Self-Care . . . Everywhere? A call to action to advance self-care for sexual and reproductive health and rights in humanitarian and fragile settings
Authors: Erin Wheeler (IRC), Roopan Gill (Vitala Global), Hannah Tappis (Jhpiego), Angel M. Foster (University of Ottawa), and Andrea Edman (IAWG/IRC)
*All authors are members of the Inter-agency Working Group for Reproductive Health in Crisis (IAWG)
In 2021, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) estimates that 1 in 33 people worldwide are in need of humanitarian assistance, a shocking increase from 1 in every 45 people in 2020. At least half of those in need are women and girls, and a quarter are of reproductive age (15-49). All individuals, regardless of their background or current situation, have the right to make their own choices about their sexual and reproductive health (SRH) and access these essential services. However, SRH related conditions are among the principal causes of death and ill-health among women of reproductive age worldwide and an estimated 61% of maternal deaths occur in countries experiencing fragility and crisis.
Prioritization and coverage of SRH services in these settings has increased in the past few decades with achievements such as the Sphere Handbook’s recognition of the Minimum Initial Service Package (MISP) for SRH as the global standard in humanitarian response. Yet, barriers to providing and accessing SRH services still exist. Crises overwhelm and disrupt healthcare systems, significantly impacting health facilities, service delivery, stock of essential medications, and overall access to lifesaving care.
In humanitarian settings, self-care offers an important opportunity to ensure access to essential SRH services, even amidst a strained health system. The World Health Organization defines self-care as 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 healthcare provider. Some examples that align with the MISP include essential newborn care practices such as thermal care and breastfeeding, self-administration of WHO recommended contraception options, and self-management of medication abortion. Though the 2018 Interagency Field Manual on Sexual and Reproductive Health in Emergencies makes reference to key self-care practices, the breadth and potential of self-care in emergencies is not fully captured. An article published in Conflict and Health in April 2021 – Sexual and Reproductive Health Self-care in Humanitarian and Fragile Settings: Where Should We Start? – identifies self-care interventions that align with the well-established humanitarian standards, points to the potential of digital health support for SRH self-care in crisis-affected settings, and discusses potential policy, programmatic and research considerations for expanding and promoting self-care in humanitarian settings.
Building off this paper, the Inter-Agency Working Group (IAWG) on Reproductive Health in Crises, Vitala Global, and the International Rescue Committee (IRC) hosted an event titled Self-Care Everywhere as part of the Self-Care Learning and Discovery Series in August 2021. The event covered a breadth of areas related to self-care in humanitarian settings: self-care and the MISP, self-care and the humanitarian-development nexus, self-care for youth in humanitarian settings, research and metrics for self-care in humanitarian settings, and adapting self-care in humanitarian settings to the context. We also called for examples of self-care interventions and received a number of submissions, including:
- A human-centred design-informed intervention for among crisis-affected South Sudanese women, allowing them to maximize their privacy (International Rescue Committee)
- Inclusion of self-management of abortion into zonal healthcare packages in eastern Democratic Republic of the Congo (International Rescue Committee)
- A Pilot project on a harm reduction approach to SAC and integration with SRH and women’s protection and empowerment services (International Rescue Committee)
- A digital and printed “buyers guide” designed to help women choose the right abortion pill for them (Ipas)
- The potential for understanding abortion self-care through an Abortion Self-Efficacy Scale (ASES)
- A study aimed at developing a digital self-care tool, called Aya Contigo, tailored to the needs of Venezuelans seeking abortion and contraception (Vitala Global)
- A scoping review on self-care interventions for SRH in humanitarian settings (JHU, Jhpiego, University of Geneva and University of Technology Sydney)
The recording of this event is accessible here. While there is great work being done, the majority of existing evidence on self-care was generated in stable settings and therefore there is an increasing need to design and test approaches adapted to humanitarian settings.
As we approach the convergence of International Universal Health Coverage (UHC) Day (December 12) and Human Rights Day (December 10), self-care options for SRH services must be prioritized as both an effective option to increase health coverage in humanitarian settings and as an essential human right. This year’s theme for Universal Health Coverage Day is “leave no one’s health behind: invest in health systems for all” and nowhere is this more necessary than in fragile and crisis-affected contexts. SRH needs do not stop in crisis and we must ensure that people have access to essential, life-saving services. Their health cannot be left behind. We want to build on the growing momentum for the promotion of self-care for SRH in humanitarian settings and therefore urge:
- Development actors to proactively engage humanitarian actors and collaborate across the humanitarian-development nexus to develop and adapt interventions that will be most effective in humanitarian settings.
- Humanitarian actors to prioritize the integration of self-care as part of a package of health services that meet the holistic needs of women and girls across all stages of crisis.
- Donors funding SRH and self-care to invest in research, advocacy, and programs for self-care in humanitarian and fragile settings to ensure the women and girls who need these services most are not left behind.
- Humanitarian donors to invest in strengthening knowledge and practice around self-care in humanitarian settings as well as new models for emergency response that are inclusive of self-care for SRH. The funding and implementation gap for self-care in humanitarian settings is conspicuous given progress on self-care in stable settings while women and girls in disrupted health systems continue to lack access to essential SRH services. There is also a tremendous need to support expansion and scale-up of successful pilot efforts.
- Governments to ensure the humanitarian and fragile settings are fully included in implementation of emerging national policies and guidelines on self care.
There is enormous potential for collaboration across the humanitarian-development nexus and we call for a more coordinated approach to SRH self-care that fully recognizes and includes the needs of those living in fragile and crisis-affected contexts.
Interested in learning more about self-care in humanitarian settings?
- “Can DMPA-SC self-injection bridge a gap in family planning access in Humanitarian settings?” Event Recording
- Sexual and Reproductive Health Self-care in Humanitarian and Fragile Settings: Where Should We Start?
- The Potential of Self-Managed Abortion to Expand Abortion Access in Humanitarian Contexts
*The recording of Self-Care Everywhere can be found on the Self-Care Learning and Discovery Platform.