The NHS used to be about treating the sick and saving lives. In recent years, however, it has strayed repeatedly into the territory of propaganda, making all sorts of unscientific claims to please minorities. Asking men whether they might be pregnant seems more about appeasing trans activists than medical necessity, and now an NHS body has faced criticism for promoting cousin marriage, a practice linked to well-documented health risks.

Children whose parents are first cousins are at higher risk of birth defects and genetic conditions such as sickle cell disease and cystic fibrosis. According to guidance published last week, however, cousin marriage is linked to “stronger extended family support systems and economic advantages”. NHS England’s Genomics Education Program appears unaware that so-called “extended family support systems” can be deeply damaging for women and children in the British Pakistani community, where the practice is more common than among other demographics. These networks often enforce honor codes, making it almost impossible to seek help from outsiders.

That’s reflected in official figures, which suggest that Asian women experience lower levels of domestic abuse than other sections of the population. It’s contradicted both by anecdotal evidence and a charity that says that a “hidden crisis” among south Asian women was exposed during the Covid pandemic. The Freedom Charity says it saw a surge in cases of forced marriage and honor crimes, yet “stigma, societal pressure, and fear of dishonor often prevent victims from seeking help”.

Cousin marriage exacerbates the situation. If your father-in-law is also your mother’s brother, the pressure to keep quiet and avoid bringing shame on the family is stronger. It’s a big factor in the isolation of women and girls, raising questions about whether they can refuse when their families insist on cousin marriage.

It’s obviously questionable whether the NHS should be in the business of promoting certain types of family structures at all, and especially not if it ignores the very different experience of men and women in traditional Asian families. What benefits fathers and husbands in any culture may be to the detriment of daughters and wives, and cousin marriage is a prime example.

One of its purposes is to keep wealth within the family. The independent MP Iqbal Mohamed acknowledged as much when he said in the House of Commons that cousin marriage “helps put families on a more secure financial foothold”. These are presumably the “economic advantages” referred to in the new NHS guidance, exposing the naïveté of taking such statements at face value.

Cousin marriage is practiced in patriarchal cultures where men hold the power. It’s a way of maintaining the status quo and that may mean persuading teenage girls to marry instead of finishing their education, for example. It perpetuates existing inequalities, and it’s mothers who shoulder most of the responsibility of caring for disabled children.

There was a time when institutions like the NHS would have prioritized health over everything else. Now, though, it seems to be run on a principle of not causing offense to anyone, even if that means abandoning evidence. Anyone except women, that is, given that they are the big losers in this shift to ideology-based medicine.

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Joan Smith is a novelist and columnist. She was previously Chair of the Mayor of London’s Violence Against Women and Girls Board, and is on the advisory group for Sex Matters. Her book Unfortunately, She Was A Nymphomaniac: A New History of Rome’s Imperial Women was published in November 2024.

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