Game of gametes : Congenital diseases imperil future generations

In a society where the term ‘marriage preparation’ predominantly equates to families expending nearly all their efforts and resources into ensuring that the grandeur of their children’s wedding events outshines that of others in their milieu, premarital testing, which has lifetime repercussions for the couple and their posterity, extending far beyond a day or two of frivolous posing and twirling, is unsurprisingly ignored.

Despite several countries in the Middle East and Europe enforcing compulsory premarital screenings against sexually transmitted diseases (STD’s) and genetic ailments for all engaged couples, Pakistan’s legislative bodies have failed to take the matter seriously, allowing families to conveniently avoid premarital testing on the abstract grounds of preserving honour, thereby multiplying the risk of fatal conditions like thalassemia and Rh incompatibility, which can be a major threat to the lives of children born to untested couples.

One such ill-fated couple was Alina and her husband, who despite suffering from anaemia did not consider getting a premarital test for thalassemia. “Today, our five-year-old daughter is a patient of thalassemia, and she requires regular blood transfusions for survival,” despondently shared Alina, who upon living through her daughter’s suffering, regretted her ignorance at not contemplating the need for a premarital test before signing the marriage contract with her husband who too was a thalassemia carrier.

Likewise, Abdul Rehman was another unfortunate parent, who had to bear the repercussions of foregoing a premarital test twice, when he lost two of his three sons due to pre- and post-natal complications arising out of an Rh incompatibility. “Two years after marriage, my wife and I were expecting our first child. Sadly, the baby died in my wife’s womb just a few hours before delivery. Four years later, we were blessed with twin boys. Unfortunately, our joy didn’t last long since soon after birth one of them passed away,” recalled Abdul Rehman, who was told by the doctors that the Rh factor of his blood group did not match with that of his wife.

According to Dr Zainab Hashmi, a consultant gynaecologist, if a man’s blood group is Rh-positive and his wife’s blood is Rh-negative, their child will be Rh-positive but since the mother’s blood will have anti-Rh components, the resultant antibodies can enter the baby’s blood and destroy its red blood cells, causing a miscarriage, stillbirth or neonatal death, which is death of an infant within the first 28 days of life.

“Similarly, if both the husband and wife or one of them has thalassemia minor, then there is a fear that the child born will suffer from thalassemia major. Therefore, premarital testing for conditions like thalassemia, Rh incompatibility, sexually transmitted infections (STI)’s, and hereditary diseases, should be made mandatory for betrothed couples,” urged Dr Hashmi.

Interestingly, contrary to popular speculation, experts assure that premarital tests are nothing more than routine blood tests, which rarely incur high costs. But despite the convenience and affordability, most couples simply express no interest in conducting any medical tests before marriage.

Rabia Yousuf, a sociologist shed light on the fact that in our society medical testing is sought only when a person is sick. “The very mention of premarital testing raises alarm bells for both the boy and the girl, who take it as an attack on their character and vigour. Therefore, we must raise awareness on the importance of these tests, and assure young couples that a simple blood test can allow them to evade trouble later in their married life. Just the way the government has passed a law mandating the minimum age of marriage to be 18 years, there should also be a law setting a prerequisite of premarital testing before marriage,” advised Rabia.