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Almost everyone in India gets married (95 per cent men of and women by the age of 35). Either they find someone or their friends, relatives, neighbours, marriage brokers and media advertisements pitch in. Society does not condone remaining single. Having children is the next step, and anyone who does not procreate within a year or two of marriage is viewed with consternation and pity.
The ideal age for marriage is debatable. Much anthropological data have been collected but there is no clear consensus. The age of maximum and healthy fertility in women is between 18-32 years; men remain fertile longer. The legal age of marriage for a girl is 18 years. By that time, her body is mature enough to cope with the rigours of pregnancy, childbirth and child rearing. But she would barely have finished high school at that age; it is probably better to wait for her to have acquired a college degree or vocational training. This helps the bride to be more mature, physically and mentally. She will also be able to bring up her children better as she will be able to read about advances in childcare, do home tutoring and follow the complicated immunisation schedule.
A great deal of money is spent arranging a wedding. It would probably be better if some of it is invested in ensuring that the girl’s health status is satisfactory and her immunisations complete.
The MMR (measles mumps rubella) vaccine prevents the mother from acquiring these infections inadvertently during pregnancy. The rubella virus can infect the foetus at any stage of pregnancy but during early pregnancy (before the sixteenth week) it results in malformations in the baby. Common abnormalities seen soon after birth are hearing loss, mental retardation, heart and eye defects. As the child grows, (if it survives) diabetes, thyroid problems and glaucoma may appear. The mother-to-be can be protected if she takes two doses of the vaccine, one at around 15 months and the second along with the DPT booster at five years. It can also be given later as two doses eight weeks apart.
Almost all adults in India (99 per cent) have had chicken pox. Usually, it is a mild attack with no after effects but it can be dangerous during pregnancy. If the mother is infected in the first 20 weeks, the child can develop skin and bone defects, abnormal limbs, eye defects and mental retardation. If it occurs close to the date of delivery, the baby can develop a life threatening infection. Again, chicken pox is totally preventable with two doses of the varicella vaccine.
Hepatitis B is be life-threatening and can pass directly from mother to baby. It can result in chronic liver disease and the eventual death of the baby. It is easily preventable with three doses of hepatitis B vaccine. The government has now started to give this vaccine free to newborns. It is combined with the DPT or triple antigen. Older children and teenagers have been missed in the free government schedule. They need to get immunised before marriage.
Even if these immunisations have been missed, “catch up” immunisation can be given to complete the schedule before marriage.
Folic acid (a vitamin) is essential to prevent defects of the brain and spine in babies. Unfortunately our diet is woefully deficient in it. Supplements (5mg per day) need to be started as soon as the engagement occurs and continued for the first five months of pregnancy.
It is also important to achieve and maintain the ideal basal metabolic rate of 23. It should be done with a judicious combination of diet and exercise. A balanced diet combined with aerobic activity (running, jogging, walking, cycling, swimming) for an hour a day most days of the week along with yoga, flexion and strengthening exercises for 20 minutes is ideal.
Marriage is a partnership. Unimmunised men can bring infections home. An unhealthy lifestyle with obesity, tobacco abuse and excessive drinking reduce sperm count and quality. It can contribute to infertility. Regular exercise is essential to prevent development of lifestyle diseases such as diabetes and hypertension. This will go a long way towards a long, secure and happy married life.
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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