Last week, a preacher in Nakuru refused to officiate a wedding in which a couple were to be joined in holy matrimony.
Joyce Waithera and Paul Waithaka spent at least a million shillings to prepare for their big day only for Apostle Jesse Karanja to frustrate their efforts.
Apostle Karanja, it is said, demanded for an HIV test and the couple yielded. He refused to admit the test and asked for a second test.
When results from the second test were presented to the clergyman he said the doctor’s handwriting was ineligible. The back and forth lasted a whole day and by 6pm the apostle had resolved that it was too late to hold the wedding.
What transpired with this couple and man of the cloth has been the subject of discussion for days with many Kenyans questioning the importance of medical tests before marriage.
It is the view of Amos Alumada, marriage and family expert at Pan African University, that premarital HIV test – as are other health tests – would be important to foster trust between the couple but not necessarily to guarantee the stability of the marriage.
“For instance,” Amos says, “you can be in perfect health at the point of getting married then suffer a debilitating disease later: would it mean that your spouse leaves?”
Margaret Kagwe, a counselling psychologist, believes that tests like HIV before saying ‘I do’ are important as part of disclosure between a couple.
“Before entering the marriage, it is important that you and your spouse commit to full openness,” Margaret points out.
If you suffer from a chronic illness or your family has a history of a certain condition, it is important to disclose.
Disclosure, Margaret explains, should not be limited to health. “Any contentious issue in your past should be placed in the open. For instance, if you have a child out of wedlock your spouse should know beforehand.”
In the old days, Margaret says, marriage was solely based on love or pre-arranged customarily.
“There was no disclosure,” she says. “But disclosure is important to prevent shocks of mistrust when a situation leads to an outing of a secret.”
According to Maragaret, if a spouse refuses to divulge certain aspects of their past it should cause alarm. “If they don’t want to talk about everything regarding their lives before meeting you then there is something they are hiding,” she says.
‘Till death do us apart’ is the ideal bar every married couple look up to. But the domestic tinderbox is complex in nature, observes Margaret, hence the need to disclose every possible aspects of one’s life.
In the wake of the Nakuru circus we researched far and wide to find out the important tests that every couple should do before committing to marriage to help you navigate the next and crucial stage of your life better.
1. Chronic medical conditions
Chronic medical conditions often last a lifetime, says Dr Jacqueline Kitulu, a family health physician. There are a myriad of chronic illnesses. Notable ones are hepatitis, diabetes, some types of cancers, syphilis, herpes, HIV and epilepsy among others. It is important that couples know their health status regarding these health conditions, notes Dr Kitulu.
However, the physician says the importance of testing for these illnesses should not be tethered to marriage. “These are tests that I advise every individual to do and find out the status of their health; regardless of marriage prospects or not,” she says. It is worth noting that a spouse suffering from a chronic condition may need care round the clock to be provided by their partner hence the need to find out prior to marriage.
“Knowing whether you suffer from these diseases or not helps you make informed decisions not just with marriage but also with other issues like which job to take up,” Dr Kitulu says.
2. Blood group test (Rhesus factor test)
Blood tests are important especially when it comes to pregnancy. Crucial in blood tests is the Rhesus factor. Women with rhesus negative blood group married to rhesus positive husbands have a greater chance of rhesus incompatibility.
“The first baby is usually born without trouble,” says Dr Elly Odongo, a gynaecologist at Moi Teaching and Referral Hospital. “Problems start with subsequent pregnancies when the mother’s body forms antibodies to attack the foetus leading to intrauterine death and miscarriages.”
Dr Odongo says blood group tests are not a standard of care for couples who want to marry: it is however, for pregnant women. Even so, technological advancement has provided a solution for Rhesus incompatibility.
Doctors can administer anti-D immunoglobulins at 28 weeks of pregnancy and save the foetus. According to Dr Odongo the blood type mismatch would only require counselling and proper medical intervention.
3. HIV and Sexually Transmitted Diseases (STD)
HIV is primarily transmitted through sexual intercourse, Dr Kitulu says. With marriage comes sex and with sex the potential for transmission of an infection from one spouse to another. A 2016 report found that married couples account for the highest number of new HIV infections (44 per cent).
Sex within marriage, notes Amos Alumada, is without suspicion and hence bears a higher risk when one spouse is a carrier of an STD. That being said, Amos does not believe that a positive HIV result should prevent a couple from marrying.
“The importance for the test is for the couple to make an informed choice: they know what to expect if they decide to go into marriage.” STDs like herpes, syphilis and gonorrhoea will be important even at the time the couple may decide to conceive as there is risk of the baby contracting the diseases.
4. Fertility tests
In 2001 Cecilia Wairimu got married in a church wedding. But by year six of matrimony, the marriage was falling apart. What happened? “We couldn’t have a baby,” Cecilia says. “The man became abusive. He accused me of not giving him a child. And then one day I came back home to find the house empty. He had taken everything and left.”
The ability to have babies matter to many spouses – especially in the African setting – Cecilia opines. Later Cecilia would lose a second marriage in the same manner. Her third marriage, which yielded children (after corrective surgeries) is strong today. For a couple who would love to have children, fertility tests may be necessary.
Dr Wanjiru Ndegwa of Footsteps to Fertility Kenya observes that marriages are greatly tested by infertility. While the doctor does not agree that fertility tests (testing for viability of sperms, eggs or if fallopian tubes are blocked) should be a basis for marriage, she agrees that these tests may prove important especially for individuals who suspect that they may never be able to sire or conceive.
5. Genotypic tests
Genes are the software that parents give to their children. Conditions like albinism, Marfan syndrome and sickle-cell disease are passed down from parents to children through genes.
According to Dr Elly Odongo, these tests become important especially when an illness proves prevalent in a certain geographical area. “For instance sickle-cell disease is prevalent in the Kenyan coast and in Nyanza,” he says.
“Gene testing to find out if spouses are carriers of the sickle-cell genes will assist them make informed choices when they chose to conceive as well as prepare them for the possibility that their offspring may suffer the disease.”
6. Mental health status
Dr Lincoln Khasakhala, a clinical psychologist, postulates that sound mental health would be good for couples in marriage. Some mental health conditions can be picked out easily – like autism spectrum disorders and cerebral palsy. Some are hard to make out, Dr Khasakhala points out.
“These include schizophrenia, bipolar disorder and some neurodevelopmental disorders,” he adds. These illnesses will need patience and understanding on the part of the healthy spouse. Knowledge of a spouse’s mental health state would help their partner prepare well in case the sick spouse needs long-term care.
“Also, some mental health conditions are hereditary and may be passed down to offspring,” Dr Khasakhala notes. “It behooves the couple to understand and internalise such possibilities.”