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Commentary

Premarital Health Counseling: A Must

Sonia Puri1, Anupama Dhiman2, Sagar Bansal3
1
Associate Professor, Demonstrator, 3Internee, Department of Community Medicine, Government Medical College and Hospital,
2

Chandigarh, India

Summary
Premarital Health Counseling (PMHC) is emerging as a growing trend worldwide. The couples are provided with accurate
and unbiased information and assistance, who are planning to get marry with the aim of screening, educating, and
counseling about nutritional disorders, communicable diseases, medical conditions, hereditary/genetic disorders, and
guiding for a healthy pregnancy. Premarital screening and adequate counseling are essential for changing attitudes
toward consanguineous marriage particularly in places where consanguineous and “tribal” marriages are common,
resulting in a high incidence of genetic disorders. Although making PMHC obligatory in India may appear to be a
very exciting and promising proposal, its implementation still has various ethical issues and other barriers that need
to be addressed.

Keywords: Genetic/hereditary disorders, premarital health counseling, screening

Premarital Health Counseling (PMHC) is emerging as a
growing trend worldwide. Couples all over are accepting
it in their quest for a safe marriage, disease free life as
well as healthy future progeny. Based on the well‑known
phrase and now a cliché, “Prevention is better than Cure.”
PMHC helps to avoid many health and stress problems
that may follow. Couples are provided with accurate
and unbiased information and assistance. One important
misconception that needs to be addressed here is that
PMHC does not just include genetic counseling.
The operational definition for PMHC involves a
consultation that comprises of history taking, medical
examination, and laboratory investigations of both
the partners who are planning to get marry with the
Corresponding Author: Dr. Sonia Puri,
Department of Community Medicine, Government Medical
College and Hospital, Chandigarh ‑ 160 030, India.
E‑mail: soniagpuri@gmail.com
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aim of screening, educating, and counseling about:
nutritional disorders such as iron deficiency disorder;
communicable diseases such as HIV, hepatitis B, hepatitis
C, and trichomoniasis that may spread to the partner and
to the offspring; medical conditions such as honeymoon
cystitis that occur postmarriage; hereditary/genetic
disorders such as thalassemia, hemoglobinopathies;
family planning; and guiding for a healthy pregnancy.1
The issue of PMHC is of great importance in Saudi Arabia
because of high prevalence  (55%) of consanguineous
marriages.2‑4 Several extensive studies have shown that
among the offspring of consanguineous marriage, there is
an increased prenatal morbidity and mortality rate together
with increased incidence of congenital abnormalities and
mental retardation.5 The incidence of consanguinity is
relatively high in Yemen with predominantly first cousin
marriage. This might be related to the deeply rooted social
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DOI: 10.4103/0019-557X.195860

Cite this article as: Puri S, Dhiman A, Bansal S. Premarital health counseling:
PMID: ***
A must. Indian J Public Health 2016;60:287-9.

© 2016 Indian Journal of Public Health | Published by Wolters Kluwer - Medknow

[Downloaded free from http://www.ijph.in on Friday, December 16, 2016, IP: 177.248.143.50]
288 Puri, et al.: Premarital counseling
and cultural beliefs in the country.6 Providing knowledge
about prevalent and avoidable disorders such as iron
deficiency anemia having prevalence among Indian
women as 57.9%7 and its risk may increase postmarriage
because of inadequate diet, successive pregnancies, and
inadequate birth spacing being important attributable
factors. It can be easily prevented by iron supplements
and emphasizing the need for a good diet in pregnancy.
Other conditions such as polycystic ovarian disease
having prevalence of 9.13% among Indian adolescents8
can be diagnosed and treated.
Guidance for a safe and healthy pregnancy is provided
right from the time when the couple is trying to conceive
like advising for appropriate folic acid supplementation
to avoid any neural tube defect or anencephaly in the
offspring. Proper information about the importance of
regular antenatal checkups, diagnosis, and treatment of
conditions such as diabetes mellitus, hypertension, thyroid
disorders, and even anemia associated with pregnancy and
about the risks of conceiving at a young or old age, for
example, Down syndrome and Turner syndrome.
Education and counseling regarding sexual health and use
of contraception forms an indispensable part of PMHC,
especially in developing and overpopulated countries
like India. Any doubt regarding contraception should be
cleared, and cafeteria approach of contraception must be
presented before the couple.
Screening tests and genetic counseling before marriage
are worthwhile aspects of preventive medicine. This not
only helps to prevent a hereditary disorder in the child
but also reduces the psychologic stress to the parents
as well as decreases the burden on the government for
providing adequate health and financial resources.9 With
the advent of genetic tests, diseases that were difficult to
diagnose are now aided by genetic screening tests. These
are new tests and not very well known among clinicians.
More importantly, the implications of the results can
be explained to patient and relatives in a professional
manner, since most of the times, the results have an
immense emotional impact on families. The education
and counseling accompanying genetic testing is provided
by genetic counselors in all developed countries as this
is essential for the decision‑making process and dealing
with test outcomes.
Premarital screening and adequate counseling are
essential for changing attitudes toward consanguineous
Indian Journal of Public Health, Volume 60, Issue 4, October-December, 2016
marriage particularly in places where consanguineous
and “tribal” marriages are common, resulting in a
high incidence of genetic disorders as in Oman there
is high incidence of hemoglobinopathies.10 In 2012,
screening for hemoglobinopathies in Burdwan Medical
College and Hospital, West Bengal, showed 29.3% of
participants being positively stressing the need of PMHC
for identification and prevention of high‑risk marriages.11
Medical examination and laboratory tests are mandatory
before marriage application12‑14 in many countries such
as the USA and China because of some important health
problems, such as STDs and hereditary diseases. In North
India, apex institutes such as PGIMER, Chandigarh and
AIIMS, New Delhi, are also running marital psychosocial
clinics for providing counseling to the couples planning
to get marry.
Realizing the importance of PMHC, many countries have
implemented Nationwide Screening programs, while in
some countries like UAE, it has made mandatory for the
couples to undergo a screening process before getting
married. Kahtani et  al.,1 in Riyadh city, found 75.2%
of study population accepted the concept of PMHC
but rejected the enforcement of PMHC by legislation.
Alam15 also found that perception of female students
toward PMHC of King Saud University was generally
positive. Acknowledging its value to public health,
Government Hospitals and Health Institutions in India
have started providing this facility. However, still its
utilization is limited because of certain barriers such
as lack of appropriate knowledge, education, religious,
and cultural reasons along with fear of outcome.16 In
contrast to premarital screening for hereditary disorders,
premarital screening for HIV and hepatitis viruses is still
highly controversial, both in terms of ethics and in terms
of cost effectiveness.16
Although making PMHC obligatory in India may
appear to be a very exciting and promising proposal, its
implementation still has various ethical issues that need
to be addressed such as PMHC be free of charge or the
cost minimal in the health institutes and the assurance of
total confidentiality. Knowledge in the general population
about the PMHC is low. Implementation of school
and university educational campaigns is important.
Therefore, counseling could be imparted in adolescent
health clinics under RMNCH + A, and anganwadis can be
involved through integrated child development services
activities. Fears with regard to PMHC were expressed
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Puri, et al.: Premarital counseling
toward the confidentiality of PMHC test results, and it
was felt that social and psychological problems would
ensue from abnormal results.
In the present, improving knowledge and prevailing
misconceptions among the youth and college‑going
individuals are very important toward improving its
acceptance and utilization in the near future.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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