The abolition of the national system of compulsory premarital medical checkups one year ago has led to a rapid increase in the rate of birth defects in China, and if the government fails to take measures, it could lead to a still more serious pubic health problem within three to five years, medical experts warned.

On October 1, 2003, the revised Regulations Governing Marriage Registration abolished compulsory pre-marital checkups. At that time, the draconian step received wide applause as an indication of social progress and increased respect for privacy.

Prior to that, the 1994 Law of the People's Republic of China Concerning the Mother and Infant Care made pre-marital checkups mandatory.

The proportion of new couples receiving premarital medical checkups had increased steadily nationwide. By 2002, the national premarital checkup rate reached 68 percent. In some developed eastern areas, especially the prosperous cities, the figure even hit 95 percent.

Earlier statistics have shown that each year about 8-10 percent of couples were found to have hereditary or infectious diseases, including diseases of the reproductive system, among which sexually transmitted diseases (STD) accounted for a large proportion of cases, doctors said.

In 2001, among the 8.79 million couples receiving checkups around the country, about 140,000 were found to be suffering from diseases relevant to marriage and child-bearing. Among these, around 20,000 couples were found to be infected by an STD, including 84 HIV carriers and AIDS cases.

In previous years prior to 2001, more than 12 percent of the approximately 170,000 checkup-takers were found to have hereditary or contagious diseases each year.

Abolition of Mandatory Check-ups

But in the year following the abolition of compulsory checkups, the pre-marital checking rate dropped to much below 10 percent. In north China's Shanxi Province, which has the highest rate of infant infections, the rate was only 2.05 percent in 2004. In Shanghai, only 3.26 percent of newlyweds took the checkups in 2004.

In 2003, 648 people were found with syphilis through premarital health checkups in Shanghai. In 2004, the disease was detected in only 13 people through a radically reduced number of premarital checkups.

"Some of the carriers had no idea of their situation since the disease can only be detected through special checks. This poses great danger to their partners or their offspring, said Wu Yu, a physician of the Shanghai Reproductive Health Technical Instruction and Training Centre.

Epidemiologists predict that the number of infants with birth defects due to hereditary or infectious diseases will increase within three to five years if effective measures are not enforced.

Given the worsening situation and increasing number of infant birth defects, the government is taking actions to improve public awareness of the importance of premarital checkups.

Gu Xiulian, vice-chairwoman of the Standing Committee of the National People's Congress and chairperson of the All-China Women's Federation said a lack of public education combined with poor services had led to new weds "not understanding, even fearing, medical checkups".

In January, a national program to promote premarital medical checkups and associated education was launched jointly by the State Council, the Ministry of Civil Affairs, the Ministry of Health and other departments.

Free Premarital Examination

In some areas including Zhejiang, Shanghai and Beijing, the governments have started to provide free checkups for new couples, a measure welcomed by brides and grooms.

In Shanghai, the downtown's Luwan District launched a free premarital checkup service on January 1. The number of new couples registering for premarital checkups has since increased. About 60 percent of the 712 new couples registered in the district applied for the free service in January, 2005.

In other districts of the city, a premarital health checkup now only costs a couple 140 yuan (US$16.90), a sum which is almost negligible compared to the tens of thousands of yuan spent on a wedding ceremony.

"Providing free medical checkups will definitely encourage more people to take the tests," said Cao Daming, director of the Marriage Registration Office of Shanghai.

Hospitals providing the service are also making additional efforts to attract more new couples for medical checks.

"Previously, local hospitals providing premarital health checkups concentrated on the tests themselves, rather than providing consultation and advice," said Wu, adding that the situation made many people unwilling to take the tests, thinking them unnecessary.

Wu said local hospitals had now taken some measures to improve their services.

"Newlyweds can now order extra tests, according to their particular requirements, for instance blood type or ultrasound tests," said Wu.

Local premarital health checkup providers have now also begun to put more emphasis on providing consultation for newlyweds, an aspect often ignored previously.

Yet other factors hinder the spread of checkups, beyond those of cost or service.

A survey by Fudan University of 1,000 couples, in Shanghai, last year revealed that a lack of time rather than expense was the primary reason for not having a checkup. The study also revealed that concern about the absence of effective protection of individual privacy and confusing the tests with ordinary health checkups also kept people from taking them.

(Shanghai Star February 20, 2005)