Six ways to advance a self-care agenda for sexual and reproductive health
by Kate H. Rademacher, Technical Advisor, Contraceptive Technology Innovation, FHI 360 and Holly Burke, Scientist, Reproductive, Maternal, Newborn, Child Health, FHI 360
Self-management. Self-testing. Self-awareness. These are three pillars of self-care interventions that can help promote the sexual and reproductive health and rights (SRHR) of women, men, and youth according to new guidelines released by the World Health Organization (WHO). WHO 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.” Self-care as part of reproductive health is not a new concept. Throughout history, people have sought to control their fertility. However, in the context of a global shortage of trained healthcare workers and with an estimated 214 million women in developing countries who still have an unmet need for contraception, both new and existing SRHR self-care interventions can play a critical role in helping close the gap while at the same time empowering individuals to take control of their health.
This July is self-care month, and FHI 360 is excited to join partners around the world in advancing strategies to meet the SRHR needs of women, men, and youth through evidence-based self-care interventions. Here are six ways that FHI 360 is helping advance the SRHR self-care agenda:
- Expanding access to self-administration of injectable contraception — For the past decade, FHI 360 has been leading research on the subcutaneous (SC) presentation of the popular injectable contraceptive, depot medroxyprogesterone acetate (DMPA), in a prefilled, all-in-one injection system (instead of a separate vial and syringe). DMPA-SC is currently available in more than 40 countries. FHI 360’s recent randomized controlled trial assessed the suitability of this method for self-injection in rural Malawi and now there are several countries introducing and scaling up self-injection programs. For example, FHI 360 is supporting the Ministry of Health (MOH) in Malawi as they introduce DMPA-SC and self-injection through community health workers and clinic-based providers in seven districts and their plan to have national coverage by the end 2020. FHI 360 also collaborated with the MOH and partners in Uganda to achieve a policy shift that allows drug shops to stock and administer injectable contraceptives and has plans to introduce self-injection in 20 districts as part of a phased rollout.
- Supporting self-testing for HIV among key populations — Self-testing is an important strategy to improve access to and use of HIV testing, including among key populations such as female sex workers and men who have sex with men. Not only is self-testing confidential and easy to use, but results can also be read directly by the individual taking the test. For example, under the LINKAGES project, FHI 360 has introduced a peer-mediated HIV self-testing intervention in three provinces in Burundi. Preliminary results suggest that self-testing was well accepted and performed well compared to other testing modalities there.
- Increasing women’s self-awareness that menstrual bleeding changes with use of contraception are NORMAL — Women who use contraception are often anxious about the changes they experience to their menstrual bleeding. These fears can contribute to discontinuation or non-use of contraception. A new tool helps women understand the changes to menses that are common when using contraception and are not harmful to one’s health. This type of awareness can help women reassure themselves which may, in turn, improve contraceptive continuation rates. Increased self-reassurance can also potentially reduce the burden on the healthcare system and on women if it translates into family planning users making fewer visits to a health care provider when they experience common side effects.
- Advancing the use of digital health interventions for sexual and reproductive health — As a founding member of the Global Digital Health Network, FHI 360 helps harness the power of information and communications technology, such as phones, tablets and computers, to improve individuals’ knowledge of and access to quality health information and services. For example, FHI 360 developed Mobile for Reproductive Health (m4RH), an automated, interactive and on-demand short-message service (SMS, or text message) system which was one of the first services to put accurate reproductive health information and decision-making directly into the hands of those who need it. FHI 360 has worked with Viamo to integrate m4RH messages onto its platforms in Afghanistan, Rwanda, Tanzania and Uganda and converted the SMS messages to interactive voice response (IVR). Through the LINKAGES project, FHI 360 also developed Going Online, a framework for how HIV programs can use online and mobile platforms to help meet their HIV education, prevention, testing and treatment objectives. We are currently supporting the implementation of Going Online activities in over 20 countries.
- Increasing access to affordable pregnancy tests — Research led by FHI 360 has demonstrated that increasing access to simple, low-cost pregnancy tests can reduce barriers to provision of family planning. In addition, access to pregnancy testing can contribute to earlier access to antenatal care services for women who are pregnant which in turn can improve health outcomes for mothers and babies. FHI 360 has worked to increase access to low-cost, high-quality pregnancy tests for women both at the facility- and community-levels. As part of this effort, it is important that women can obtain affordable pregnancy tests to administer themselves to learn their pregnancy status as part of a self-care strategy.
- Developing new contraceptive technologies that have the potential to expand self-care options — Existing contraceptive methods do not always meet the needs and preferences of women and men. FHI 360 is working to develop new contraceptive options including methods that do not require provider administration (such as a microarray patch) or removal (such as a biodegradable implant). For each product in our contraceptive development program, we begin with the end in mind by using human-centered design and by developing Target Product Profiles — planning tools which outline product criteria — that include method attributes that will facilitate self-care. We are also exploring options for self-removal of long-acting, reversible contraception.
As we work to promote these and other self-care interventions, it is important to remember that self-care is only one component of a comprehensive approach to meeting the SRHR needs of women, men and youth. We must also work tirelessly to improve the quality, affordability, and accessibility of facility- and community-based services and to increase the affordability of high-quality contraceptive commodities. Yet, as part of a broader health and development agenda, we cannot afford to ignore the power and potential of empowering individuals with tools and resources they can use to improve their own reproductive health.
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Learn more about FHI 360’s work here.
