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

On October 1, 2003, the revised Regulations Governing Marriage Registration abolished compulsory pre-marital checkups. At the time, this step received general applause as an indication of social progress and increased respect for citizens?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 increased steadily nationwide. By 2002, the national premarital checkup rate reached 68 per cent. In some developed areas, especially prosperous cities, the figure reached 95 per cent.

Each year about 8-10 per cent of couples were found to have serious hereditary or infectious diseases ?including diseases of the reproductive system, among which sexually transmitted diseases (STD) accounted for a large proportion of cases.

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, more than 12 per cent of the approximately

170,000 checkup-takers were found to have hereditary or contagious diseases each year, according to statistics from the Shanghai Health Bureau.

But in the year following the abolition of compulsory checkups, the pre-marital checkup rate dropped to below 10 per cent. In North China's Shanxi Province, which has the highest rate of infant infections, the rate was only 2.05 per cent in 2004. In Shanghai, only 3.26 per cent 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 children,?said Dr Wu Yu 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 haven't been taken.

Encouraging measures

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 couples?not understanding, even fearing, medical checkups.

In January, a national programme 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.

However, medical experts say further efforts are needed to encourage more couples to take the tests. In some areas including Zhejiang Province, Shanghai and Beijing, the governments have started to provide free checkups for new couples because the investment required for this will be far lower than possible medical costs spent in the future.

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 per cent of the 712 new couples in the district applied for the free service in the first month after the new measure came into effect.

At present, a premarital health checkup 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.

"The free service is encouraging. I will go and have the medical checkup before marriage. It's the responsible thing to do, for the marriage and for myself,?said Billy Chi, a 30-year-old local man who plans to get married soon.

"Providing free medical checkups will definitely encourage more people to take the tests,?said Cao Daming, director of the Marriage Registration Office of Luwan District. "However, the effect of the new measure may be quite limited.?

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 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.

Among the respondents, 18 per cent regarded the checkups as unnecessary, 40 per cent said they would take the checkup, while the remaining 42 per cent claimed "not to care?

"Public education is of vital importance to encourage premarital checkups,?said Chen Linan, president of the International Peace Maternity and Child Health Hospital, adding that: "It takes time. Even if people have a knowledge of the importance of premarital checkups and hold the right attitude to them, they might not take advantage of the service immediately.?