The connotation of reproductive health

The individual is in good condition in the three dimensions of physical, psychological and social adaptation during the entire reproductive life cycle, not just the absence of diseases or infirmities related to the reproductive system.

A while ago, I met a 32-year-old girl at a free cancer screening clinic in the community. She was unmarried, had no history of pregnancy, and did not feel any discomfort in her private parts such as itching or pain. She was originally asked by her best friend to do a check-up, but it was found that HPV16 type persistent infection was also accompanied by low-grade squamous intraepithelial lesions. She was completely confused when she took the report and asked me repeatedly, "I don't feel anything at all, so why is there a reproductive health problem?" ”

This misunderstanding is all too common. In the early years when the domestic public health system just started, the entire industry’s focus on reproductive health was indeed more focused on the physiological level: for example, whether there were inflammations such as vaginitis and pelvic inflammatory disease, whether there were organic lesions such as uterine fibroids and ovarian cysts, whether there was normal conception, pregnancy, and delivery, and whether there were sexually transmitted diseases such as syphilis and AIDS—after all, that At this time, maternal mortality and birth defect rates were still at high levels. Solving the most important physiological problems first was the most pragmatic choice. Until now, many scholars in the field of public health insist that under the premise of limited resources, the core of reproductive health must first focus on disease prevention and control and reproductive safety. This judgment is fully in line with the actual needs of underdeveloped areas.

But if you have come into contact with front-line clinical cases, you will know that just normal physiological indicators cannot really be called reproductive health. Last year, I received a client who was 8 months postpartum. All the indicators in the 42-day postpartum review were normal, and the pelvic floor muscles had recovered better than many people who had never given birth. However, she completely refused to have sex with her husband. The thought of living as a couple made me break out in cold sweats. It was serious. Sometimes I even suffered from insomnia all night, and all six items of sex hormones were checked within the normal range. Finally, after two months of psychosexual intervention, it gradually improved. This kind of discomfort caused by sexual psychological disorders and reproductive-related anxiety and depression is also a category that reproductive health should cover. Nowadays, many young clinicians and sex education practitioners will pay more attention to this dimension. Many gynecology and reproductive departments in tertiary hospitals have also opened reproductive psychology clinics one after another to make up for the previous shortcomings.

There are also many people who have no idea about the social nature of reproductive health. To give the most common example: How many women have experienced being forced to take emergency contraceptive pills by their partners because they refused to wear condoms? How many underage children have unexpected pregnancies and are afraid to tell their parents, so they can only go to irregular small clinics for surgery, causing lifelong problems? Even many junior high school girls are booed and ridiculed by their male classmates when they menstruate. They would rather faint from the pain than ask for leave from the teacher to attend physical education class. These scenes that seem to have nothing to do with "diseases" are essentially manifestations of damaged reproductive health: Do you have the right to choose your own contraceptive method? Can you make your own decision? If you want to have children, when should you have children, whether you can acquire scientific reproductive health knowledge while growing up, and do not need to be ashamed of normal physiological phenomena, and whether you have channels to obtain safe and affordable reproductive health services, these social-level supports are inherently core components of reproductive health.

Of course, there is still controversy over this part in the academic community until now. Many scholars feel that incorporating social rights into the connotation of reproductive health will make the concept too broad, which is not conducive to implementation. It is better to focus on problems that can be solved by medical treatment. This view certainly has its rationality. After all, in many remote mountainous areas, it is not easy to have a qualified obstetrician to deliver babies. Talking about sexual psychology and reproductive rights is indeed a bit "luxury". But I have been working as a reproductive health consultant for almost 11 years, and I have seen too many cases where "curing the disease cannot solve the problem." Instead, I feel more and more that these three dimensions are inherently tied together: if you ask a woman who is forced by her husband to have a son every day, even if her polycystic ovary syndrome is cured, her reproductive status will not be healthy.

To put it bluntly, reproductive health is complex. It must cover the entire life span from adolescence to old age, take into account the physical, psychological and social aspects, and also balance the actual conditions of different regions.； But it is very simple. It is nothing more than allowing everyone, whether they are men or women, whether they are married or not, whether they want children or not, to be able to face the physiological phenomena related to their own reproduction calmly, without being ashamed of it, to have enough knowledge and resources to protect their own bodies, and to have the right to make all decisions related to their own reproduction. This is enough.