In the UK, as many as 46% of women of Pakistani descent have children with their cousins - a shocking rate of "extreme" inbreeding. Kinship is important to British health care because there are now large populations of settlers from South Asia, the Middle East and sub-Saharan Africa (Ahmad 1994; Bittles 2009; Hoodfar and Teebi 1996) who practice inter-cousin marriages. The Pakistani-Kashmiri community is one of the largest ethnic groups in the UK (ONS 2011) and is highly related (Shaw 2009). This group also has a higher prevalence of autosomal recessive disorders (Taylor 2013b), with Pakistani children accounting for 30% of cases of autosomal recessive disorders among all children born in the UK, while their share of the total number of births is only 4% (Modell and Darr 2002). The effect of consanguinity on potential genetic risk is increased by endogamy in subpopulations (Al-Gazali et al. 2006). Endogamy differs from kinship in that it refers to marriage within a closed group that is not necessarily related, but belongs to a subset of the population, such as a kinship network (Bittles 2010a). Within the Pakistani-Kashmiri community, kinship networks such as biraderi exist to determine the hierarchical preference of marriage partners within the community (Ajaz 2013; Darr and Modell 1988; Shaw 2000).