Daily Times

On the 24th of September 2011, Pakistani television and culture changed forever. Fawad Khan and Mahira Khan dazzled audiences with their performance in one of the most influential TV serials in the country’s history: Humsafar. Who doesn’t love a bit of family drama served up with a healthy side of romantic angst, after all? It’s been over a decade and I’m yet to come across something as brilliant.

You may be wondering, what does Humsafar have to do with premarital screening? Is this another attempt to shoehorn science into popular media? Zara coming back to life isn’t supposed to make sense! I’ll grant Humsafar the artistic liberty it deserves, but the conflict that drives the show touches on a real struggle that puts thousands of children like Hareem in life-threatening danger and rips apart as many households. Science and Humsafar are on the same side here: Khirad and Asher are cousins, and that’s where our story begins. Often, families choose to marry amongst relatives, opting for consanguineous marriages as a consequence of antiquated ideas of unity. Recently, modern science and developments in genetic technology have given rise to discussions surrounding the potential risks surrounding consanguineous marriages. As is often the case in our ever-changing world, people often find themselves divided when science raises questions on the tenets of culture.

Premarital screening lies at the heart of this divide. Alswaidi and O’Brien define premarital screening as a medical examination of individuals about to enter into marriage. This test checks for potential risk of blood genetic and infectious diseases like thalassemia, HIV, Hepatitis, etc.

On the surface, such facilities present an objectively beneficial proposition for prospective couples. In Pakistan, however, families are often forced to choose between the well-being of their future offspring or pandering to a social setup rife with stigmas. To understand the nuance of premarital screening and explore its potential applications in Pakistan, it’s important first to understand both the process itself and Pakistan’s attitude towards similar technology.

We are a country that just loves drama, and it’s bound to creep into quite a few aspects of our daily lives.

Unlike an article you’re bound to find discussing the wonders of brand new quantum computers or black hole imagery, premarital screening isn’t a new revolution in science. In fact, it’s been around longer than Pakistan. First deployed in the US during the 1940s to screen for sickle cell anaemia, the process was soon being used across the world. Not only has it been around for a while, but premarital screening is also definitely here to stay: recent advances in screening techniques and improved accessibility have allowed for a much broader application of premarital screening; the process has significantly contributed to a sharp decrease in the incidence of diseases such as cystic fibrosis and metabolic disorders across the world.

These advances are directly correlated with the much wider adoption of premarital screening.

“If everyone’s jumping off the roof, would you do it, too?” Well, if jumping off the roof leads to clear improvements in quality of life and public health, how bad can it really be? Premarital screening’s medical benefits are well-documented and reported across several journals, and it is known to reduce the risk of genetic and infectious diseases in one’s offspring. In some cases, premarital screening can even be a vital tool for medical professionals to guide couples in situations where they are willing to take risks in spite of the results obtained.

It is reasonable to assume that the aforementioned benefits will translate well to Pakistan’s society, especially considering the country’s complicated relationship with genetic illnesses. Every year, over 5,000 Pakistani children are diagnosed with Thalassemia, a blood disease that lasts a lifetime and is exorbitantly expensive to treat. This high incidence of this genetic disease corresponds to transmittance via carriers who do not exhibit symptoms themselves, and estimates show that Pakistan has more than 10 million carriers of Thalassemia.

Practices such as intermarriage and consanguineous marriage lead to a greater risk of Thalassemia in offspring and hence premarital screening offers an alternative approach that preserves a historic practice while protecting the future of several Pakistani households.

There’s also a consideration for the overarching impact on families and society as a whole in Pakistan. It’s no secret that healthcare is often prohibitively expensive for a large majority of the population; treatments for long-term illnesses such as thalassemia and Cystic Fibrosis are practically unaffordable. Beyond the quantifiable, dealing with a long-term illness is often stressful for all members of a family; evidence shows that illnesses such as Thalassemia leave patients’ families with lasting psychological and social impairments.

Premarital screening has the potential to reduce the incidence of such illnesses and mitigate the burdens associated with them.

Let’s check up with Asher and Khirad once again to paint a clearer picture. Asher loves Khirad, and things are going great. They do the responsible thing and get themselves screened. Unfortunately, the results show that any children of theirs will have an elevated risk of developing heart disease. Khirad and Asher don’t want that for their children so they decide to consult with a doctor and work out their best course of action. Since they’re at the doctor’s when Asher’s mother hatches her evil plan, it fails terribly. Hareem is born healthy, and the three live happily ever after. Not a story that would make the best drama, but a better life for everyone involved, wouldn’t you say?

Congratulations, I’ve solved one of the most significant problems Pakistan faces. Well, not quite. In fact, not even close. You see, these benefits only paint one-half of a grander picture because the question of premarital screening extends beyond the medical benefits it represents. The biggest roadblock in the widespread acceptance of premarital screening is Pakistan’s complex socio-religious landscape. Religious scholars have argued that basing the decision to marry someone on the results of a test goes against the ideas of destiny in Islam. This interpretation extends to severe cases where aborting a pregnancy may become necessary, embroiling the practice in controversy. Further, Pakistani culture places a strong emphasis on the compatibility of a couple’s families and social standing when arranging a match, which often relegates the results of premarital testing to a much less significant position. I wouldn’t be surprised if someone told me people put more time into figuring out the colour of the outline on the invitation card than they do thinking about getting screened.

However, it would be amiss to ignore a far deeper issue that extends across Pakistan’s medical sector: inaccessibility. The process in its current form is both expensive and geographically limited. Consequently, a majority of Pakistan’s rural population is unable to access testing facilities, and a major portion of the urban population is priced out of them due to their financial situation. Since premarital screening is not mandated by Pakistani law, access to it is currently restricted to the affluent few. What’s more, the government’s efforts to counter this inaccessibility have been severely limited and considerably ineffective, with only one bill ever reaching the national legislature.

Things in Pakistan are never straightforward. We are a country that just loves drama, and it’s bound to creep into quite a few aspects of our daily lives. As we look ahead, the future of premarital screening remains uncertain, a reality compounded by increasing social division, an economic crisis, and the scepticism we all hold so close to our hearts. There is a potential future where premarital screening is the norm for all citizens of Pakistan, but it is futile to expect that such a future will materialize any time soon.

The writer can be reached at haider18542@gmail.com.