Mises Wire

Why States Don’t Require Blood Tests for Marriages Anymore

In one of her more incoherent columns in 2011, Ann Coulter attacked then-presidential candidate Ron Paul for his laissez-faire position on marriage. Coulter praised government regulations imposed on marriage, stating that Paul’s position is “chicken-s**t” and “[t]here are reasons we have laws governing important institutions, such as marriage. As in landscaping, it’s never a good idea to remove a wall until you know why it was put there.”

Specifically, Coulter praised government mandated blood tests for marrying couples, stating “Under Paul’s plan, siblings could marry one another.” 

This statement was apparently intended as some sort of great “gotcha” comment. “Why, if it weren’t for government, we’d all marry our sisters!” is the implied sentiment. 

Coulter’s comment may seem like ancient history at this point, but her statement’s publication in major media outlets illustrates that even in recent years, many Americans still seem to be under the impression that mandatory blood tests are relatively common in the United States. 

They aren’t. At least, they aren’t anymore. 

Like so many invasive procedures mandated by governments, mandatory blood tests for couples seeking marriage licenses were a product of the age of eugenics and Progressive politics — two things that often go together. 

As Ruth C. Engs notes in The Progressive Era’s Health Reform Movement: “’Racial improvement’ through positive eugenics, such as marriage to a healthy individual, [and] blood tests for syphilis prior to marriage ... were promoted for improving the ‘race,’ thus leading to a healthier nation.”

The rights of individuals to marry whom they wished was thus swept aside in the name of “hygiene” and public health. Blood tests took their place along with prohibitions on interracial marriage as a means of “racial improvement.” 

Today, though, only one state — Montana — continues to require blood tests. Between 1980 and 2008, the remaining requirement for blood tests were abolished as certain elements of the Progressive public health philosophy lost influence, and as the perceived benefits of mandated blood tests were clearly far less than thought. 

Kasey S. Buckles, Melanie Guldi, and Joseph Price provide a concise summary of the movement: 

Historically, many states have required applicants for a marriage license to obtain a blood test. These tests were for venereal diseases (most commonly syphilis), for genetic disorders (such as sickle-cell anemia), or for rubella. The tests for syphilis were part of a broad public health campaign enacted in the late 1930s by U.S. Surgeon General Thomas Parran. Parran argued that premarital testing was necessary to inform the potential marriage partner of the risk of contracting a communicable disease, and to reduce the risk of birth defects associated with syphilis. According to Brandt (1985), “by the end of 1938, twenty-six states had enacted provisions prohibiting the marriage of infected individuals.” Screenings for genetic disorders and for rubella were also implemented in the interest of minimizing the risk of genetic disease or birth defects in the couple’s offspring.

Buckles, et al., note that it soon became apparent that the cost of the mandate was very high and benefits were quite low: 

In the case of syphilis, however, it was soon recognized that premarital blood testing was not a cost-effective way to screen for the disease. Despite reports that 10% of Americans were infected, only 1.34% of applicants in New York City’s first year of testing were found to have the disease. Brandt (1985) notes that a premarital exam was “not the optimal locus for screening,” since couples seeking to marry were not likely to be in the most at-risk groups, and individuals who knew they were infected could wait until the infection cleared to apply for a license. ... Nationwide, couples spent over $80 million to reveal 456 cases. 

By 2008, the requirements had nearly all disappeared: 

We identified 34 states that had a BTR in 1980. Of these 34, 19 states repealed their law in the 1980s, 7 repealed in the 1990s, and 7 more repealed between 2000 and 2008, leaving only Mississippi with a BTR in 2009. 

Nor was this all just a matter of deliberation over the medical efficacy of the laws. Ordinary people never appeared to be enthusiastic about the mandates, and many resented the additional hoops they needed to jump through to carry on with their personal lives. 

It should surprise no one, then, that couples actively sought to avoid the costly and time-consuming test requirements.

Blood test requirements led to couples choosing to marry in states that did not have the mandates: “it appears that about one-third of the decrease in licenses is due to couples marrying out of state, while about two-thirds choose not to marry at all.”1

So, it turns out the mandated blood tests worked to discourage marriage while doing little to actually identify people with disease or improve public health. Moreover, none of these mandated tests have ever screened for the “marry-your-sister” problem. Even when the blood tests were mandated, they were there to test for disease. They weren’t there to test for possible incest. Genetic testing for family relations is much more expensive than disease screening, and has never been considered to be cost effective.  (Coulter was either blissfully unaware of this fact in 2011, or was lying about it.)

The mandate was great for the medical industry, however, since it required the payment of many millions of dollars for otherwise unnecessary medical procedures. 

Needless to say, mandatory blood tests are far less likely to uncover people married to their sisters than they are likely to uncover disease — regardless of what Ann Coulter may think. The cost of a government mandate to uncover genetic similarities of potential newlyweds would be immense, with virtually no payoff.

The fact that the arithmetic doesn’t work in its favor is just one reason to oppose mandatory blood tests. The right to free association and free contracting among people wishing to get married is also something to consider. Also important is the fact that making it difficult to get married — especially nowadays — will simply encourage fewer people to get married at all. The idea that these unmarried people will then abstain from having sex or birthing children, of course, is adorably cute. 

  • 1See Buckles, et al. 
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