Sitting at a health centre for women and children in Shenyang of Northeast China's Liaoning Province, Xiao Ying has a blank, vacant look.

The 26-year-old woman suffers from a psychiatric disorder and is six months pregnant.

There is a sense of concern among her relatives and doctors. No one knows whether the baby will inherit its mother's unfortunate condition. What doctors do know is there is 25 to 50 per cent chance of a baby being born with similar disorders through maternal passage.

"I was too shortsighted and eager to get her married so that she can have a family of her own," laments Xiao Ying's mother.

Xiao has since been diagnosed as, rather coldly, "not suitable to give birth to children" by doctors at her local hospital. But the advice has come somewhat late.

Before, when premarital health check-ups were compulsory in China, the unexpected fears overshadowing what should be a joyous period, would have never occurred.

Back then, before the knot was tied, medical experts would have warned the happy couple babies were out of the question.

"If she had pre-marriage medical check-up, she could have received instructions from doctors and the worst might have been avoided," says Zhang Li of the Shenyang Health Centre for Women and Children.

The new Marriage Registration Regulation made pre-marriage health check-up optional from October 1 last year. Without the need to collect the bill of health, clean or otherwise, before walking down the aisles, the rate of premarital health checks has declined sharply. At the same time, the number of new borns with inherited diseases has been rising steadily.

The Beijing-based Haidian Maternity and Child Care Hospital found from prenatal screening that the birth defect rate this year has reached 1.78 per cent, already double 2003 figures.

More than 8,000 babies with some form of mental or physical disorder were born in Central China's Hunan Province in the past 12 months.

"Their defects also included hyperdactylia and congenital heart disease," said Hu Rushan, an official with the Health Bureau of Hunan Province.

"Parents of these babies have been burdened with tremendous sorrow and responsibility," Hu said.

In 2002, about 51.33 per cent of would-be married couples received pre-marriage medical check-ups in the province.

However, Hu predicted the rate will fall to less than 5 per cent this year.

New laws

When the new rule for marriage registration began to take effect, many experts and national media hailed the move as a "big stride" towards social civilization in the country.

The new regulation of marriage registration management provided more freedom for would-be couples in deciding their own marriage.

Both parties can voluntarily go to hospitals to have medical check.

The new rules fully protect individuals' rights including privacy. "They (the new laws) also provide a more relaxed social environment for marriage applicants and are in line with the healthy development of personality and society," says lawyer Cheng Yuan with Zeda Law Firm in Central China's Henan Province.

"Getting married is a legitimate right for every citizen. Pre-marriage medical check-ups should be a protective measure to ensure a healthy marriage instead of being a compulsory action formulated by laws and regulations .

"The new regulation respects an individual's rights, so it represents a social advancement," he added.

Nevertheless, some medical experts have grave concerns about the problems arising from the drop in check-ups .

"Voluntary check-ups are a humanistic policy as it aims to respect individual's privacy," said Zhang Xizhi, a doctor with the Maternity and Children Care Centre of Hunan Province. "However, due to a weak awareness among the public, especially in rural areas, people tend to ignore the significance of such health benefits."

If mothers also ignore health check-ups during pregnancy, the chances of birth defects would "grow a great deal," he said.

Zhang said it is an issue that would increase social burden for China's future. He called for effective measures to reverse the trend, including a beefing up of publicity and lowering the cost of the checks.

Zhang is not alone in such views.

Hou Yongtai, director of the Family Planning and Maternity and Child Care Centre in Pingyao County of North China's Shanxi Province, is also facing "unprecedented" difficulties in his work.

Decline of rate

Since the new marriage registration regulation was put into force and the once compulsory check-up made optional, the rate of premarital check-ups fell from previous 90 per cent to almost zero in the county.

Although efforts have been made to advocate the significance of visiting a doctor, there has been little impact.

"In order to intensify the premarital education and improve the pre-marriage check, we have moved the marriage registration office to our centre," Hou said.

Costs were also reduced from the previous 108 yuan (US$13) per couple to 60 yuan (US$7.30).

"Even so, many people are reluctant to pay this, and we can't force them to do so," Hou said.

Many think the check-ups are unnecessary and troublesome, he said.

"They complain they have no time to go to hospital since they are busy with their wedding affairs," Hou explained.

Many take it for granted they are free of possible heredity or infectious diseases, such as HIV. while others complain the check-up in some hospitals is a mere formality, he said.

Unreasonable charges in some hospitals adds to people's reluctance to see if they are healthy, Hou added.

Experts warned it will lead to the omission of the report on hereditary and infectious diseases as well as venereal diseases in particular.

Statistics from Beijing Public Health Bureau reveals that, from 1996 to 2002, a total of 15,794 people were found to have heredity diseases during premarital check-up. Among them, 695 were diagnosed as "not suitable to have children."

Currently, Chinese health departments take three steps to prevent birth defects to ensure healthy births and sound care, including pre-marriage medical check-up, pre-pregnancy education and prenatal and neonatal screening.

If the first-step prevention cannot be guaranteed, the healthy birth will be influenced, medical experts warned.

Besides the increase in birth defects resulting from the lack of premarital checks, what puzzles Hou is the contradiction between different regulations.

According to the government's law of maternity and child care, would-be couples should hold a medical certificate before tying the knot.

However, existing marriage registration regulations say a pre-marriage medical examination is optional.

Wu Xiuping, deputy to Beijing People's Congress, urged legislators to verify the law and make them coherent.

"Meanwhile, efforts must be intensified to make the public understand the significance of pre-marriage medical checks," she said.

"The existing problem does not lie in the system of premarital medical check-up itself, but is a result of the poor implementation of the system," said Professor Jiang Yue in Xiamen University in East China's Fujian Province, who is an expert of the marriage law.

Considering the economic difficulties in some families, experts say medical check-up should be conducted free of charge as a part of social welfare.

Gao Peng, chairman of the Women's Federation of Liaoning Province in Northeast China, said in a proposal at this year's National People's Congress that government departments should offer subsidies to would-be couples.

Chen Shu, deputy-director of All-China Federation of Lawyers, advised medical departments to promote the importance of a premarital check for family health.

"If the awareness of the public is improved, they will go to hospitals for a medical check-up voluntarily," he said.

(China Daily 11/30/2004 page5)