Progress and Potential of Self-Care: Taking Stock and Looking Ahead

The momentum around self-care is building through an array of self-care practices, policies, and interventions worldwide. This report aims to take stock of the SRH self-care field and document its progress. It is intended to provide a resource for global and national advocacy, to inform implementation of self-care guidelines, and to link the reader to evidence and learning exchanges. It includes case examples describing the process of introducing and scaling up DMPA-SC self-injection in Malawi and Nigeria.

This guidance from the World Health Organization (WHO) aims to provide a people-centred, evidence-based normative guideline that will support individuals, communities, and countries with quality health services and self-care interventions, based on PHC strategies, comprehensive essential service packages and people-centredness. The guidance includes a “strong” recommendation for self-administered injectable contraception, stating that this should be made available as an additional approach to deliver injectable contraception for individuals of reproductive age.

This resource aims to set a global standard for the measurement of three priority self-care interventions: self-injectable contraception, HIV self-testing, and self-managed abortion. The measurement tool comprises a set of priority indicators for each intervention. It was developed through a consensus-driven process led by the Self-Care Trailblazer Group’s evaluation learning working group, engaging global experts, including academics, implementers, donors, and intergovernmental organizations.

This conceptual framework articulates how social and behavior change can support sexual and reproductive health (SRH) self-care  initiatives and contribute to improved health outcomes. Developed by Breakthrough Action and the Self-Care Trailblazer Group, the framework is designed for use by policymakers and government representatives, donors, and self-care program implementers. The framework was also featured in a webinar held on September 28, 2022.

This report presents an in-depth analysis of Burkina Faso’s policies, regulations, and guidelines, based on an extensive document review followed by key informant interviews. The findings are organized by select family planning methods, including voluntary surgical contraception, implants, injectables, and pills. The report also includes a section describing COVID-19’s effect on task sharing and self-care policies. The authors recommend policy and regulatory revisions and actions to further improve the country’s family planning and regulatory environment and scale implementation of the World Health Organization (WHO) guidelines and note that the Burkina Faso experience may serve as evidence when the WHO next updates its task sharing guidance.

As new reproductive health products become available, women increasingly want to take a participatory role in their health. New developments and formulations of contraceptive products provide an opportunity to support this evolving trend toward self-care. Self-care, as defined by the World Health Organization (WHO), highlights the ability of individuals to promote health, prevent disease, and manage their own health with or without the support of a health care provider. WHO self-care guidance includes self-care recommendations related to use of family planning, including self-injection of injectable contraceptives and over-the-counter provision of oral contraceptive pills.

This paper published in Best Practice & Research Clinical Obstetrics & Gynaecology focuses on the research evidence of self-administration (self-injection) of DMPA-SC, and the practical experience of providers, women, and family planning programs adopting self-injection practices. The authors also explore the role of self-care in the provision of other contraceptives.