The difference between reproductive health and family health

The core difference between reproductive health and family health is the difference in coverage and intervention targets - the former focuses on the individual/partner's reproductive system function, reproductive autonomy, and the status of the full cycle of sexual health, and is a core subset of family health.； The latter is an overall health set that covers the entire life cycle of all family members and includes physical, psychological, and social support. The two have clear service boundaries and are deeply cross-correlated. There are even certain practical disputes in the field of public health resource allocation.

Let me tell you a true story that I encountered when I was helping at a community public health site. Sister Zhang, who had just given birth to her second child, took the pelvic floor muscle repair brochure from the family planning department, raised her head and asked, "My boss has been suffering from allergic rhinitis for the past six months, and my mother-in-law's blood pressure has always exceeded the standard recently. Can you give me some advice?" ”You see, it is easy for ordinary people to confuse these two concepts. After all, they are both health services related to "home". But in fact, our reply to Sister Zhang at that time was: Regarding postpartum reproductive recovery, we can make an appointment for your mother and child on the spot. For problems related to the elderly and children, we will refer you to the family doctor in charge of your family, and then visit you for a health assessment of the whole family - the service ports of the two have been separated since then.

Many people think that reproductive health is just about “having a baby”, but it is not. In the traditional definition given by the WHO, reproductive health is not only the absence of diseases in the reproductive system, but also the ability to decide independently whether to have children, when to have children, how many to have, and to enjoy a safe and satisfying sex life. In the past two years, many domestic public health scholars have been calling for broadening this boundary to include adolescent sex education, pre-marital reproductive health examinations, infertility assistance, reproductive-related psychological intervention, and even male reproductive health. Last year, our center received a couple who had been trying to conceive for three years but had not conceived. The ex-wife took conditioning drugs for almost two years, and it was finally discovered that the man had weak sperm. The whole family had previously put all the pressure on the woman. At this time, it is useless to just provide general family health guidance. You need to conduct precise reproductive function assessment and psychological counseling for reproductive anxiety, which are the exclusive scope of reproductive health.

To use an inappropriate analogy, if reproductive health is your faucet, you have to ensure that the water is clean and you have the final say to turn it on and off. Then family health is the water supply ecology of the entire home - from how much oil and salt you put in your home to whether your children's vaccines are on time, to the management of chronic diseases of the elderly and the smoothness of communication between family members, all are covered by family health. Let’s go back to Sister Zhang’s house. Her pelvic floor muscle repair is a matter of reproductive health, but she always suffered from insomnia after giving birth. The eldest son was always throwing tantrums because he felt that her parents favored the second child, and her mother-in-law had high blood pressure and always liked to eat pickles. These problems were put together, and it was useless to focus on any one of them alone. The family doctor had to come to provide dietary guidance for the whole family, educate the children on allergy protection, and also find time to communicate with the couple and mother-in-law to create a healthy atmosphere in the whole family.

Interestingly, public health practice circles have not yet reached a unified consensus on the allocation of resources between the two. One school of thought believes that the fertility rate is now low, and reproductive health directly affects the desire to have children and the quality of childbirth. More resources should be allocated to reproductive health, such as free cancer screening, free pre-pregnancy eugenics examinations, and post-abortion care services. These investments are extremely cost-effective and can directly reduce the rate of birth defects and improve the health of people of childbearing age. But the other view is also very practical: in many underdeveloped areas with insufficient resources, the elderly's hypertension and diabetes have not been properly managed, and the malnutrition problem of left-behind children has not been completely solved. It is useless to focus on reproductive health alone - the support system of the entire family is broken. Even if the woman's reproductive health is not a problem, the children born will not receive good care, and the health level of the whole family will still not improve. Nowadays, the practices in different places are different. Many economically developed areas in Jiangsu and Zhejiang have already tied the two. Family planning officers will collect the health needs of the whole family at one time during door-to-door visits and refer them to the corresponding staff. In many places with limited resources in the central and western regions, it is better to focus on key groups first, with reproductive health services being given priority to people of childbearing age, and services for the elderly and children will be gradually followed.

I have been working as a grassroots public health officer for almost six years, and my biggest feeling is that the boundary between the two does not need to be so clear-cut. I once met a 17-year-old girl who did not dare to tell her family after an unexpected pregnancy. We performed an abortion on her in accordance with reproductive health service standards, and also provided post-operative anti-inflammatory and contraceptive guidance, but we did not dare to inform her parents. As a result, her mother took her for psychological counseling six months later and said that she dropped more than 100 places in her grades. She locked herself in her room every day and did not talk, and she quarreled whenever she talked to her parents. Looking back now, if we had done some family health intervention after the reproductive health intervention, provided sex education to her and her parents, and smoothed the parent-child relationship, maybe what happened later would not have happened.

To put it bluntly, for us ordinary people, there is no need to worry about the difference between these two concepts. Reproductive health is a "personal basic item" that you should pay attention to whether you are married or not, or have children. You should have a gynecological/andrological examination every year, know how to protect yourself, and master the autonomy of reproduction. This is your responsibility. Family health is a "collective bonus" that you and your family manage together. The whole family can eat less salt, exercise more, communicate well about things, and don't put off minor problems, and you will naturally live a comfortable life.