2019 was the year that the blood-test requirement for marriage was finally abolished in all 50 US states.
This past March, the governor of Montana signed the legislature's bill abolishing the state's requirement that women submit to blood tests to be screened for rubella prior to the granting of a marriage license.
Technically, Montana had removed the absolute mandate in 2007, but the change would only "allow brides to opt out after signing an acknowledgement of the pregnancy risks related to rubella, and only if the groom signs too. Otherwise, the female applicant must provide a medical certificate signed by a physician stating that she has been tested or is exempt for medical reasons."
The 2019 legislation now completely removes the requirement.
Montana was the only remaining state with a blood test requirement. As recently as 1980, though, 34 states still had laws on the books requiring blood tests before marriage. Kasey S. Buckles, Melanie Guldi, and Joseph Price provide a concise summary of the legislative trend:
Of these 34, 19 states repealed their law in the 1980s, 7 repealed in the 1990s, and 7 more repealed between 2000 and 2008, leaving only Mississippi with a BTR in 2009.
(Buckles, et al,counted the Montana "opt out" as abolition, leaving only Mississippi.)
Mississippi ended its requirement in 2012.
But why was there ever a requirement at all?
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."
Between 1980 and 2008, abolition was more a function of medical treatment options rather than any commitment to medical freedom or marriage freedom.
Buckles, et al note:
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 the 1980s, sexually-transmitted diseases were far more treatable than was the case in the 1930s. This lessened the importance of alerting future sex partners about one's health status. (This theory, of course, relies partly on an assumption people rarely have sex outside marriage — a view that was rather fanciful even in the 1930s.)
Nonetheless, abolition was not 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."
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.
The mandate was great for the medical industry, however, since it required the payment of many millions of dollars for otherwise unnecessary medical procedures.
You'll Marry Your Sister!
Another source of confusion over mandated blood tests has been a belief held by some that blood tests were used to screen for the "marry-your-sister" problem. That is, some think that blood-test mandates exist for purposes of genetic testing.
Unlike tests for venereal disease, however, genetic testing for consanguinity is very expensive, and has never been generally mandated by states. The issue could much more cheaply and pragmatically be addressed by granting people the legal right to know who their biological parents are, when the information is available. Cases of consanguinity are generally tied to cases when a marriage partner has been adopted, abandoned, or otherwise is unaware of his or her biological parents.
Conflicting Messages on Medical Freedom
It may be, however, that the abolition of one violation of medical freedom could be replaced by another.
After all, Montana's blood-test requirement was justified on the grounds that it prevented health problems for a third party. That is, if a woman with rubella becomes pregnant, this can have devastating effects on the developing fetus. Functionally, it was more a pre-pregnancy requirement than a pre-marriage requirement.
Just as modern treatments for STD lessened the need to test for syphilis ahead of time, the need for pre-pregnancy testing for rubella was largely supplanted by the prevalence of vaccines against rubella. Will the repeal of the rubella blood test signal a renewed drive toward mandatory rubella vaccination in Montana? For now, efforts to remove all non-medical exemptions for vaccines are concentrated in states like New York and California. But the issue is certainly not confined only to these places.
It should not be assumed the movement toward abolishing blood tests was motivated by libertarian impulses.