The Time is Now: Building the Evidence for Self-Care

by Martha Brady, Director of Sexual and Reproductive Health, PATH @PATHtweets

We stand at the opportune moment for supporting women’s rights and capabilities by moving the self-care agenda forward with both enthusiasm and evidence. Self-care has been highlighted as among the most promising approaches to advancing the Sustainable Development Goals. It has an important—yet largely untapped—potential to transform the global health field by putting decision-making power into the hands of women. Essential components of our agenda are designing and testing self-care products and practices and evaluating their impact on health outcomes.

A woman in Senegal holds DMPA-SC in both hands. © PATH/Gabe Bienczycki

An expanded array of products, procedures and practices is already being introduced and scaled, enabling women and girls to more actively participate in their own healthcare. Among the many tools in sexual and reproductive health are contraceptive self-injection, medication abortion, HIV self-testing, human papillomavirus self-sampling, phone-based applications for predicting menstrual cycles, ovulation prediction kits, pericoital “on-demand” contraception, contraceptive vaginal rings, diaphragms, and newly emerging multi-purpose prevention products. Digital and diagnostic tools that help individuals manage chronic conditions such as diabetes and hypertension can also be considered part of self-care.

PATH has not only developed many products for the global health field but has also introduced them as part of task-shifting efforts within the context of primary healthcare. We see self-care as the ultimate form of task-shifting—where women receive information and training and then administer interventions themselves. Task-shifting cuts across many areas of health and will become increasingly important as policymakers and managers seek opportunities for cost and program efficiencies within primary healthcare.

Acceptability, Feasibility, Effectiveness: What does the evidence tell us?

Overall, we have good evidence of acceptability and feasibility for products and practices that promote self-care, among both women clients and healthcare workers. Evidence is growing that women not only can safely and effectively use these tools, but that they like doing so. Research has demonstrated that when people are active participants in their own health, they can better adhere to instructions, medication, and treatment.

A woman in Guatemala holds her HPV self-sampling kit at her stall in the market, where Ministry of Health workers offered women the opportunity to be screened in their workplace. © PATH/Xiomara Celeste Gonzalez

Two recent examples of mounting evidence for women’s ownership of practices are HPV DNA self-sampling for cervical cancer screening and contraceptive self-injection. PATH’s experience working with HPV testing in Central America showed that self-sampling was highly acceptable to women and reached never-before-screened women—who are at the greatest risk of developing cervical cancer. In Nicaragua and Guatemala, self-sampling was chosen by 96 percent and 72 percent of women, respectively, when they were offered this opportunity. In Nicaragua, 47 percent of these women had never been screened, in spite of the existence of a long-standing Pap-based public screening program.

For contraceptive use, a growing body of evidence suggests that self-injection of subcutaneous depot medroxyprogesterone acetate (DMPA-SC) leads to equal or improved continuation rates compared with provider-injection. This benefit comes without notable increases in unintended pregnancy or safety concerns. Thus, self-injection of DMPA-SC is a promising approach to increasing contraceptive use.

Making self-care a reality

Self-care has come a long way and will continue to evolve. If embedded within the primary healthcare continuum of care, this practice can have a dramatic impact on health and well-being. Self-care has the potential to make products more accessible; it also helps women make and enact decisions about their health, reinforcing the internationally agreed upon human right to good health and self-determination. Further research will determine which self-care interventions work best, for which populations and for what outcomes. Now is the time to provide crucial evidence that will make self-care a reality and contribute to broad health and development goals.

This article appeared in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: A woman in Senegal self-injects the contraceptive, DMPA-SC. © PATH/Gabe Bienczycki