In China nearly 20 million people get married every year, but first they have to pass the premarital medical examination. As a client of the process myself 10 years ago, I recall that the examination was a minor hurdle in the bureaucratic mire of getting married. Having obtained the certificate of non-impediment from the UK Registry Office and arranged notarisation first by the British Embassy and then the Zhejiang Provincial Notary Public Office, I had to obtain the certificate of approval to get married from my work unit. With these documents the certificate for permission to have a premarital examination was issued.

My main memories of the examination are of detailed questions about illness in first and second degree relatives, being examined fully clothed (it was winter and there was no heating), and being led into a room with other women undergoing the examination for a far from private pelvic examination. Then there was the peeing into a little plastic cup in the very insalubrious public toilet on the street outside before walking back into the hospital amid the crush of outpatients, trying to avoid any spillage. Two days later the certificate of health for marriage was duly awarded.

Nowadays in many parts of China the process has become more sophisticated, though no less bureaucratic. For this article I obtained information about the current status of the examination by visiting 10 maternal and child health hospitals serving populations across the socioeconomic range in four provinces: Zhejiang, Jiangxi, Yunnan, and Shaanxi. In each hospital I observed the premarital medical examination process, examined records, and held discussions with health workers and officials.