Policy shift toward mandatory premarital screening in a Middle Eastern country: agenda- setting through the lens of Kingdon’s multiple streams framework

Premarital screening policies are increasingly adopted to prevent hereditary disorders in populations with high consanguinity. In Oman, a Middle Eastern country with significant sickle cell disease prevalence, the shift toward mandatory premarital screening emerged through a strategic policy process influenced by cultural, tribal, and religious values. In this context, premarital screening offers a critical opportunity for early detection and informed reproductive decision-making. This paper provides an explanatory analysis of the agenda-setting process that enabled the formal adoption of compulsory premarital screening for genetic disorders, using Kingdon’s Multiple Streams Framework (MSF) as an analytical lens. The analysis demonstrates how hereditary blood disorders, in particular Sickle cell disease (SCD), transitioned from a socially normalised condition to a recognised public health and socioeconomic problem, and how a technically feasible and ethically sensitive policy solution was advanced. Oman’s case illustrates how preventive health policies targeting socially sensitive issues can gain traction through stream convergence, and incremental reframing.