Reinstate compulsory pre-marriage medical tests
By Liu Shinan

Vice-Minister of Health Jiang Zuojun revealed a few days ago that less than 3 per cent of China’s newly-weds have a medical examination before they tie the knot. He said the rate had fallen dramatically since China scrapped the compulsory pre-marriage medical check three years ago.
China dropped its compulsory test for couples getting married in October 2003 in the new “Regulations on Marriage Registration,” a move advocating increased respect for citizens’ human rights and privacy. The following year, however, the rate of pre-marriage medical checks plummeted drastically. Take Beijing for example. Only 5 per cent of couples planning to get married received a medical examination. As a result, the incidence of congenital defects among newborn babies soared to 1.4 per cent. The incidence had been about 1 per cent during the six years from 1997 to 2003 in the Chinese capital.
The rate of voluntary medical check-ups is even lower in other places. In East China’s Fujian Province, for example, only 0.98 per cent of newly-weds received examinations in 2004. In the same year, Northeast China’s Heilongjiang Province also reported a low check-up rate 0.43 per cent and a rising incidence of congenital defects.
Falling rates of pre-marriage medical checks across the country also increased the risk of AIDS and venereal diseases spreading.
The situation was so serious that Heilongjiang’s people’s congress passed new regulations in 2005 to resume the practice of compulsory pre-marriage medical examinations.
This is an embarrassing dilemma for the central public health authorities: Resuming the compulsory treatment would mean a kind of retrogression in civilization; but continuing the present policy would be tantamount to giving up an otherwise effective defence blocking marriage and birth-related diseases and defects.
Actually this dilemma reflects the relationship between compulsory administration on the part of the government and the voluntary action of contributing to social goodness on the part of citizens in a broader sense. Less administrative measures and more voluntary public action is certainly the ideal for good management of society and progress of civilization. Voluntary public action, however, is based on citizens’ awareness of their responsibility to society. This awareness needs time to build up. For some issues, it is a slow course.
China began its compulsory pre-marriage medical examinations about 20 years ago. Over the period, Chinese citizens gradually developed a sense of obligation about pre-marriage medical examinations. And people’s awareness of its importance became increasingly stronger until the time when compulsory check-ups were abolished. Why the sudden collapse, then, of people’s willingness to take the test?
The easiest explanation is that people lack conscientiousness. The sudden removal of the requirement gave them the liberty to evade obligation. The final reason, however, lies in the way compulsory examinations were conducted in the past.
First, the examination was conducted in a way that put more emphasis on people’s obligation than on helping them understand the importance, even the vital need, of the check-up. Examinations were done in government-designated hospitals, where doctors and nurses behaved like bureaucrats. Newly-weds were ordered about in different departments. Marriage-related health education was also conducted in a condescending manner rather than in a friendly way. Unpleasant experiences caused repulsion in the recipients of the examination.
To make things worse, the medical examination was costly. A fairly large number of, if not all, hospitals even turned it into a profit-making business. Those being forced to undergo examinations felt they were being ripped off.
Under the circumstances, people took the examination more as an obligation to the government than a necessity for their health and that of their offspring.
Given the fact that AIDS and sexually transmitted diseases have shown a tendency to spread quickly and that the worsening ecological environment has increased the risk of foetal defects, compulsory medical check-ups must be resumed.
But it should be done in a different way from the past practice. It should be free and people should be given the freedom to choose their hospital for the examination.

—The Daily Mail-China Daily news exchange item