Craig Lissner
Acting Director of Sexual and Reproductive Health and Research including UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction
Self-Care Month starts 24th of June, culminating with Self-Care Day 24th of July. This symbolic day, chosen because self-care can be practiced "24 hours a day/7 days a week", is also a practical opportunity to reflect on a growing dimension of WHO's pioneering work on health systems contribution for self-care interventions toward advancing primary health care (PHC) and realizing universal health coverage (UHC) for all.
WHO defines self-care as the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker. This concept positions people as active agents in health management. Self-care interventions are the tools that support self-care.
Autonomy and empowerment through self-care
The autonomy and empowerment gained from self-care and the use and uptake of self-care interventions are crucial elements of sexual and reproductive health and rights (SRHR). Proven self-care interventions like self-administration of injectable contraception, pregnancy and HIV self-tests, self-sampling for HPV and other STIs, and self-monitoring of blood glucose or blood pressure are all known to help people reach their full health potential.
As health care challenges and solutions evolve, self-care interventions are some of the most promising new ways to improve the health and well-being of people everywhere, across many different areas of health. From health promotion, to disease prevention and control, self-medication and rehabilitation, the evidence shows self-care interventions save lives and enable people to take control of their health. This is exciting both for the people who make use of these interventions, and also for the health systems which make them available.
Self-care interventions are increasingly in the global spotlight, with the ongoing health, conflict, climate change and other humanitarian crises. During the COVID-19 pandemic, countries around the world were challenged to stop the spread of infection, while also reducing disruption to essential health services, and addressing broader implications of economic disruptions. At the same time, health systems were severely strained in an unprecedented way. As a result, countries have relied on laypersons, from community networks, peers, family, friends and neighbors to play an essential role in keeping themselves and one another healthy.
At its best, self-care interventions bring sexual and reproductive health (SRH) services closer to the people who need them and is the first line of defense in all health-related issues. Self-care interventions enable options and choice in the context of safe, supportive health systems. This is particularly useful in situations where stigma and discrimination create a barrier to access, especially in SRHR.
Promoting
contraception choice for every individual
The importance of self-care, empowerment and choice in SRH comes out loud and clear in a new special supplement on WHO Values and Preferences in the journal, Contraception. Researchers reviewed the literature to find what people want when it comes to family planning. While there is great variation depending on geography and demographic, researchers also identified universal preferences for choice, safety and affordability.
Advocating for comprehensive sexuality education
Knowledge is power. This rings true in SRH, and yet this truth remains controversial in many contexts, at the detriment of young people and their communities. The evidence on how comprehensive sexuality education (CSE) is essential to autonomy and self-determination was a key focus at the Global Partnership Forum on CSE, where WHO colleagues joined experts and allies in support of widespread CSE as a proven way to appropriately develop the agency of young people for better health outcomes everywhere.
Access to abortion care
Choices and knowledge in sexual and reproductive health and human rights are essential, but are not guaranteed. This is where much work remains. Last month Dr. Zsuzsanna Jakab, Deputy Director-General WHO advocated strongly for choice through access to abortion care as health care. "Women should always have the right to choose when it comes to their bodies and their health," she said, in a video recorded for the anniversary celebration of SheDecides. "While this is fundamental, women's rights continue to come under threat."
There is no UHC without SRHR
We are working to pave a clear path forward that clearly makes the linkages between SRH and UHC. In July, we will be launching new tools in the pursuit of achieving access to comprehensive SRH services within wider UHC-related reforms and through a primary health care approach. The tools include the "SRH UHC Handbook", launching 12 July 2022 and the WHO, UNFPA and HRP Sexual and Reproductive Health and Universal Health Coverage Learning by Sharing Portal, launching 19 July 2022.
Universal access to SRH services, and the promotion and protection of human rights, dignity, and empowerment of all people, are globally-agreed commitments underlying UHC. We are looking forward to a month ahead focused on expanding our understanding of how listening, learning, and responding to each other – especially to the voices of those most left behind – can help us achieve our goal of SRHR for all.
