Martha Brady, MS, director of sexual and reproductive health for PATH in Washington, DC, spoke to Contraceptive Technology Update about reproductive health self-care and how it works in other nations.

CTU: Could you explain what reproductive health self-care is? How is it being studied and used in other countries?

Brady: The World Health Organization’s Consolidated Guideline on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights defines self-care as “the ability of individuals, families, and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a healthcare provider.” (The guidelines are available at: https://www.who.int/reproductivehealth/publications/self-care-interventions/en/.)

Self-care allows people to become agents of their own health, leading to improved outcomes — especially in the area of sexual and reproductive health where stigma may prevent them from seeking care. Through self-care approaches, women and girls can identify their own health needs, access appropriate health technologies, and effectively manage their health conditions, including seeking health services and professional help when necessary. Exciting developments and an expanded array of user-centered sexual and reproductive health products and practices are being researched, introduced, and scaled up for use around the world, enabling women and girls to have more active participation in their health. These include phone-based applications for predicting menstrual cycles, home pregnancy tests, pericoital “on-demand” contraception, contraceptive vaginal rings, contraceptive self-injection, HIV self-testing, and human papillomavirus DNA self-sampling.

Women’s sexual and reproductive health self-care also may introduce advantages from a health systems perspective, especially in low-resource settings. In some ways, self-care is the ultimate form of task-shifting — where specific tasks are moved from higher to lower levels of the system to make more efficient use of human resources for health. In this case, it is the woman who receives the training and administers the intervention herself. This means that health workers are freed up to devote more time and resources to conditions that require medical intervention (like vaccinations or treating illnesses). Self-care is an integral part of the health system, linking to people-centered primary healthcare.

CTU: From one of PATH’s reports, it appears that clients in lower-resource nations are comfortable with self-care because of previous experiences, such as immunization, HIV testing, and taking antiretroviral medication. Could you please explain how these types of self-care experiences have paved the way for reproductive health self-care strategies?

Brady: For millennia, women around the world — in both high- and low-resource settings — have managed the self-care elements of menstruation, contraception, pregnancy, and childbirth, in addition to combating illness for themselves and their families.

Currently, women in many countries and diverse economic contexts regularly use self-care approaches such as HIV self-testing, pre-exposure prophylaxis for HIV prevention, oral contraception on a routine monthly basis or in the form of emergency contraception — or, in fact, the contraceptive patch and ring, which are self-care options only available in higher-resource settings. Digital health innovations also have helped advance use of self-care strategies, as has the current COVID-19 outbreak, with its increased burden on health systems and physical distancing requirements. For example, as hospitals and clinics increasingly focus on COVID-19 patients, new medical and digital tools, products, and services are becoming available to improve individuals’ ability to assess and manage their own health needs. These measures protect frontline health workers, but also ensure the most effective healthcare can be provided at scale.