In December 2024, Conservative MP Richard Holden proposed a bill to ban marriage between first cousins (see BioNews 1269).
Members of Parliament debated the Marriage (Prohibited Degrees of Relationship) Bill, with Holden arguing that first-cousin marriage is problematic; creating issues to health, freedom and our national values. Primarily, he proposed that first-cousin marriage should be banned due to the increased risk of inheriting a serious disorder.
The British Society for Genetic Medicine (BSGM) has several concerns about the proposed bill, including that Holden misunderstands the genetic risks associated with first-cousin marriage.
We are an independent body that supports the promotion, encouragement and advancement of genetic and genomic science in clinical and research practice for the public benefit. We have always taken an active role in considering social, ethical and legal issues. As such, we have written a Parliamentary Briefing in response to the proposed bill.
The response from the BSGM argues that:
- The bill is based on misunderstandings about the genetic risks associated with first-cousin marriages.
- The bill will have a negative impact, due to stigmatisation, on healthcare for women and children in communities where first-cousin marriage is common.
- The bill will create further distrust within those communities, and build barriers to them accessing appropriate healthcare and other services.
- The bill fails to recognise the benefits of first-cousin marriages, including the strengthening of family bonds and care arrangements within the extended family.
- The bill seems to conflate first-cousin marriages with the issues of forced marriages and so-called honour killings.
- The bill appears to be in contravention of Article 8 (right to respect for private and family life), Article 12 (right to marry) and Article 14 (protection from discrimination) of the Human Rights Act 1998.
Unrelated parents have a 2-3 percent chance of having a baby with a genetic condition or congenital anomaly, whereas parents who are first cousins have a 4-6 percent chance. Most of this increased risk is due to recessively inherited genetic conditions. This means that most babies (94-96 percent) born to parents who are first cousins do not have a genetic condition or congenital anomaly.
Many other factors can increase the chance of babies being born with genetic conditions or congenital anomalies, and are not prohibited in the UK. These include:
- The use of assisted reproductive technology.
- The age of the father (if the father is aged 35 or older).
- The age of the mother (if the mother is aged 19 or younger, or is aged 35 or older).
- Smoking or vaping.
- Drinking alcohol.
- Taking prescription drugs.
There are several adverse consequences of discriminating against and stigmatising couples in first-cousin marriages and their communities. Dr Aamra Darr, senior research fellow at the University of Bradford and director of genetics communication diversity at Breaking Down Barriers, and colleagues write in the Journal of Community Genetics about the negative effect experienced by couples in first-cousin marriages and their communities when genetic risk information is discussed with an emphasis on first-cousin marriage. This is in contrast to when the discussion is led with the increased risk of having a baby with a genetic condition or congenital anomaly being due to recessive inheritance. Dr Darr suggests that focusing on first-cousin marriage negatively affects the couples' engagement with clinical services.
In addition, emphasising first-cousin marriage rather than recessive inheritance alienates communities. Dr Mubasshir Ajaz, from the Institute for Health Research at the University of Bedfordshire, and colleagues write in the Journal of Community Genetics that when communities are singled out, they do not accept any evidence that may link first-cousin marriage with genetic conditions. Furthermore, Dr Ajaz stressed the need for culturally sensitive information on genetic risk and clinical services.
A number of projects and programmes have raised awareness about inherited conditions and improving access to genetic counselling and testing in communities in which first-cousin marriages are common.
Nasaim Khan and colleagues explain in the Journal of Community Genetics that people value information about genetic conditions and how these are inherited. This, in turn, empowers them to make informed choices about marriage and reproduction. In another paper, Dr Darr and colleagues explain that people are keen to access accurate, clear and understandable genetic information.
Improving genetic literacy is crucial to enable and empower people to make informed decisions about genetic testing before and/or during pregnancy. However, this can only work effectively when trust is established and maintained at the community level, as Professor Sarah Salway from the department of sociological studies at the University of Sheffield and colleagues discuss in the Journal of Community Genetics.
Meghan Cupp, academic researcher from University College London Institute of Child Health, and colleagues have conducted a study highlighting the importance of involving the community in efforts to increase awareness around first-cousin marriage and genetic risk. Publishing their research in the Journal of Community Genetics, they emphasise the need for enabling educated choices and the value of co-developing and co-designing educational and clinical services with the community.
Overall, we believe that these strategies can alleviate some of the negative consequences of discriminating against and stigmatising couples in first-cousin marriages and their communities.
In conclusion, misunderstandings and misinformation about first-cousin marriages have a negative impact for minority groups and marginalised communities. This in turn risks increasing social tensions, further alienation, worsening social and health inequity, and adverse societal and economic impacts.
The BSGM and its members work with patient groups, with the NHS across the four nations, with Government and with devolved administrations to identify ways to improve the healthcare system for all communities. Communities where first-cousin marriage is high, such as Irish Travellers and British Pakistanis, should be encouraged to engage with clinical services, including genetic counselling. This will bring health and economic benefits to the population, and will promote unity between and within communities. Citing health as a reason to ban first-cousin marriage is not justified.
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