Sexual and reproductive health

Self-care can be an effective part of national health systems

2 April 2019 ¦ A new supplement supported by UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme – HRP and published by the BMJ looks at issues of self-care interventions for sexual and reproductive health and rights (SRHR). The special supplement includes a collection of analyses, systematic reviews and opinion pieces, providing an evidence base for the development of global normative guidance.

A man walks by a pharmacy, Italy
Marius Malinescu/Photoshare

What is meant by “self-care”?

Included in the World Health Organization’s definition of self-care is “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider.”

Most of us already practice self-care that protects our health each and every day, for example in eating healthy, doing exercise or ensuring we get enough sleep. Sometimes these acts are not sufficient to protect us and additional support from health professionals is needed.

From a public health perspective, self-care plays an important role both for individuals and for health systems. For individuals, the capacity and ability to make informed decision and make use of available health resources is an important contributor to the successful management of a health condition. For many people in low-resource settings where access to professional medical care is challenging, self-care may be their only option. For others it may be their preferred option. The contribution of self-care may also help avoid stigma, bring improved mental well-being and increase the agency and autonomy, particularly for vulnerable populations.

For the health system too, there are many advantages to promoting self-care interventions, while still remaining responsible and not putting additional burden on individuals. Health systems can thus optimise self-care as one of the most innovative approaches to improving health coverage for all.

A woman in Senegal self-injects the contraceptive, subcutaneous DMPA  in her leg
A woman in Senegal self-injects the contraceptive, subcutaneous DMPA in her leg.
PATH/Gabe Bienczycki, Courtesy of Photoshare

Providing self-care to vulnerable populations implies a safe and supportive enabling environment and ensuring quality products and interventions are available outside of formal health systems. Just as high quality healthcare is important, high quality self-care is too. A WHO conceptual framework has therefore been developed to support policy-makers and implementers who are thinking through the complexity of promoting high quality self-care interventions. The framework aims to ensure that all individuals are considered, including those who may not be aware of their right to health and those who may fall through the cracks of the existing healthcare system.

New technologies and products

The conceptual framework recognises that in addition to the traditional self-care practices which promote health and well-being, that societies have passed on through generations, people are accessing quality, evidence-based, information, products, and interventions through places such as stores, pharmacies, and through the internet. Digital health and mobile technologies are also increasing rapidly. For this reason, the first step will be to have a clear conceptualisation of self-care in order to support health policy.

WHO guideline on self-care for sexual and reproductive health and rights

While self-care is important in all aspects of health, it is particularly important and challenging for sexual reproductive health and rights, where many people are not able to have autonomy over their body or to make decisions around sexuality and reproduction. Safe linkage between self-care and quality healthcare for vulnerable individuals is critically important to avoid harm. When self-care is not a positive choice but born out of fear or because there is no alternative, it can increase vulnerabilities and lead to poor health outcomes. WHO is therefore currently developing a new evidence-based guideline that will provide recommendations on self-care interventions in sexual and reproductive health. The guideline will use a holistic, people-centred approach that holds human rights, ethics and gender equality at its core.