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Thalassemia test
before marriage.

One blood test for each partner can prevent most cases of thalassemia major. Some countries made it part of getting married, and the results were dramatic. Here's what they did, what happened, and how couples in India, Pakistan and beyond can do the same.

By the DontMarryYourBro team · Updated October 2026 · 9 min read · How we fact-check

The short answer

  • If both partners carry beta-thalassemia trait, each pregnancy has a 1 in 4 chance of thalassemia major.
  • Cyprus cut thalassemia major births from an expected 30–50 a year to fewer than 5 with premarital screening.
  • Iran's national program, launched in 1997, reduced affected births by about 70% within a few years.
  • India has an estimated 35–45 million carriers and 10,000–12,000 affected births a year; Pakistan sees at least an estimated 5,000 new patients a year.

Why test before marriage?

Thalassemia trait is usually silent: carriers feel healthy and often don't know. The risk appears only when both partners carry it. Testing before marriage or pregnancy gives couples the most time and the most options.

  • Worldwide, over 330,000 babies are born each year with a serious hemoglobin disorder; about 56,000 of them have thalassemia.
  • India: about 3.5–4% of people carry beta-thalassemia trait, ranging from 1% to 17% across communities. In one South Gujarat screening of nearly 33,000 students, carrier rates reached about 10% among Lohana and Sindhi students.
  • Pakistan: carrier rates are estimated at about 5–8%.

Thalassemia also clusters in families. A landmark Pakistani study found that 31% of relatives of affected children were carriers, compared with none in a comparison group, and 8% of married couples in those families were both carriers. If someone in your extended family has thalassemia, testing matters even more.

Cyprus: the country that went first

Thalassemia was once a major public health burden in Cyprus, where about 1 in 7 people carry beta-thalassemia trait. Laboratory screening began in 1978, and from 1983 the Church required a carrier certificate before marriage. Births of children with thalassemia major fell from an expected 30–50 a year to fewer than 5.

Iran: a national program

Iran approved a national program in 1995 and rolled it out in 1997 as part of the mandatory premarital blood tests. By the end of 2001, about 2.7 million couples had been screened and 10,298 at-risk couples identified. About 29% of at-risk couples chose to separate, 53% married anyway, and the rest were undecided. Prenatal diagnosis was permitted from 1998. By 2000, affected births were running at about 30% of what was expected.

Saudi Arabia: testing, with the choice left to couples

Saudi Arabia made premarital screening for sickle cell disease and beta-thalassemia mandatory in 2004. Couples receive their results, but marriage certificates are issued either way. From 2004 to 2009, about 1.57 million people were tested. Of 5,370 at-risk couples followed up, about 26% chose not to marry, a share that rose steeply over the period, and the number of at-risk couples per 1,000 tested fell by about 60%.

The lesson from all three countries: information works best alongside good counseling and real options, like prenatal testing and IVF, so couples who still want to marry can protect their children too.

Pakistan: laws on the books

  • Khyber Pakhtunkhwa: the Preventive Health Act 2009 requires premarital screening reports for thalassemia and hepatitis C.
  • Sindh: passed a thalassemia prevention law in 2013–14, but it was reported in 2017 as largely unimplemented.
  • Punjab: passed a law in 2025 making thalassemia screening mandatory at admission to schools, colleges and seminaries.
  • Nationally: a bill for premarital screening of couples and their blood relatives was reported passed by the National Assembly in March 2026.

Implementation has often been weak, so for now, testing is mostly up to couples and their families.

India: recommended, not required

India has no national law requiring a thalassemia test before marriage. National guidelines recommend screening during pregnancy, one-time screening of school students and premarital counseling in colleges. Many hospitals and diagnostic labs offer premarital thalassemia packages.

How to get tested

  • Complete blood count (CBC): small red cells are the first clue.
  • Hemoglobin HPLC or electrophoresis: confirms beta-thalassemia trait.
  • DNA testing: often needed for alpha-thalassemia trait.
  • Expanded carrier screening: covers thalassemia plus hundreds of other inherited conditions in one test. More on what thalassemia trait means.

Test both partners. If one of you is a carrier, the other's result is what decides the risk.

If you both carry it

You still have options: testing a pregnancy early, IVF with embryo testing, or going ahead fully informed. A genetic counselor can walk you through each one. We'll never tell anyone not to marry. We just think every couple deserves to know.

This article is general information, not medical advice. Talk to your doctor or a genetic counselor about your own results.

Sources

  1. Modell B, Darlison M. Global epidemiology of haemoglobin disorders. Bulletin of the WHO (2008)
  2. Colah R et al. Global burden, distribution and prevention of β-thalassemias in India (2014)
  3. Patel AP et al. Thalassemia trait among students in South Gujarat. Indian J Hum Genet (2012)
  4. Ahmed S et al. Screening extended families for genetic hemoglobin disorders in Pakistan. NEJM (2002)
  5. Kountouris P et al. The molecular spectrum and distribution of haemoglobinopathies in Cyprus. Scientific Reports (2016)
  6. Cyprus Mail: Thalassaemia prevention methods need modernising (2023)
  7. Samavat A, Modell B. Iranian national thalassaemia screening programme. BMJ (2004)
  8. Memish ZA, Saeedi MY. Six-year outcome of the national premarital screening programme in Saudi Arabia. Annals of Saudi Medicine (2011)
  9. North-West Frontier Province (Khyber Pakhtunkhwa) Preventive Health Act, 2009
  10. The News: Laws vacuum (on the Sindh thalassaemia law, 2017)
  11. Geo News: Thalassemia screening mandatory for student admissions in Punjab (2025)
  12. National Assembly of Pakistan: premarital thalassaemia screening bill (2026)
  13. Medical Dialogues: Health Ministry issues national policy on thalassemia (2017)
  14. Baig et al. (background estimate of new thalassaemia patients in Pakistan). BMJ Open Ophthalmology (2023)

Test both of you, from anywhere.

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Questions people ask.

Is a thalassemia test mandatory before marriage in India?

No. As of 2026, India has no national law requiring it. National guidelines recommend premarital counseling and screening during pregnancy, and many labs offer premarital thalassemia tests.

Is a thalassemia test required before marriage in Pakistan?

Some provinces have laws: Khyber Pakhtunkhwa requires premarital screening reports, Sindh passed a thalassemia prevention law, and a national premarital screening bill was reported passed by the National Assembly in 2026. Enforcement has varied, so couples often need to arrange testing themselves.

Which test shows thalassemia trait?

A complete blood count followed by hemoglobin HPLC or electrophoresis shows beta-thalassemia trait. Alpha-thalassemia trait often needs a DNA test. An expanded carrier screen covers both.

Can two people with thalassemia minor marry?

Yes, legally. But each pregnancy has a 1 in 4 chance of thalassemia major, so couples should talk to a genetic counselor about their options, such as prenatal testing or IVF with embryo testing.

Did premarital screening work in other countries?

Yes. Cyprus reduced thalassemia major births from an expected 30–50 a year to fewer than 5, and Iran's national program reduced affected births by about 70% within a few years.