The Emergence of an Integrated Sexual and Reproductive Health System

Context: Public health prevention initiatives (inclusive of clinical care/services) concerning women have historically pursued two relatively independent tracks: a maternal and child health (MCH) track and a family planning track. While not so far apart from one another, their language, practice, and policy have kept MCH and family planning services in silos at the expense of providing a comprehensive continuum of care and services for sexual and reproductive health.

Methods: MCH and family planning trajectories were examined as complex adaptive systems through policy examples, their intended and unintended impacts on population health, and the emergence of recent strategies that provide a vision for a more integrated system of care that promotes whole-person health.

Findings: MCH and family planning policies were driven by poverty and civil rights, established to realize the potential for “longer term economic development.”The development of each track was, and continues to be, an adaptive response to social needs, and medical and technological advancements. An emerging “new order” that recognizes the importance of a whole-person approach to address the impact of social determinants on health is needed. Such systems transformation is driven by focused commitment to transform functions and structures to respond to a changing environment. Integration provides a wider range of services and enables patients to benefit from the expertise of multidisciplinary teams.

Conclusions: Mitigating disparities requires a comprehensive systems transformation that promotes quaternary prevention and supports better alignment and integration of MCH/sexual and reproductive health. The process of establishing practice based on system thinking, in service of health equity, must become the new normal.