A Manchester NHS Trust recently announced an intriguing job opportunity for a specialized nurse aimed at supporting cousins who are planning to have children together. This role, which has since closed for applications, was introduced earlier this year to promote ‘informed reproductive decision-making’ among such couples.

The ideal candidate for this position was expected to be fluent in Urdu and to possess a strong appreciation for diversity and cultural differences.

New guidelines from the health service, released last month, address the common concerns regarding the increased risk of congenital diseases in children born to cousin couples. The guidance suggests that fears are ‘exaggerated’ and ‘unwarranted,’ noting that ’85 to 90 percent of cousin couples have children without congenital issues.’

For comparison, the national average for children born without such issues stands at 98 percent.

The guidelines acknowledge some ‘risks to child health associated with close-relative marriages,’ but they also emphasize that these risks should be weighed against the ‘potential benefits’ of maintaining this marriage practice within certain communities.

Admitting there are some ‘risks to child health associated with close relative marriage’, the guidance says these should ‘be balanced against the potential benefits… from this marriage practice’.

And marrying a relative – fairly common in the Pakistani community – can offer ‘economic benefits’ as well as ’emotional and social connections’ and ‘social capital’, the document says.

The Manchester Foundation Trust, one of the largest NHS Trusts in England, advertised the Neonatal Nurse position as a fixed-term 12-month contract.

It is one of a number of similar positions being publicised across the NHS, including a Frimley Health NHS Foundation Trust role in Slough, ‘close relative’ midwifery and nursing posts in Bedfordshire Hospitals and at GP practices in Bradford.

A Manchester NHS Trust has advertised an ‘exciting new job opportunity’ for a close-relative marriage nurse – to help cousins who are having children together (File image: Manchester University NHS Foundation Trust)

The role – now closed for applications – was shared earlier this year in a bid to enable ‘informed reproductive decision making’

This graphic, from NHS material distributed to couples in Bradford, explains some of the genetic risks of having children with a close relative. Two parents with a recessive gene have an increased chance of having a child with an inherited condition

The successful applicant will receive a salary of between £37,338 to £44,962 a year, working full-time to ensure ‘support and improve engagement with genetic services for affected families’ and enable parents to ‘make informed choices in a culturally sensitive empowering way’.

An NHS source told the Mail: ‘The purpose of the role is to advise families of the genetic risks associated with children born from close relative marriages and promote an informed understanding.

‘The purpose of the role is not to advise how cousins can have children, it is about working with families to assess the risks and provide access to relevant information and research on genetics so that informed choices can be made.’

Cousin marriage is popular among certain communities in Britain such as those of Pakistani and Bangladeshi heritage. 

Critics have accused the NHS of turning a blind eye to an ‘indefensible cultural practice’.

Kellie-Jay Keen, leader of the Party of Women, described the phenomenon as ‘dangerous’ – insisting it is ‘not part of our culture’.

The gender-critical activist told the Daily Mail: ‘The cost to the NHS and social care of this practice is enormous.

‘Subjecting children to this risk unnecessarily is cruel.

‘The reason it continues is political cowardice. The government knows the harm, but it is unwilling to confront the cultural practices of certain communities for fear of being labelled “racist” or “Islamophobic”.

‘So instead of protecting children, it chooses silence and appeasement. When it comes to deliberately bringing children into the world with a high risk of serious disabilities, it is unconscionable to pander to any special group.’

Kellie-Jay Keen, leader of the Party of Women, described the phenomenon as ‘dangerous’ – insisting it is ‘not part of our culture’

Manchester NHS Trust is one of multiple employers to have advertised roles akin to the close-relative marriage nurse over the past year-and-a-half.

A similar position was publicised at Frimley Health NHS Foundation Trust in Slough – as well as ‘close relative’ midwifery and nursing posts in other parts of England such as in Bedfordshire Hospitals and GP practices in Bradford.

Aisha Ali-Khan, a child of first cousins, has previously spoken out about the dangers of promoting the benefits of close-relative marriage.

Ms Ali-Khan said: ‘My parents Mohammed and Barkat were first cousins. Four of their seven children were born with severe disabilities. 

‘Three have died – one of them my twin brother – and I am carer to my beloved older sister Tahira, who has a mental age of about eight. I also have a genetic medical condition.’

The Women’s Rights Activist said it was clear there was a need for a better understanding of the associated risks – not just within affected communities but within the NHS.

But she told the Daily Mail: ‘In an ideal world we wouldn’t need this – there wouldn’t be cousins marrying and having children.

‘It is actually quite a lot of money that is being spent on these positions too – especially when you ask how many other trusts are doing it.

Aisha Ali-Khan (pictured), a child of first cousins, has previously spoken out about the dangers of promoting the benefits of close-relative marriage

‘I think there should be more education around this in schools – for example, learning about genetics in a biology lesson.’

Ms Ali-Khan went on to describe the experience of her friend – who she said was ‘generally very educated and intelligent’ but had ‘no idea that first cousins getting married could lead to this (fetal abnormalities) situation’.

But she said talking to a qualified practitioner was ultimately better than getting advice from ‘some aunt down the street’.

After it emerged the NHS had published an online article citing the ‘various potential benefits of cousin marriage’ Ms Ali-Khan condemned the ‘highly dangerous stance’ in a Daily Mail comment piece.

She said: ‘This stance is highly dangerous, as it encourages a deadly precedent – marry your cousin first, deal with the consequences later. And what might those consequences be?

‘It is nothing short of wickedness, a shocking position by a health service which seems to condone a practice that can lead to serious disabilities and life-changing circumstances.

‘My parents, my siblings and I have suffered an indescribable burden of grief over many years. No parent should have to bury their children; my parents have buried three.’

Marriages between cousins were once commonplace among Britain’s upper echelon and seen as a practice to strengthen alliances and keep wealth and land within families.

Despite falling out of fashion, the practice is still common in some communities, including among Travellers and in South Asian circles.

As of May 2025, it was estimated just one per cent of white British couples were first cousins.

Experts first began tracking the prevalence of consanguinity in Bradford – home to one of the UK’s biggest Pakistani communities – in the late noughties.

Almost 12,500 pregnant women were quizzed about their relationship status with the father of their child.

The Born in Bradford study was later repeated with another cohort of 2,400 women between 2016 and 2019.

The study found that cousin relationships are no longer a ‘majority’ in Bradford’s female Pakistani community amid rising awareness of the birth defect risks.

A decade ago, a Government-funded surveillance project found that 62 per cent of Pakistani heritage women were in consanguineous relationships. This figure has since dropped to 46 per cent, according to researchers.

It was said that the figures from the study could indicate the numbers of Pakistani people marrying cousins across the UK as a whole is falling.

Reasons behind the fall are thought to include higher educational attainment, stricter immigration rules and changes in family dynamics.