By Amina Rehman Rana (Pakistan)
As marriage is a contractual relationship, all the essential aspects must be fulfilled by disclosing all the relevant facts by keeping egalitarianism in mind as it is the cornerstone of a fair, balanced, and just society. Pré marital medical testing has become imperative to address as of rising health concerns that threaten future generations and pertinent in Pakistan in the context of public health.
Pre-marital medical screening is a testing of couples before marriage for a range of health conditions that could affect their marriage or future offspring. These tests often include screening for genetic blood disorders that includes sickle cell anaemia, thalassemia (a blood disorder causing the body to produce abnormal haemoglobin, leading to anaemia and other health issues, particularly if both parents carry the gene),In Pakistan β-thalassemia (β-thal) trait frequency ranges between 5.0-7.0%, thus, there are more than 10 million carriers in the country; and every year, around 5000 children-are diagnosed to carry β-thal major (β-TM) in Pakistan, blood borne diseases that includes HIV (Human Immunodeficiency Virus), Hepatitis b (lead to both acute and chronic liver disease, increasing the risk of liver cancer or cirrhosis), Sexually Transmitted Infections (STIs) that includes HIV/AIDS, Gonorrhoea, Herpes, Syphilis, Hepatitis C (out of a total of 4,199,195 individuals screened, 81,266 (1.94%) tested positive for HCV, 71,688 (1.7%) tested positive for HBV, and 6,711 (0.15%) tested positive for HIV. The total number of positive cases across all three infections was 159,665 (3.80%), Infertility Tests that includes Ovarian Health,Sperm Count ,Rh Factor Test (Rh incompatibility between partners can lead to complications during pregnancy, such as hemolytic disease in the newborn) about 10% of pregnancies involving Rh-negative mothers carry the risk of Rh incompatibility when the fetus inherits Rh-positive blood from the father ,Hereditary (Genetic) Diseases that includes Breast Cancer (breast cancer are linked to genetic mutations (like BRCA1/BRCA2) that can be passed down from parents to children (researchers estimate that only around 5 to 10 out of 100 breast cancers (5 to 10%) are caused by an inherited faulty gene),Colon Cancer, Kidney Diseases ( conditions like polycystic kidney disease (PKD) can be inherited and cause cysts in the kidneys, leading to kidney failure), Diabetes. These are tests that should be done of both male and female before their marriage.
The primary purpose of pre-marital medical screening is to address health concerns and mitigating transmission genetic or infectious ailments but also impacts matrimonial life that leads to mental health issues, emotional turmoil, erodes trust and in many cases divorce. The goal of pre-marital medical screening is to protect well-being and relation integrity, so it is imperative to add drug test into the regimen as it is much like medical condition (rehabilitation programs and counselling should be offered, with a focus on helping individuals rather than penalizing them), substance abuse can devastate both partners that leads to health consequences and irrevocable strain on the relationship this test would safeguard the physical or mental wellbeing but also fortify mutual responsibility within marriage.
Legislation on pre-marital medical screening should be promulgated in Pakistan, with the government ensuring medical screenings are economically affordable or accessible for individuals across all the strata of society and for those who possessing health cards these tests should be rendered free of cost. The medical reports should be verified or duly authenticated by doctors appointed by government and these verified reports should be mandatorily appended to the marriage registration documents or submitted to registrar.
Islamic scholars have an imperative role to be played in endorsing pre-marital medical screening by issuing fatwas by considering Pakistan, s Islamic ethos. For cultivating societal acceptance public awareness campaigns should be disseminated through mosques and religious gatherings as being Muslims individuals seek counsel from religious authorities for guidance.
In Islam, human life is perceived as a unique blessing from Allah, and therefore, it needs to be honoured and protected.
“If anyone slays a human being, unless it be (in punishment) for murder or spreading corruption on earth, it shall be as though he had slain all mankind; whereas, if anyone saves a life, it shall be as though he had saved the lives of all mankind” (Quran, 5: 32)
,this verse emphasizes the immense value of human life and the responsibility to protect it that is the main purpose of pre-marital medical screening that contribute to overall health of society and this is the key tenet of Islamic teaching.
As dignity and privacy are two fundamental rights for all individuals so confidentiality is one of the most imperative factors to be considered in medical screening and medical reports must be treated with utmost discretion as the paramount concern regarding pre-marital medical screenings is the protection of privacy and remedial action should be prioritized if any medical issue arises before the marriage proceeds.
In 2004 ,Saudia Arabia and UAE introduced a pre-marital medical screening law that required or made mandatory for couples to do medical tests before marriage to detect genetic disorders and infectious diseases like Sickle Cell Anemia, Thalassemia, Hepatitis B & C, HIV/AIDS, Syphilis and Rubella (for women).In Saudia Arabia, before 2004 it was estimated that around 5% to 10% of the population carried genes for these diseases, with high rates of children born with hereditary disorders and hereditary diseases like sickle cell anemia and thalassemia also increasing in contagious marriages (marriages between relatives due to cultural practice) due to lack of medical screening but the implementation of pre-marital medical screening law a significant reduction has been showing that in some regions, the number of marriages at risk for producing children with thalassemia or sickle cell anemia dropped by 60%, Hepatitis B and C infections have also seen dropped after screening became mandatory. In UAE, before the implementation of the pre-marital medical screening law, it was estimated that 1 in 12 individuals were carriers of individual genes 8.5% of Emiratis were passing genetic disorders to their offspring, and Infectious diseases like HIV and hepatitis due to lack of screening before marriage but after implementation of screening law 50% decrease has been reported fromThalassemia Center in Dubai within a few years of screening law enforcement and Infectious diseases like hepatitis decreases 20-30%, especially in populations that regularly undergo pre-marital screening also caught and treated early with the help of medical interventions programs that are considered a public health success, particularly in terms of reducing the burden of genetic and infectious diseases in both countries. Pakistan can draw parallels or inspiration from other Islamic nations like Saudia Arabia and UAE with similar religious or cultural norms, which have successfully instituted mandatory pre-marital screenings without facing societal resistance.
Author is a practicing lawyer with three months of experience at a law chamber. She is also an advocate for social change, writing insightful articles on issues like human rights and gender equality. Passionate about both law and social justice,
