genetic conditions. Infant mortality in Luton is notably above the national average, prompting the local council to set up a review group to investigate and address such health risks.

While drug poisoning and substance abuse remain critical public health challenges in England and Wales, with a record 5,448 deaths recorded in 2023, their direct contribution to infant mortality appears smaller relative to deaths linked to consanguineous marriage, according to the NCMD data.

The debate over cousin marriage pits deeply rooted cultural traditions against urgent public health concerns. With the majority of public opinion favouring a ban, policymakers face the challenge of balancing cultural sensitivity with the need to protect child health, emphasising education, genetic counselling, and prevention as key strategies in addressing this complex issue.

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Source: Noah Wire Services