The future of the reproductive health industry

In the next 5-10 years, the reproductive health industry will not follow the single path of "technology-oriented high-end" or "purely public welfare". It will eventually fall into a state of integration of "technological sinking to level the service threshold, privacy protection matching needs upgrade, and rights coverage taking into account diverse groups." The core service scenarios of the entire industry will extend from the "treatment" scenario of the hospital's reproductive department to daily health management, pre-marital and pre-pregnancy assessment, and meeting the needs of special groups.

Last month when I was working at a maternal and child health hospital in a prefecture-level city in Hebei, I met a 22-year-old girl squatting in the corner crying with her gynecological registration form in hand. After asking for a long time, she said that she suspected she had inflammation and did not dare to tell her parents. She was also afraid that she would be called "disrespectful" if she met an acquaintance in the clinic. She had been cheated out of a private clinic for more than 3,000 yuan and was not cured. She came to a public hospital because she had no choice. I was standing in the corridor and suddenly felt that we had talked about so many grand narratives about the future of the industry, but in fact they were not enough to allow an ordinary girl to step into the clinic.

What’s interesting is that when talking about the future in the industry, there are actually two schools of thought arguing fiercely. One group is technical. I visited a reproductive medicine laboratory in Shenzhen last month. Their AI-assisted sperm motility screening system is 12% more accurate than a medical examiner with 20 years of experience. The person in charge there counted on his fingers: "In three years, the cost of third-generation test tubes will be reduced to less than 30,000 yuan. With medical insurance coverage, 90% of infertile families can afford it. With the widespread use of technologies such as egg freezing and embryo screening, many genetic diseases can be blocked before pregnancy." In their view, technological iteration is the core key to solving all problems.

Another group of friends who work in grassroots public health totally disagree with this statement. They handed me a survey data from a northwest province last year: the coverage rate of cancer screening for women of childbearing age in local rural areas was only 47%, and 60% of the women surveyed did not know the correct method of contraception, and some even used medical abortion as a routine method of contraception. “No matter how good the technology is, what is the use if it cannot reach the grassroots? Even basic reproductive health knowledge has not been popularized. How can we talk about high-end technology being inclusive? ”

To be honest, both sides are correct. The current reproductive health industry is a bit like dentistry ten years ago. In the past, people only went to the hospital when their toothache was unbearable. Now regular dental cleaning, orthodontics, and dental implants have long become daily consumption. Reproductive health will also follow this path in the future - not everyone needs in vitro fertilization, but almost everyone needs basic reproductive health services. Technology must go up to make breakthroughs, and services must go down to make them popular. The two are never antagonistic.

Don’t believe it, a lot of changes are already happening. A while ago, I was chatting with the director of a public tertiary-level reproductive department. He said that 30% of the people who come to register now are not for medical treatment: there are newly married couples coming for pre-pregnancy eugenic evaluation, girls in their 20s coming to consult about the combined plan of HPV vaccine + cervical cancer screening, and unmarried women coming to inquire about the policies related to egg freezing. Five years ago, this was something that would have been unthinkable. Nowadays, self-service kiosks in many community hospitals allow you to get contraceptives for free, and online consultation platforms can even provide anonymous consultations and door-to-door sampling. The reports are directly encrypted and sent to your personal mailbox. You no longer have to worry about your name being called through a loudspeaker in the hospital lobby. Everyone knows what disease you are coming to see.

Of course, controversy has never stopped. For example, some people think that the commercialization of assisted reproductive technology will become a privilege for the rich: they can freeze eggs and select embryos for hundreds of thousands, while ordinary people cannot even afford basic screening, which will widen the class gap in fertility. ； However, some people feel that only commercialization can drive down the price of technology. Five or six years ago, the third-generation test tube cost more than 100,000 yuan. Now many domestic institutions have achieved 50,000 to 60,000 yuan. Beijing, Guangdong and other places have already included some reproductive assistance projects in medical insurance. In a few years, they will be widely available and ordinary working-class families can also afford them. Some people are calling for the complete liberalization of reproductive-related policy restrictions, and some are worried that ethical chaos will arise after liberalization, such as the emergence of red-line services such as gender screening and customized babies. There are no standard answers to these debates, and we will definitely have to find a balance through trials in the future.

I have been working in this industry for almost five years, and the most obvious feeling is that everyone's understanding of "reproductive health" has changed a long time ago: in the past, everyone's first reaction to these four words was either infertility or sexually transmitted diseases, which they were hiding and afraid to talk about. Now, the post-00 generation dares to openly ask about contraceptive methods online, and couples who are planning to conceive will take the initiative to conduct comprehensive reproductive assessments. Even many sexual minority groups have begun to publicly appeal for their reproductive rights. To put it bluntly, the future direction of the industry is never determined by someone sitting in an office patting their heads. It is determined by the needs of specific people.

There will definitely be many hurdles to overcome in the future: the cost of sinking technology, the coverage of grassroots science popularization, the standardization of ethical boundaries, and the protection of the rights and interests of special groups. Just pick any one of them and it will take five to ten years. But the direction is always right - whether you are a rural woman from the 18th tier, or an unmarried white-collar worker in a big city, whether you want to prepare for pregnancy, seek medical treatment, or just want a routine screening, you can get the services you need without being judged, without wasting money, and with dignity. This is the most anticipated future of this industry.