Abstract
This article examines the complex interplay of cultural practices, genetic health risks, and evolving legal frameworks surrounding consanguineous marriage, with a focus on England and Wales. Consanguineous unions, increase offspring's risk of autosomal recessive genetic disorders and congenital anomalies due to heightened homozygosity. The 'Born in Bradford' study revealed that 37% of babies in the cohort were born to related parents, with over 60% of marriages in the Pakistani-origin population being consanguineous. This was associated with a near doubling of the congenital anomaly risk (3% to 6%) and accounted for an estimated 30% of all congenital anomalies and 25% of infant mortality in Bradford. While Norway and Sweden have recently banned or are set to ban first-cousin marriages, citing public health and forced marriage concerns, England and Wales maintain a permissive stance. Proposed legislation, like the Marriage (Prohibited Degrees of Relationship) Bill 2025, aims to prohibit these unions and is argued to mitigate NHS strain. However, such proposals face significant human rights challenges (right to marry, privacy, non-discrimination) and concerns about driving the practice underground. The paper concludes by advocating for nuanced, culturally sensitive public health strategies-including enhanced genetic counselling, targeted education, and proactive screening-to empower informed choice and improve health outcomes without legal coercion, aiming to balance state responsibility with individual and cultural freedoms.