Partners in health

THE Sindh government has announced that the Premarital and Marital Counselling Bill is in the works, an important attempt to address a long-ignored public health gap. At a press briefing last week, provincial ministers said the bill would make counselling mandatory before a marriage is registered. Couples would receive guidance on family planning, reproductive health, mental well-being, newborn care and basic communication within marriage. These are simple goals, yet their absence has cost women and families far too much. Pakistan?s maternal health indicators remain among the worst in the region. Many women face repeated, closely spaced pregnancies because they lack information or support. Others undergo multiple C-sections without understanding the risks. Unsafe abortions continue because access to reliable contraceptive advice is scarce. Too many women still do not know how to protect themselves or their babies, and too many couples make life-altering decisions without proper knowledge.

The proposed bill seeks to fill these gaps and build on the Sindh Reproductive Healthcare Rights Act, 2019. While that Act formalised reproductive health as a right, it did not include structured, couple-based counselling or premarital education. The new legislation attempts to turn those rights into practical guidance offered before a family is formed. If couples understand birth spacing, safe contraception, breastfeeding rights and early childhood vaccinations, they are better placed to build healthier households. Premarital counselling also gives partners a chance to discuss expectations ? something that seldom happens, yet often shapes whether a marriage becomes stable or strained. The ministers also raised issues that receive little public attention, such as the genetic risks linked to cousin marriages and the fact that a child?s gender is determined by the father. These basic facts could help reduce stigma and the unfair blame placed on women. Pilot projects in Karachi South and Tando Allahyar are already underway, but the bill?s implementation will decide whether the idea can take hold. Counselling should empower couples, not judge them. Proper training, standardised modules and monitoring will be essential. At a time of high maternal mortality, rising mental health stress and weak family planning outcomes, a preventive step is better than another crisis response. If delivered with care, the bill could improve family health in Sindh and, if it succeeds, offer a model for the rest of the country.

Published in Dawn, December 9th, 2025