Manchester Foundation Trust has closed applications for a 12-month fixed-term position paying up to £44,962 annually for a neonatal nurse to work specifically with families practicing close-relative marriage.
The role, advertised earlier this year, requires fluency in Urdu and seeks a candidate who “values diversity and difference” to support families and enable “informed reproductive decision making” in what the job listing described as a “culturally sensitive empowering way.”
The successful applicant will work full-time on a salary ranging from £37,338 to £44,962, tasked with ensuring “support and improve engagement with genetic services for affected families.” Manchester Foundation Trust represents one of the largest NHS employers in England.
Multiple NHS organizations have advertised similar positions over the past 18 months. Frimley Health NHS Foundation Trust in Slough publicized a comparable role, whilst “close relative” midwifery and nursing posts appeared at Bedfordshire Hospitals and GP practices in Bradford.
The positions emerged after NHS guidance published last month stated concerns about congenital disease risks from cousin marriage are “exaggerated” and “unwarranted” on grounds that “85 to 90 per cent of cousin couples do not have children.” The national average rate for unaffected children stands at 98 per cent.
The guidance acknowledges “risks to child health associated with close relative marriage” but states these should “be balanced against the potential benefits… from this marriage practice.” According to the document, marrying a relative can offer “economic benefits” as well as “emotional and social connections” and “social capital.”
Aisha Ali-Khan, whose parents Mohammed and Barkat were first cousins, has spoken publicly about the genetic consequences of such unions. Four of their seven children were born with severe disabilities, with three having died including her twin brother. She serves as carer to her older sister Tahira, who has a mental age of approximately eight, whilst also managing her own genetic medical condition.
“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,” Ali-Khan stated.
The women’s rights activist condemned NHS guidance citing “various potential benefits of cousin marriage” as a “highly dangerous stance” that “encourages a deadly precedent – marry your cousin first, deal with the consequences later.”
However, Ali-Khan acknowledged the need for better understanding of associated risks within both affected communities and the NHS. She told the Daily Mail that whilst ideally cousins would not marry and have children, talking to qualified practitioners remained preferable to “getting advice from ‘some aunt down the street’.”
She suggested more education in schools, including learning about genetics in biology lessons, could address knowledge gaps. Ali-Khan recounted how an “educated and intelligent” friend had “no idea that first cousins getting married could lead to this (fetal abnormalities) situation.”
Statistics from Bradford, home to one of Britain’s largest Pakistani communities, show cousin marriage rates declining significantly. A Government-funded Born in Bradford study tracking 12,500 pregnant women found 62 per cent of Pakistani heritage women were in consanguineous relationships a decade ago. A follow-up study of 2,400 women between 2016 and 2019 recorded the figure dropping to 46 per cent.
Researchers attributed the decline to higher educational attainment, stricter immigration rules and changes in family dynamics. As of May 2025, an estimated one per cent of white British couples were first cousins, with cousin marriage remaining relatively common in Traveller and South Asian communities.
Kellie-Jay Keen, leader of the Party of Women, described the practice as “dangerous” and criticized the NHS for what she termed turning a “blind eye to an ‘indefensible cultural practice’.” She stated: “The cost to the NHS and social care of this practice is enormous. Subjecting children to this risk unnecessarily is cruel.”
Keen accused the government of “political cowardice” in refusing to confront cultural practices “for fear of being labelled ‘racist’ or ‘Islamophobic’,” choosing “silence and appeasement” over protecting children.
Marriages between cousins were historically commonplace among Britain’s upper classes as a means to strengthen alliances and keep wealth within families. The practice fell from fashion but remains present in certain communities including those of Pakistani and Bangladeshi heritage.
The specialized nursing positions represent NHS efforts to provide genetic counseling and support services tailored to communities where cousin marriage occurs, balancing public health concerns with cultural sensitivity whilst families make reproductive decisions.
