SHOW YOUR CERTIFICATE, PLEASE!

From now on, the citizens of Azerbaijan who intend to enter into a marriage will have to present a health certificate along with an application for registration of marriage. This is in line with amendments to the legislation adopted by the Milli Maclis [parliament] last autumn, which came into force as of the beginning of this year.

Amendments to the Family Code of Azerbaijan adopted by parliamentarians provide that persons who are going to marry must undergo a free medical examination at their local state healthcare institutions. Those examined will receive two certificates: one saying that the person was examined and the other describing the state of health proper. Only a certificate evidencing the fact of medical examination is to be presented to the civil registry office. None of its officials has the right to require the submission of a health certificate. Thus, the examination results remain a medical secret. The law does not oblige the newlyweds to acquaint each other with the results of examination. This should be done on a voluntary basis. Of course, if a person has nothing to hide, they will not withhold the certificate from their better half. Also, persons to be married will get counselling on health-genetic, medical and psychological problems and recommendations on issues of reproductive health.

In general, the law is aimed at creating conditions for the formation of healthy families, precluding the birth of children with hereditary and congenital diseases and preventing transmission of severe infections such as hepatitis, HIV, STD and others. A separate provision in the law stipulates that the infection of a newlywed with skin and venereal diseases or HIV/AIDS may justify termination of the marriage.

Sceptics say that, if need be, the desired health certificate can be purchased from clinic staff for a fee, just as certificates for a driving school or employment are obtained sometimes. Is the same fate going to befall this law too?

As regards its social impact, this decision is important and requires responsibility on the part of not only doctors but also ordinary citizens. There is every reason to hope that the citizens will behave prudently this time, at least proceeding from a sense of self-preservation. Firstly, the conclusion of the medical institution on the results of the examination should be stamped and signed by the head of that institution. When registering a marriage, the registry authorities must satisfy themselves that the persons who are about to be married have passed medical examination and are aware of its results. Secondly, if one of the persons married concealed from the other person the presence of a venereal disease or human immuno-deficiency virus (HIV), the latter is entitled to apply to the court for annulment of their marriage. Furthermore, in the case of HIV, a deliberate infection will involve a penal sanction in the form of imprisonment. With a false certificate, a healthy-looking person can get a driving licence or a job but it is virtually impossible to cheat the environment in which the person lives.

The registry offices of Sabayil, Narimanov, and Yasamal districts as well as the House of Celebrations told R+ that as yet, they have not received any forms of the formal health certificate to be presented to the registrar's office, hence marriage applications are accepted without health certificates. Once such forms have arrived, all of the applicants will be notified when and where they can undergo examination.

According to lawyers, this law has been formulated very competently from the point of view of legislation. To give a notion of the extent of its coverage, suffice it to say that as many as 90,000 marriages are concluded in Azerbaijan each year, i.e. about 180,000 people will have to undergo examination. And if any disease is identified in them, they will be treated in a timely manner and will not pose a threat to others. This will also give a possibility to prevent the birth of children with hereditary diseases. During a debate of this law in the parliamentary committee, it was noted that up to 20,000 children suffer from various hereditary diseases in Azerbaijan.

A positive aspect is the compulsory nature of the requirement to pass examination before a wedding. While a test for drug use is not yet provided for, a visit to a psychiatrist is a must. Unfortunately, there is a criminally erroneous stereotype in society that mental health problems in the young can be eliminated by forming a family, which is ostensibly based on the assumption that positive emotions from a wedding and the joy of family life can fix psychiatric deviations. This popular belief is wide-spread not only in Azerbaijan but also in other countries. In the famous Indian film "Bobby" starring Rishi Kapoor, the "evil" parents wanted to marry their son to a girl with a deeply infantile mind of a young child, who was reassured by the doctor that "everything will pass after the wedding". Perhaps it is this factor that underlies unmotivated murders in families, which have become ever more frequent of late.

Medical examination as a method of informing prospective spouses about each other's health is provided for, in one form or another, in the legislation of Turkey, Uzbekistan, Ukraine, Canada, the USA, France and other countries.

In contrast to the Azerbaijani legislation, the Russian legislation, for example, does not provide for liability of a spouse who concealed their disease or other pathology prior to the registration of marriage. Meanwhile, Ukrainian laws stipulate the obligation of the newlyweds to notify each other of the state of one's health and the results of the voluntary medical examination. Concealment of information about the health of one of the spouses, which may result in deterioration of the physical or mental health of the other newlywed, or their descendants, may constitute grounds for annulment of a marriage. Moldova abolished the compulsory medical examination some time ago, explaining that it is a "violation of human rights". However, according to lawyers, there is no evidence of discrimination as the state does not decline to register a marriage even in the face of an infectious disease.

In the meantime, doctors believe that the principle of voluntary participation in a medical examination by persons entering into a marriage, which is embedded in the legislation of many countries, has not paid off since only a very small part of the population undergoes this procedure voluntarily. Moreover, a voluntary procedure involves no liabilities and, accordingly, cannot prevent the transmission of infectious diseases.

The need for mandatory medical examination in the event of marriage is also corroborated by experts of the countries which have already gained experience in implementing this system. "In Turkey, a mandatory examination before marriage has been in place for several years. This system has proved its value in terms of both preventing the spread of infectious diseases and providing the possibility of timely medical intervention," Hakan Tanriverdi, a Turkish speci-alist and a doctor at the hospital of the Ministry of National Security of Azerbaijan, told R+. The subjects of the examination in Turkey are hepatitis B and C, HIV, syphilis and mental disorders. According to the doctor, statistics show an increase in the detection frequency of these diseases in Turkey after the law on mandatory premarital medical examination came into force. However, there is no screening for genetic diseases in Turkey and a visit to a psychiatrist is unfortunately a mere formality. Even such serious diseases as AIDS cannot be considered a justifiable reason for refusing registration of a marriage. The newlyweds are only warned about the presence or absence of a disease.

"It is important that citizens will definitely receive information about treatment options and the possibility to create a family and give birth to healthy children. Falsifications are out of the question. Both the population and physicians understand the significance of this matter, and it is impossible to buy a false certificate of health. Another important point is that such examinations can prevent the worsening of a disease, while early diagnosis can ensure a more effective outcome of treatment," says Hakan Tanriverdi.

Thus, a mandatory premarital medical examination in Azerbaijan will be an important step in protecting the health of the nation, strengthening the foundations of the modern family and improving the demographic situation in the country. Thus, while at first this process is probably going to be purely formal in nature because of certain mindset factors, with time the awareness of the need for medical examination and mutual notification of diseases that hamper the formation of a healthy family will become self-evident even to the inhabitants of the most remote places.