by Kristy Kade, Deputy Executive Director, White Ribbon Alliance Global Secretariat & Co-Chair, What Women Want @WRAglobal
Self-care is not new, but it’s recently become more firmly embedded within the larger global health and development agenda. Now, the task before health advocates is to institutionalize self-care as part of health policy across systems, programs and practice. The task seems daunting at times, due in part to a lack of shared vision about what constitutes self-care. There is general agreement that self-care is a critical component of any comprehensive health program. We at White Ribbon Alliance (WRA) are fond of saying that self-care “is the root of all healthcare.” Beyond that, perspectives diverge. Does self-care include new diagnostics, products and devices to support self-testing or self-treatment? Does it provide the resources and resilience to keep yourself mentally and physically strong? Does it let you know when to take yourself to a provider? Depending on who you ask within global health and development, the answer is all, some or none of the suggestions above—therein lies the dilemma.
What’s the advocacy ask for self-care? Where do we start? I can tell you the answer to the second question. It is both maddeningly complex and simple: start with women.
If self-care is about putting power in her hands, that must apply to self-care advocacy, too. Effectively institutionalizing self-care necessitates a bottom-up approach to advocacy. Without directly engaging women and girls in self-care design and development, the approaches being developed risk missing their intended mark. While universal in some regard, self-care is also startlingly personal.
In 2017, WRA embarked on an effort to engage women, along with their families and providers, in self-care activities in Bangladesh, Bolivia, Indonesia and Zimbabwe. The project was unique in its relative lack of parameters. Local women’s groups were asked to support communities with poor maternal and newborn health outcomes, where women had fairly limited interactions with the healthcare system and where there were few development projects. The only other stipulation was that self-care goals, messages and activities would be designed by the women themselves.
As expected, projects varied in topic and activity. For example, in Bangladesh, the focus was on birth preparedness. Women organized book clubs to discuss “Babu Barta,” akin to What to Expect When You’re Expecting. In Bolivia, the subject was maternal and newborn nutrition, cooking classes and recipe books, among many other topics. The surprising element was what these projects all had in common.
The women involved independently identified two key components of self-care largely missing from current discourse. A recently published framework in the British Medical Journal (BMJ) identified 16 aspects of self-care organized under the headings of self-testing, self-management and self-awareness. What BMJ’s framework left out, and what these women explicitly included, were the ideas of self-advocacy and self-organizing. We all know that self-care is individualistic in practice, but it is rarely practiced in isolation. Women recognized the need for both ability and confidence to negotiate for their own health within households, health centers and halls of parliament. They also recognized their power in coming together to make joint asks and to overcome geographic, structural, social and political barriers to effectively practice self-care.
This brings me to an additional element all our endeavors had in common: astounding and rapid results. Women, health providers and local leaders attributed dramatic increases in healthy behaviors and service utilization to the projects. They also achieved rapid changes in policy and programs. In Zimbabwe, participants successfully advocated for district officials to utilize their own funds to continue and expand activities. Their advocacy continues to pay forward: half of Zimbabwe’s community clinics are now supporting self-care initiatives and the country is working toward the inclusion of self-care in national guidelines. In Indonesia, the Ministries of Health, Education and Maritime Affairs and Fisheries are developing the first-ever joint initiative to promote self-care activities for maternal and newborn nutrition in the project’s rural fishing communities.
These new self-care activists wanted to talk about it with others and when they did, people not only listened, they invested.
Indispensable to the institutionalization of self-care is the idea that women know best for themselves—as much as any decision-maker or health expert—and as a collective there is no more powerful force for change. For professional advocates, it means truly believing in and trusting women. It means pushing for a paradigm shift away from top-down policy-making and toward one of community-driven policy change. It means amplifying, listening and responding to women’s voices as the centerpiece of self-care efforts.
This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.
Banner Image: Asma Begum (center) and family implement her birth preparedness plan as part of a WRA-supported self-care project in Bangladesh. © White Ribbon Alliance, Photo by WRA Bangladesh.