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| COMMENTARY |
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| Year : 2016 | Volume
: 60
| Issue : 4 | Page : 287-289 |
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Premarital health counseling: A must
Sonia Puri1, Anupama Dhiman2, Sagar Bansal3
1 Associate Professor, Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
2 Demonstrator, Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
3 Internee, Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India
| Date of Web Publication | 15-Dec-2016 |
Correspondence Address:
Sonia Puri
Department of Community Medicine, Government Medical College and Hospital, Chandigarh - 160 030
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-557X.195860
 Abstract | | |
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
How to cite this article:
Puri S, Dhiman A, Bansal S. Premarital health counseling: A must. Indian J Public Health 2016;60:287-9 |
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 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],[3],[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 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 adolescents [8] 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 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 application [12],[13],[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. Alam [15] 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 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.
| References | |  |
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| 11. | Jain BB, Roy RN, Ghosh S, Ghosh T, Banerjee U, Bhattacharya SK. Screening for thalassemia and other hemoglobinopathies in a tertiary care hospital of West Bengal: Implications for population screening. Indian J Public Health 2012;56:297-300. [ PUBMED]  |
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| 16. | Alswaidi FM, O'Brien SJ. Premarital screening programmes for haemoglobinopathies, HIV and hepatitis viruses: Review and factors affecting their success. J Med Screen 2009;16:22-8. |
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