The Reason People Used To Have To Get Blood Tests Before Marrying

Premarital blood testing may seem pretty odd to us now, but it was once normal across the United States. Despite some prevailing myths, it has nothing to do with the potential for incest — a problem in tiny, insular countries like Iceland, but not so much in America.

In reality, the tests were initially instituted due to concerns about disease and infection. There are a whole host of gross illnesses that premarital blood tests could be used to check for, from gonorrhea to tuberculosis. Rubella, for example, was once a chief concern that these tests could help control. Now a routine vaccination, this nasty virus is of particular concern to pregnant women and can cause terrible birth defects and a risky delivery. Easily the biggest driving factor behind the legislation was syphilis, a debilitating disease that is now easy to cure with antibiotics but once presented a terrifying sexual health risk. Back when it was still pretty taboo to talk about sex, mandatory blood testing was a way of forcing couples to confront the problem, potentially preventing someone from acquiring a death sentence along with their marriage license.

While syphilis has been around for a long time, it became a particularly big concern during 1930s, when marital testing was made mandatory in many states. The illness can cause a range of terrible symptoms from blindness to brain damage.

America's syphilis problem

While today the illness is hardly ever mentioned, syphilis was once an enormous health problem that was often spread by philandering husbands or anyone who regularly visited sex workers. It has also often been associated with soldiers, people who tend to care little for societal taboos when enjoying what could be their last day on earth. The enormous martialing of manpower during the 20th century's two world wars for example caused a major spike in syphilis across the globe. According to the Journal of Military and Veterans' Health medical journal, during World War I only Spanish flu caused more medical absences among American servicemen.

By the 1930s, Surgeon General Thomas Parran decided to take action to slow the epidemic and called for mandatory blood tests. These appear to have been reasonably effective, and by 1938, 26 states had introduced pre-martial tests. In New York alone, the new rules caused marriage rates to drop by 41 percent seemingly overnight, as those infected suddenly became shy about getting down on one knee (via The Washington Post). Although penicillin had already been discovered in 1928, an effective treatment for syphilis would not be developed until 1942.

Premarital Blood Tests and HIV

In the 1980s, Ronald Reagan put forward a proposal to introduce widespread premarital blood testing for HIV. The president argued that tests should be routine, although he added that there should be no legal penalties for those who refused. Reagan's idea got a frosty reception, and he was booed in public for making the suggestion. Nonetheless, both Louisiana and Illinois introduced mandatory premarital HIV testing in 1988.

The test results were strictly confidential, but the legislation was still controversial. The results of the experiment ultimately suggested that testing on a state-by-state basis does not work very well. A study in the American Journal of Public Health found that both states saw a drop in marriages — but there was an increase in marriages in their neighboring states; in other words, people simply crossed state lines to avoid the tests. According to an OLR Research Report, so few people tested positive for HIV in the Louisiana and Illinois tests that the legislation was repealed in both states.

Does mandatory testing still exist?

Although in some states pre-marital blood tests were used well into the 1980s and '90s due to concerns about HIV, in general testing gradually disappeared in the U.S. at this time. Testing was repealed in 19 states in the 1980s and seven more in the 1990s (via the National Bureau of Economic Research). The last few have been phased out since the turn of the millennium. The final state to get rid of its mandatory blood tests was Montana — which still had a test for women to check for rubella all the way up to 2019. The law was unanimously voted down in the senate, and Gov. Steve Bullock supported the move, bringing the state in line with everywhere else in the U.S.

Outside of the U.S. testing still exists in some places. According to the Open Society Foundation, more than 25 countries around the world have mandatory pre-marital blood tests due to the very serious risk of HIV. Countries that require tests include Guinea and Saudi Arabia, and many other nations strongly encourage tests, though they are not mandatory.