Premarital counselling — a human right

Premarital counselling can play an important role in improving our appalling maternal and child health indicators

Premarital counselling is a means to help couples better plan and prepare for marriage. In some cases, especially in the Middle East, premarital counselling is mandatory for screening couples to prevent genetically transmitted diseases. Premarital counselling is now being routinely offered in most countries including several Islamic nations. Iran provides a good example of an Islamic country where the concept has been successfully applied with the aim of ensuring marital harmony and family wellbeing. The Iranian model covers topics such as family planning; maternal health and nutrition; marital rights; skills to overcome marital disagreements and social pressures.

Premarital counselling in Pakistan can play an important role in improving our appalling maternal and child health indicators. Counselling prior to marriage on preventing pregnancies in ages below 18 and over 35 years and spacing between pregnancies for at least two years can significantly help lower the incidence of maternal and child deaths. Currently, 37% births take place in a short interval of less than two years after the preceding birth. When the inter-pregnancy interval is less than two years, the under-five mortality rate is 122 deaths per 1,000 live births, while the rate is 44 deaths per 1,000 live births for children born at least four years after a previous birth. Furthermore, among women married in the age group 15-19 years, 8% begin childbearing which predisposes them to a higher risk of maternal mortality. Research shows that 18% of married women aged 15-19 years have an unmet need for family planning. Premarital counselling can help reduce this unmet need by providing couples with family planning information so they can plan according to their aspirations and available resources, enabling their children to have a better future.

Another advantage of premarital counselling is that it can help reduce the burden of genetic disorders. We are among those countries which have the highest burden of thalassaemia, a crippling blood disorder. Its prevalence is closely linked to marriages among relatives. Currently in Pakistan, nearly 50% of marriages are consanguineous which increases the risk of genetic disorders including thalassaemia in the offspring. Premarital screening can help identify high risk couples, who must be counselled about the importance of prenatal detection and timely intervention. This can significantly reduce the prevalence of such disorders. Similarly, guidance on specific vaccinations prior to pregnancy can also prevent birth defects in the child.

After the 2017 census, the Supreme Court of Pakistan took suo moto notice of the alarmingly high population growth rate and constituted a team of experts to draw a plan of action to lower this rate. The plan approved by the Council of Common Interests (CCI), includes providing mandatory premarital counselling for marriage registration.

To implement the CCI decision, we will need to adopt a phased approach. Starting with listening to young people about their information needs. Followed by engaging with a wide spectrum of stakeholders including officials of the health, population welfare and local government departments, religious leaders, parliamentarians, and private sector organisations to decide the modalities of introducing premarital counseling in rural and urban settings. Creating mass awareness, followed by legislation on mandatory premarital counselling certification. This sequence will ensure that all the necessary prerequisites are in place for the legislation to be effectively implemented. Lessons from many Islamic countries point to the need for optimal training of the counsellors, appropriate selection of the counselling venue and adequate time spent on the counselling session.

Premarital counselling can play an important role in influencing fertility behaviours, educating couples on their rights and responsibilities and help improve health outcomes.

Published in The Express Tribune, March 23^rd, 2021.

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