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.

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.

Self-care reproductive health innovations are increasingly valued as practices that enable women to manage their fertility with greater autonomy. While self-care, by definition, takes place beyond the clinic walls, many self-care practices nonetheless require initial or follow up visits to a health worker. Access to self-care hinges on the extent to which health care workers who serve as gatekeepers find the innovation appropriate and practical. Self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) is being introduced and scaled in many countries. In late 2018, health workers in Uganda began offering self-injection of DMPA-SC in the public sector, and this study examines health workers’ views on the acceptability and feasibility of training women to self-inject. We conducted in-person interviews with 120 health workers active in the self-injection program to better understand provider practices, program satisfaction, and their views on feasibility. A subset of 77 health workers participated in in-depth interviews. Quantitative data was analyzed using Stata (v14) software, and chi square and student t tests used to measure between group differences. Qualitative data was analyzed using Atlas.ti, employing an iterative coding process, to identify key themes that resonated. The majority of health workers were very satisfied with the self-injection program and reported it was moderately easy to integrate self-injection training into routine service delivery. They identified lack of time to train clients in the clinic setting, lack of materials among community health workers, and client fear of self-injection as key challenges. Community health workers were less likely to report time challenges and indicated higher levels of satisfaction and greater ease in offering self-injection services. The relatively high acceptability of the self-injection program among health workers is promising; however, strategies to overcome feasibility challenges, such as workload constraints that limit the ability to offer self-injection training, are needed to expand service delivery to more women interested in this new self-care innovation. As self-injection programs are introduced and scaled across settings, there is a need for evidence regarding how self-care innovations can be designed and implemented in ways that are practical for health workers, while optimizing women’s successful adoption and use.

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.

The ability of individuals to space, time, and limit pregnancies in alignment with their preferences, with or without the support of a healthcare provider

This Family Planning High Impact Practice brief outlines the principles and practices of contraceptive self-care: the ability of individuals to freely and effectively space their pregnancies, time their pregnancies, and prevent pregnancies in alignment with their fertility preferences, with or without the support of a healthcare provider. This is facilitated by the integration of contraceptive self-care interventions into policies, programs, and delivery channels across health systems including family planning and reproductive health.

Building upon the latest normative recommendations and good practice statements from the World Health Organization (WHO), this guidance includes key considerations to support the introduction and scale-up of self-care interventions in countries, at the national or subnational level. In implementing the global recommendations on self-care interventions for health and well-being, countries will need to adapt them to the local context, considering the economic conditions and the existing health services and facilities. This guidance is intended to assist with that process. This guidance is relevant for all settings and should, therefore, be considered as global guidance.

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.

Self-Administration of Subcutaneous Depot Medroxyprogesterone Acetate

The United States Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by the Centers for Disease Control and Prevention (CDC) from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers. In 2021, the CDC evaluated the 2019 WHO recommendation on self-administered DMPA-SC. CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.