This article has been written by Sneha Jaiswal, currently pursuing BA LLB (Hons.) from Christ (Deemed to be University) Delhi NCR. This article analyzes the most important concern of pre-marital examination and its implementation. Additionally, it tries to explain the relationship between premarital tests and the right to health under Article 21 which ensures the Right to life and personal liberty.

Introduction 

One of life’s key milestones is marriage. Marriage is the cornerstone of emotional, healthy, and familial connections, as well as a vital building block of society. It is the commitment of two individuals who have decided to take the next step in their relationship. Horoscopes and mental compatibility aren’t the only factors to consider for couples considering marriage. Compatibility is essential in every relationship, but it is more important in marriage. Acceptance and adjustments lead to understanding. Physical compatibility is one factor that may be easily assessed based on both couples’ well-being and health.  A happy and stable family is built on the foundation of a healthy marriage, which protects family members from genetic and infectious illnesses. As the excitement of wedding planning rises, one crucial item on the checklist is sometimes overlooked: a pre-marital health test. 

In this article, the author shall be discussing its significance and its relation with Article 21 of the Constitution of India. Pre-marital health screening is a test that evaluates the health of couples who are thinking about getting married and informs them about their existing health situation. It also identifies potential health issues that might endanger their spouse and children if they decide to establish a family in the future. Knowingly, this is one of the primary reasons why so many individuals are expressing interest in a pre-marital health test these days.  

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Premarital medical examination

A premarital medical examination is a series of laboratory and clinical examinations offered to any partners before they sign a marriage contract in order to advise them on how to have a happy married life and healthy offspring, and therefore a healthy family and society. Premarital screening is intended to provide medical advice on the risks of spreading illnesses such as HIV/AIDS, sickle cell anaemia, and other blood disorders to the other partner/spouse or children, as well as to present partners/spouses with choices to help them prepare for a healthy family.

Many studies suggest that the medical examination before marriage is one of the most important preventive health care because it is very important to avoid many diseases, especially genetic and familial diseases, that are prevalent in societies. This may be attributed to the increase in the proportion of relatives marrying each other and the increased possibility of confluence genes that cause hereditary disease. Where there is a higher risk of these diseases occurring when relatives marry, the odds of inheriting recessive genetic characteristics are higher when each parent possesses the disease’s causal character, severely affecting family life and leading to disintegration and disorientation.

The relevance of pre-marriage blood testing is still not well understood among Indians. According to physicians, a pre-marriage blood test is critical to avoid unfavorable future situations such as the delivery of a kid with life-threatening diseases.

Objectives

Premarital health examinations (PHEs) are beneficial for preventing sexually transmitted infections (STDs) within a couple, detecting reproductive issues or hereditary disorders that may be passed down to kids, and providing family planning and genetic health counseling. The purpose is to get a blood test before getting married will help you avoid spreading any genetic, infectious, or transmissible illnesses to a spouse or children.

  • Some hereditary blood disorders (such as sickle-cell aneamia and thalassemia) and infectious diseases (such as hepatitis B, hepatitis C, and HIV/AIDS) are being controlled.
  • Increasing public understanding of the notion of a complete and healthy marriage.
  • Reducing the amount of stress placed on hospitals and blood banks.
  • Keeping families from experiencing social and psychological issues as a result of their children’s suffering.
  • Reducing the financial burden of treating wounded people on the family and community.

As a result, couples who are going to marry soon should have their premarital screening done at least a few months before the wedding day, so that they may better arrange their life, as the premarital compatibility certificate is only valid for a limited period. When necessary, the infectious illness screening might be repeated.

Significance 

Premarital screening raises awareness of each person’s medical condition and its potential impact on the relationship.

  • Determine the intended bride and groom are in good health.
  • Developing knowledge of hereditary blood disorders such as sickle-cell aneamia, aneamia, and thalassemia, which may be handed down from one generation to the next.
  • Infectious illnesses and sexually transmitted diseases such as syphilis, hepatitis B, hepatitis C, and HIV are being controlled.
  • Avoiding social and psychological issues for families dealing with serious illnesses like HIV/AIDS and thalassemia.
  • Create a suitable treatment strategy to enhance fertility by identifying any issues or health-related disorders that might influence pregnancy and the fetus.
  • Raising awareness of the importance of having a complete, responsible, and healthy marriage.

Functions 

Premarital health examination (PHE) is a preventative health strategy that includes:

  1. early detection of sexually transmitted diseases (STDs), 
  2. reproductive issues, 
  3. hereditary illnesses that can be passed down to offspring, and 
  4. advice on family planning (number of children in a family) and genetic health. 

PHE can provide appropriate and required actions to prevent the transmission of diseases among couples, particularly curable sexually transmitted diseases, STDs, to enhance successful conception and fecundity, or to prevent genetic disorders from being handed down to the next generation.

Checking reproductive system : to enhance confidence before pregnancy

A vaginal ultrasound is a kind of technology that uses sound waves with high frequency to create images of the inner parts and it is performed using a probe that is placed into the vagina of an individual. It helps to analyze the inner structure maximally used during pregnancy to study reproductive organs so that harm like miscarriages can be avoided.  Vaginal ultrasonography is being done by the obstetrician. It helps  in the examination of:

  1. The structure of the vagina,  uterus, fallopian tubes, ovaries, and cervix.
  2. Monitoring the growth and development of an unborn
  3. Myoma uteri, cysts, and polycystic ovary syndrome (PCOS), as well as excessive monthly flow, irregular menstruation, and menstrual clots, are all abnormal disorders that reduce the chance of pregnancy or result in unhealthy pregnancy.

The necessity of premarital screening for women with low chances of getting pregnant

According to the World Health Organization (WHO), women are most fertile during the age of 18-35. Women’s fertility begins to decline beyond the age of 35. Infertility is defined as the inability to conceive babies regardless of having sexual intercourse even without a contraceptive for a long period. An individual also faces infertility even though with regular periods. Statistical data shows that a large number of couples, up to 20-30 percent, face the issue of unhealthy pregnancy or sexual-related concerns, resulting from medical issues with either male or female or with both that interfere with pregnancy. Due to these kinds of concerns, premarital screening comes as a savior for the affected people.  Fertility in females is known to decline consistently with age, hence the risk to develop infertility rises substantially. 

The family plays a significant role in disability prevention by identifying the factors that cause disability through awareness and maintaining the safety and health of children before and after birth, thus preventing the occurrence of disability in their members through medical examinations prior to marriage. It is possible to minimize the transfer of some diseases, as well as the transmission of some mental and biological problems caused by hereditary factors, between couples. Despite the fact that pre-marital medical screening is required to avoid inherited diseases, many people in society hold different opinions on its relevance. Although a modest percentage of couples get pre-marriage blood tests these days, the number is still relatively small. When it comes to their habits and beliefs, people are generally resistant to any new activity that they are unfamiliar with.

Fortunately, due to advancements in technology, around 70 percent of couples who opt for premarital tests get to know about abnormalities that are causing harm to them which require timely care. Premarital or reproductive testing advice, delivered by professionals should be followed by people with due care to avoid the chances of conception.

The pre-marital medical examination case at the High Court of Madras 

Apart from other violations like child marriages, denial of the right to select a life partner, forced marriages against one’s choice, elderly men marrying young girls, and so on, are the number of illustrations of marital crimes. This instance is an ideal illustration of how weddings are handled by concealing the prospective spouse’s flaws, sicknesses, and incompetence. This case was heard before the Madras High Court on the 5th of August, 2016, and it sheds light on the need for pre-marital screening before marriage.

Facts of the case: 

The petitioner, an unfortunate young lady, has pleaded before the Family Court for annulling the marriage. She contends that after her marriage when she went outside on their first trip. She got to know that her husband has a huge wound on his left thigh and when she asked about it, he told her that he is having a boil on his left thigh that got bursting oozing pus. Due to this, the marriage could not be consummated. The petitioner states that the trip was a nightmare to her as pus was oozing out of the wound during the trip. On their return, they consulted a skin specialist and he advised him surgery. But pre-testings revealed that he has a hole in his heart. Additionally, after surgery, it was investigated that shocked and shattered the petitioner as it revealed traces of Cancer in the specimen.

It is further contended that the respondent’s health issue was discovered when he was young and that the respondent and his family members purposefully concealed it from the petitioner and her family members prior to marriage.

Issues raised 

The devastated petitioner sought divorce from the respondent after feeling tricked and cheated. Despite the petitioner’s and her parents’ requests, the respondent refuses to agree to a mutual divorce. In addition, the respondent is infertile and unable to have children is a counterblast to the petitioner’s divorce petition at which the respondent seeks restitution of conjugal rights.

Later, during the trial, the medical records produced by the respondent himself before the Court proved the hole in his heart and cancer. Then, the only question to be decided is as to whether there was the suppression of these serious health problems by the respondent when he got married to the petitioner.

Judgment of the case

The Court rejected the respondent’s claim that he told the petitioner about his heart disease prior to marriage and came to the firm judgment that the respondent married the petitioner fraudulently by concealing his heart disease. Therefore, for suppression of the respondent’s health problems, the marriage between the petitioner and respondent has to be annulled.  Since the respondent’s health condition is established by medical records, and it is also clear that the respondent was aware of his disease prior to his marriage, it must be concluded that the respondent has deceived the petitioner for marrying.

Significance of this case concerning pre-marital screening 

If the pre-marital examination of the respondent had been done, the diseases would have been diagnosed and the marriage would have certainly been stopped.

This case would amply demonstrate how a young lady suffers as a result of a marriage that was done without sufficient investigation and verification of the groom. Therefore, it is essential for the prospective brides’ and grooms’ parents to conduct the required investigations before the marriage. However, most weddings are performed in haste and hurry, and the participants are inevitably victims of violations of their “dignity,” “human rights,” and “right to a decent and meaningful life,” as provided under Article 21 of the Constitution. Many difficulties related to medical concerns, marriage failure due to fraud, non-disclosure of health problems, and other issues may be avoided if pre-marital tests are performed.

Potential risks : if premarital checkups are ignored

If a couple avoids premarital screening, they may face the following health issues:

  • Inadequate family planning for having children
  • Time waste for addressing fertility-inhibiting diseases that may have been detected and treated sooner.
  • Excessive worry and tension during pregnancy as a result of poor planning and preparation
  • Increased risk of significant pregnancy problems such as aneamia, diabetes, thyroid disorders, and eclampsia, a life-threatening pregnancy condition characterized by high blood pressure, protein in the urine, convulsions, and coma.
  • Preterm labor, miscarriage, and poor fetal growth and development are all examples of fetal difficulties.

However, issues are not restricted to health; couples may have difficulties in their daily lives and relationships, including:

  • Post-marriage issues: Failing to undergo fertility testing might ruin a couple’s relationship. Negative findings from a premarital test may result in the wedding being canceled in rare instances. On the other hand, completely avoiding these tests may jeopardize the marriage. 
  • Unnecessary expensive procedures: Couples who are unsure about their fertility may be led to pricey therapies in order to avoid infertility. When couples choose to participate in numerous expensive procedures, they are frequently unaware of their real fertility. These therapies are ineffective and might even cause significant health concerns in some people.

Many cases are reported at various places, in which a lenient approach has been taken, or due to less awareness regarding this people face unnecessary trials that they can avoid at the very onset simultaneously save their expenses on treatment and trials that result due to its absence. Even though many couples are looking forward to getting married, many are wary about premarital examinations. These tests, on the other hand, are a crucial component of general health.

What happens if the findings of the premarital screening reveal an anomaly or a high risk

Following the acceptance of the individual with an abnormal test, the couple meets with a doctor for additional counseling and clarity on the screening results. The doctor will explain the issue, answer any questions they may have, alleviate any worries they may have, and propose appropriate choices so that they can make an informed choice. That is why pre-marital screening is recommended by many medical specialists as well as judiciary also tries to aware people of this respective test so that people may avoid aftermath consequences that carry the potential to destroy peace in the family.

Recommendations to premarital screening

  • Before the pre-marital examination, it is recommended that the couples fill out separate questionnaires on every sex experience, sickness history, family history of genetic disorders, family planning, and reasons for taking PHE.
  • Staff carefully examine the responses to the completed questionnaire and recommend STD and genetic illness testing.
  • For the PHE program, many packages are advised. STDs (syphilis, human immunodeficiency virus (HIV), gonorrhoea, and hepatitis B), reproductive issues (sperm analysis), and offspring or inherited diseases should all be tested as part of the PHE program’s baseline screening (rubella, thalassemia).
  • Couples with a family history of a certain hereditary illness should undergo further testing. After finishing the PHE program, counseling on family planning, genetic health, and result explanation are suggested.
  • Awareness regarding pre-marital screening is necessary as it additionally avoids the trials that happened due to non-disclosure of health issues before marriage.

How to pick an appropriate diagnostic center for a pre-marriage test

Before picking the finest diagnostic facility for their pre-marriage test, a couple should think about a few things.

  • The diagnostic center’s repute
  • If the diagnostic center employs high-tech equipment 
  • The report is delivered on time
  • The accuracy of the diagnostic center’s reports
  • The center’s hygiene and sanitation are up to par
  • Staff members’ and nurses’ expertise and experience
  • Affordable rates
  • Home collection services are available.

Role of women : pre-marital screening

Premarital health checks for men and women are comparable, there are certain extra tests for women who want to start a family in the future. Between the ages of 18 and 35, women are most fertile. Their fertility begins to diminish once that timeframe has passed. Premarital screening not only assists in discovering problems that impair fertility but can also help in increasing the odds of conceiving.

Before getting pregnant, vaginal ultrasounds are frequently suggested to evaluate a woman’s reproductive system. The imaging scan offers a good view of the reproductive organs, making abnormalities and grounds for worry simpler to spot.

In this domain, there has been a minimal study on the impact of gender. However, it has been discovered that the majority of the time, it was women who recommended having a PHE, which is not unexpected considering how active women are in raising the next generation. Such gender differences are significant in PHE counseling and advertisement availability. Suggestions for promoting PHE may be most useful when directed at women. One option is to teach students about the role and value of PHE in schools, with a focus on young women.

Premarital screening and the right to health: Article 21

The Supreme Court of India in Bandhua Mukti Morcha v Union of India & Ors (1983) defined the right to health under Article 21 of the Indian Constitution, which ensures the right to life, as there is no express acknowledgment of the right to health or healthcare in the Constitution. 

The premarital medical examination is a concern under the Right to health that may safeguard an individual from harm that may be recognized after marriage. There are many instances in which Honourable Courts have interpreted the need for premarital testing to avoid the issues. Additionally, showed the requirement of awareness among the people to acknowledge the premarital screening.

Premarital screening from a human right’s perspective

Premarital testing not only violates the right to privacy, but it also violates human rights, particularly the “right to marry” and the “right to have a family.” It considers obligatory premarital testing to be a basic ‘human rights problem,’ citing Article 16 of the Universal Declaration of Human Rights, which gives a right to an individual of the required age to marry and have a family irrespective of discrimination on the basis of race, country or religion. Inadvertently stigmatizing persons who may be at risk of infection and who may choose not to marry because they are afraid of a positive test and the questions that family members may ask.

Other concerns raised include a lack of privacy, like in the example from Malaysia, one Muslim couple having to ‘submit a certificate exposing their HIV status to the state religious department while seeking for a marriage license.’ The number of people involved in the testing and counseling procedure undermines the right to privacy and confidentiality, with often no clear guidelines or protocols as to who has access to the results and where this information could be disseminated, and potentially catastrophic consequences in terms of social stigma and discrimination if confidentiality is breached.

Furthermore, others have objected to such measures, particularly in Asia and the Middle East, such as India. People argue against premarital testing for a variety of reasons, including the increased risk of stigma and discrimination for HIV-positive people, the issue of a test-taking place during the ‘timeframe,’ the role of the state in limiting women’s rights, and the conclusion that ultimate responsibility lies with the individual. They argue that, rather than supposedly protecting women’s rights, premarital testing can denigrate and disempower them, because if both parties test negative before marrying, the woman will be less able to negotiate to condemn the use of safe sexual practices, leaving them vulnerable and at risk of infection.

They also believe that rather than using coercive obligatory testing techniques, the state’s responsibility should be to establish an enabling environment for obtaining information about testing that is conducive to voluntary counseling and testing. These services would be well-received by the public, and they would be effective in preserving and improving health. Only by giving proper education and training to primary health care professionals on all health and social concerns could public literacy on pre-marital checks be increased.

International Covenant on Economic, Social, and Cultural Rights (ICESCR), which was adopted by the United Nations General Assembly on December 16, 1966, and supervised by the UN Committee on Economic, Social, and Cultural Rights. Taking into account, Article 12.2 of the International Covenant on Economic, Social, and Cultural Rights (ICESCR)  that defines the Right to Health; “ the right of everyone to the enjoyment of the most elevated achievable standard of the physical and psychological well being” that also mentions about the right for the prevention of the disease, the right to treatment and control that creates a need for the foundation of prevention and instruction programs for health-related concerns such as sexually transmitted diseases (STDs), particularly HIV/AIDS, & those influencing sexual and contraceptive wellbeing, just as the advancement of social determinants of good wellbeing.

As per the United Nations Convention on the Rights of the Child, which was adopted in the year 1989“ says that “the family, as the fundamental group of society and the natural environment for the growth and well-being of all its members, particularly children, should be afforded the necessary protection and assistance so that it can fully assume its responsibilities within the community,”.

Framework for the implementation of the Right to Health

As per the WHO, In this case, the framework of Availability, Accessibility, Acceptability, and Quality should be enough for implementation of the Right to Health.

  • Availability alludes to the availability of pre-marriage and pre-pregnancy genetic mentoring and testing administrations at specific offices/focuses the nation over.
  • Accessibility implies governments should give it free or at a diminished expense for the couples planning to wed soon, and it ought to be accessible without prejudice as pre-marital screening is expensive. Information about consanguinity and its effects on public health, as well as assistance for consanguineous couples expecting to marry soon, ought to be accessible through TV, radio, the web, papers, versatile applications, banners, and different means.  Accessibility might vary among rustic and metropolitan districts, destitute and affluent communities, and rich and helpless areas.
  • Acceptability suggests that the previously mentioned administrations stick to clinical morals and are socially appropriate, for example, being mindful of gender needs and keeping up with the privacy of premarital screening results and individual wellbeing data. 
  • Quality alludes to the previously mentioned services being logically and medicinally appropriate, just as of top-caliber; this requires educated wellbeing laborers and appropriate equipment. Simultaneously, it is evaluated from both the wellbeing framework and consanguineous couples’ perspectives.

The ability to marry and have children is a basic human right. Article 23 of the International Covenant on Civil and Political Rights (ICCPR) gives the right to an individual of marriageable age to marry and simultaneously recognizes the right to start a family.  Human rights ideas should be used to guide all components of the premarital screening program, may include planning, design i.e. defining strategies, objectives, implementation, monitoring, and evaluation. Nondiscrimination, involvement, inclusion, and responsibility are among the ideals by UNICEF, Human Rights-Based Approach. Personnel working in premarital screening programs can also attend introductory training in this human rights-based approach.

According to WHO, all accomplices should contribute to the implementation of pre-marital programs. Concerned authorities shall enact laws, religious leaders shall reconsider therapeutic abortion if the fetus is afflicted or diagnosed with a grave congenital malformation, employees in primary health care, researchers, doctors, geneticists, disease prevention and control, and social services, subject-matter experts, mother and child health care.

The program’s monitoring and evaluation should be presented in terms of progress toward attaining goals in terms of the program’s allotted budget and government spending, percentage of couples who have access to the screening program, cost-effectiveness analysis, rates of infectious diseases (e.g., hepatitis B, hepatitis C, and HIV/AIDS), and genetic-recessive diseases (e.g., hepatitis B, hepatitis C, and HIV/AIDS), congenital malformations among children, inborn errors of metabolism diseases (e.g. mucopolysaccharidosis, phenylketonuria), multifactorial disorders (mental retardation, asthma, diabetes, and epilepsy) and sensorineural deafness, consanguine.

Outlook of the people : pre-marital screening

Marriage is a significant event in a couple’s lives since it marks the beginning of their plans to create a family and ushers in a new stage in the development of emotional, social, familial, and healthy connections. A premarital test is a health examination of couples who are about to tie the knot, in which they are tested for genetic, infectious, and transmissible diseases in order to decrease the risk of disease transmission to each other and their children.

Few people believe that knowing your partner’s genetics will not only provide you with the necessary precautions and treatment options, but it will also help you understand the tendencies of health conditions in your partner, such as cholesterol and blood pressure levels, and it will help couples better care for their partner, whereas others believe that there are certain things you need to know. Marriage is the start of a new and exciting adventure. It’s ideal when both partners are aware of each other’s health. There’s no going back after you’ve tied the knot.

Another issue about premarital examinations is that some individuals feel that if abnormalities in the findings are discovered, the couples would be separated, and it will prevent the suffering people from having a family and a tranquil existence. Like; for example, In India:

Indian status

Premarital screening is regarded as a human tragedy that may have been avoided. If physicians conduct premarital clinical tests, it would prevent not only impotent from marrying but also marriages between persons suffering from severe and incurable illnesses. Furthermore, governments should prioritize addressing these types of human problems before imposing this screening procedure, since doing so will cause mayhem in society. It was also emphasized that women were the worst victims in such situations and that it would be a violation of women’s basic human rights, as well as their right to a good and meaningful existence.

Unfortunately, there are no regulations in India that require pre-marital screening, and there is a social stigma associated with requesting such testing before a wedding. For example, In Australia, premarital screening is required for all couples. The regulation is now in effect in the United Kingdom and China as well. People are hoping that India would follow suit shortly.

There are many cases due to which people fear getting a pre-marital screening. Like in the case of Surjit Singh Thind v. Kanwaljit Kaur (2003), the husband wanted to produce his wife’s virginity test since she was requesting a divorce because he was impotent. The Court dismissed the husband’s claim, ruling that forcing a woman to take a virginity test is a violation of her right to a dignified existence and her right to privacy under Article 21 of the Indian Constitution.

International scenario 

The necessity for Pre-marital Health Examination (PHE) implementation in terms of service differs country-to-country. Except in Heilongjiang, China mandates couples to undergo PHE before registering for marriage, and PHE is no longer required for getting a marriage certificate after 2003. Saudi Arabia made it necessary for anyone planning to marry to take PHE in 2003. Couples contemplating formal marriage in Iran are required to go through a series of screening procedures in government-run laboratories. In the United States, several states mandate premarital serologic screening for syphilis, rubella, HIV, and other diseases. PHE is not needed in Taiwan, nor is it covered by National Health Insurance. In Taiwan, just 7-23% of married couples reported having PHE. Couples in Australia are required to undergo premarital screening. The regulation is now in effect in the United Kingdom and China as well.

In 1973, Cyprus was one of the first countries to make -Thalassaemia premarital testing obligatory. Iran (1997), Saudi Arabia (2004), and the United Arab Emirates (UAE) were among the nations that participated in the program recently (2011). The usefulness of premarital testing for -Thalassaemia in the Middle East was investigated, and it was discovered that it reduced afflicted births in countries where prenatal screening is available and therapeutic abortion is considered, such as Turkey, Iran, and other Middle Eastern nations.

The goods covered in PHE differed according to the policies of every country. Rubella, a dangerous illness produced by a virus that exclusively affects women, and HIV testing is needed for premarital couples in several states in the United States, is included in the mandatory PHE in Saudi Arabia, and the voluntary PHE in Heilongjiang, China.

In Saudi Arabia, Iran, Heilongjiang, China, and Taiwan, hepatitis is tested as part of the obligatory PHE. In Saudi Arabia, thalassemia is tested as part of the required PHE, whereas in Taiwan, it is covered in parts of the voluntary PHE. In Saudi Arabia, screening for G6PD deficiency, sickle cell aneamia, and hemophilia is included in the obligatory PHE. PHEs, in other words, are more concerned with sexually transmitted infections or genetic disorders than with reproductive issues.

Conclusion

Premarital health examinations (PHEs) are beneficial for preventing sexually transmitted infections (STDs) within a couple, detecting reproductive issues or hereditary disorders that may be passed down to kids, and providing family planning and genetic health counseling. However, nothing is known about the PHE program’s implementation. Premarital testing programs that give credible and unbiased information should be used to educate couples. The entire image is influenced by family history, hereditary factors, age, nutrition, exercise, weight control, and addictions. Pre-marital screening aids in the detection of potential health concerns and dangers for both the couple and their offspring. Couples should be examined so that they may better understand their genetics and take precautions or treatments as needed.

References 

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