Self care interventions for sexual and reproductive health and rights: costs, benefits, and financing

Abstract Background Pakistan is among a number of countries facing protracted challenges in addressing maternal mortality with a concomitant weak healthcare system complexed with inequities. Sexual and reproductive health and rights (SRHR) self-care interventions offer the best solution for improving access to quality healthcare services with efficiency and economy. This manuscript documents country experience in introducing and scaling up two selected SRHR self-care interventions. A prospective qualitative study design was used and a semi-structured questionnaire was shared with identified SRHR private sector partners selected through convenience and purposive sampling. The two interventions include the use of misoprostol for postpartum hemorrhage and the use of subcutaneous depomedroxyprogesterone acetate (DMPA) as injectable contraceptive method. Data collection was done through emails and telephone follow-up calls. Results Nine of the 13 partners consulted for the study responded. The two selected self-care interventions are mainly supported by private sector partners (national and international nongovernmental organizations) having national or subnational existence. Their mandates include all relevant areas, such as policy advocacy, field implementation, trainings, supervision and monitoring. A majority of partners reported experience related to the use of misoprostol; it was introduced more than a decade ago, is registered and is procured by both public and private sectors. Subcutaneous DMPA is a new intervention, having been introduced only recently, and commodity availability remains a challenge. It is being delivered through health workers/providers and is not promoted as a self-administered contraceptive. Community engagement and awareness raising is reported as an essential element of successful field implementation; however, no beneficiary data was collected for the study. Training approaches differ considerably, are standalone or integrated with SRHR topics and their duration varies between 1 and 5 days, covering a range of cadres. Conclusion Pubic sector ownership and patronage is essential for introducing and scaling up self-care interventions as a measure to support the healthcare system in delivering quality sexual and reproductive health services. Supervision, monitoring and reporting are areas requiring further support, as well as the leadership and governance role of the public sector. Standardization of trainings, community awareness, supervision, monitoring and reporting are required together with integration of self-care in routine capacity building activities (pre- and in-service) on sexual and reproductive health in the country.

Download Full-text

The role of self-care interventions on men’s health-seeking behaviours to advance their sexual and reproductive health and rights

Health Research Policy and Systems ◽

10.1186/s12961-020-00655-0 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Manjulaa Narasimhan ◽

Carmen H. Logie ◽

Kevin Moody ◽

Jonathan Hopkins ◽

Oswaldo Montoya ◽

...

Keyword(s):

Public Health ◽

Reproductive Health ◽

Social Norms ◽

Sexual And Reproductive Health ◽

Self Care ◽

Men’S Health ◽

Men's Health ◽

Health Seeking ◽

Digital Platforms ◽

Care Practices

Abstract Background Self-care interventions are influencing people’s access to, expectation and understanding of healthcare beyond formal health delivery systems. In doing so, self-care interventions could potentially improve health-seeking behaviours. While many men proactively engage in maintaining and promoting their health, the focus on men’s health comes from the recognition, at least partially, that male socialization and social norms can induce men and boys to have a lower engagement in institutionalized public health entities and systems around their sexual and reproductive health and rights, that could impact negatively on themselves, their partners and children. Main text A research agenda could consider the ways that public health messaging and information on self care practices for sexual and reproductive health and rights could be tailored to reflect men’s lived realities and experiences. Three examples of evidence-based self-care interventions related to sexual and reproductive health and rights that men can, and many do, engage in are briefly discussed: condom use, HIV self-testing and use of telemedicine and digital platforms for sexual health. We apply four core elements that contribute to health, including men’s health (people-centred approaches, quality health systems, a safe and supportive enabling environment, and behaviour-change communication) to each intervention where further research can inform normative guidance. Conclusion Engaging men and boys and facilitating their participation in self care can be an important policy intervention to advance global sexual and reproductive health and rights goals. The longstanding model of men neglecting or even sabotaging their wellbeing needs to be replaced by healthier lifestyles, which requires understanding how factors related to social support, social norms, power, academic performance or employability conditions, among others, influence men’s engagement with health services and with their own self care practices.

Download Full-text

Regulatory standards and processes for over-the-counter availability of hormonal contraception and drugs for medical abortion in five countries in the Eastern Mediterranean Region

Health Research Policy and Systems ◽

10.1186/s12961-020-00661-2 ◽

2021 ◽

Vol 19 (S1) ◽

Author(s):

Anne Ammerdorffer ◽

Mark Laws ◽

Arinze Awiligwe ◽

Florence Erb ◽

Wallada Im-Amornphong ◽

...

Keyword(s):

Reproductive Health ◽

Health System ◽

Emergency Contraception ◽

Sexual And Reproductive Health ◽

Self Care ◽

Medical Abortion ◽

Health System Strengthening ◽

World Health ◽

Over The Counter ◽

Regulatory Status

AbstractThe World Health Organization 2019 WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights includes recommendations on self-administration of injectable contraception, over-the-counter (OTC) oral contraception and self-management of medical abortion. A review of the regulatory status of these two self-care interventions can highlight processes required to ensure that the quality of the medicines and safety of individuals are safeguarded in the introduction and scale-up in countries. This review outlines the legal regulatory status of prescription-only medicine (POM) and OTC contraceptives, including emergency contraception, and drugs for medical abortion in Egypt, Jordan, Lebanon, Morocco and Tunisia using information obtained from internet searches, regulatory information databases and personal contacts. In addition, the review examines whether the national medicines regulatory authorities have documented procedures available to allow for a change in status from a POM to OTC to allow for increased accessibility, availability and uptake of self-care interventions recommended by WHO. Egypt, Jordan and Lebanon have a documented national OTC list available. The only contraceptive product mentioned in the OTC lists across all five countries is ellaOne (ulipristal acetate for emergency contraception), which is publicly registered in Lebanon. None of the five countries has an official documented procedure to apply for the change of POM to OTC. Informal procedures exist, such as the ability to apply to the national medicines regulatory authority for OTC status if the product has OTC status in the original country of manufacture. However, many of these procedures are not officially documented, highlighting the need for establishing sound, affordable and effective regulation of medical products as an important part of health system strengthening. From a public health perspective, it would be advantageous for licensed products to be available OTC. This is particularly the case for settings where the health system is under-resourced or over-stretched due to health emergencies. Readiness of national regulatory guidelines and OTC procedures could lead to increased access, availability and usage of essential self-care interventions for sexual and reproductive health and rights.

Download Full-text

Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage

Sexual and Reproductive Health Matters ◽

10.1080/26410397.2020.1778610 ◽

2020 ◽

Vol 28 (2) ◽

pp. 1778610

Author(s):

Manjulaa Narasimhan ◽

Carmen H. Logie ◽

Alice Gauntley ◽

Rodolfo Gomez Ponce de Leon ◽

Karima Gholbzouri ◽

...

Keyword(s):

Reproductive Health ◽

Universal Health Coverage ◽

Sexual And Reproductive Health ◽

Self Care ◽

Health Coverage ◽

Universal Health

Download Full-text

Preparation for sexual and reproductive self-care in Iranian adolescent girls: a qualitative study

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2016-0094 ◽

2017 ◽

Vol 30 (1) ◽

Cited By ~ 1

Author(s):

Zainab Alimoradi ◽

Nourossadat Kariman ◽

Fazlollah Ahmadi ◽

Masoumeh Simbar

Keyword(s):

Health Care ◽

Content Analysis ◽

Reproductive Health ◽

Data Collection ◽

Qualitative Study ◽

Adolescent Girls ◽

Sexual Behaviors ◽

Sexual And Reproductive Health ◽

Self Care ◽

Main Theme

AbstractBackgroundAdolescence is one of the most important stages in every individual’s life. Pubertal changes and acquiring reproduction capability require adolescents to perform special health care processes. Also the possibility of involvement in high-risk sexual behaviors endangers adolescent girls’ sexual and reproductive health.ObjectiveIncrease and deepen the understanding and knowledge of the factors affecting Iranian adolescent girls’ readiness to take care of their sexual and reproductive health.Materials and methodsThe present qualitative study was conducted using conventional content analysis method. The participants included 18 adolescents who were aged 13–19 years old, single, studying at high school, art school, or university and had no history of chronic medical or psychological diseases; further, most of them had the experience of menstruation. Purposive sampling was initiated and continued until data saturation. Data collection were performed using in-depth and unstructured interviews. Qualitative content analysis of the interviews was conducted simultaneously with data collection using the Graneheim and Lundman approach .MAXQDA 2010 software was used for storage, retrieval, and management of the data.FindingsPreparation for care was the main theme that emerged in this study along with 19 subcategories and four main categories, including desirable interaction between families and adolescents, readiness for puberty and menstruation, life skills and spiritual self-monitoring.ConclusionThe education and health care systems’ authorities of the country can exploit the results of this study for making policies and interventions expedient to the society’s cultural conditions in order to improve the reproductive and sexual self-care status of adolescents’ girls.

Download Full-text

Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start?

Conflict and Health ◽

10.1186/s13031-021-00358-5 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Nguyen Toan Tran ◽

Hannah Tappis ◽

Pierre Moon ◽

Megan Christofield ◽

Angela Dawson

Keyword(s):

Reproductive Health ◽

System Approach ◽

Sexual And Reproductive Health ◽

Digital Health ◽

Self Care ◽

Global Community ◽

Care Continuum ◽

Service Package ◽

Health Support ◽

Context Specific

AbstractRecent crises have accelerated global interest in self-care interventions. This debate paper aims to raise the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions. We start by exploring self-care interventions that could align with well-established humanitarian standards, such as the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises, point to the potential of digital health support for SRH self-care in crisis-affected settings, and discuss related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other live-saving SRH interventions—it does not eliminate the need for provider-led services in health facilities. Further research on SRH self-care interventions focusing distinctively on humanitarian and fragile settings is needed to inform context-specific policies and practice guidance.

Download Full-text

Human rights and legal dimensions of self care interventions for sexual and reproductive health

BMJ ◽

10.1136/bmj.l1941 ◽

2019 ◽

pp. l1941 ◽

Cited By ~ 3

Author(s):

Laura Ferguson ◽

Susana Fried ◽

Thabo Matsaseng ◽

Sundari Ravindran ◽

Sofia Gruskin

Keyword(s):

Human Rights ◽

Reproductive Health ◽

Sexual And Reproductive Health ◽

Self Care

Download Full-text

Self-care and remote care during pregnancy: a new paradigm?

Health Research Policy and Systems ◽

10.1186/s12961-020-00627-4 ◽

2020 ◽

Vol 18 (1) ◽

Cited By ~ 1

Author(s):

A. Metin Gülmezoglu ◽

Anne Ammerdorffer ◽

Manjulaa Narasimhan ◽

Alyce N. Wilson ◽

Joshua P. Vogel ◽

...

Keyword(s):

Quality Of Care ◽

Reproductive Health ◽

Health Services ◽

Sexual And Reproductive Health ◽

Healthcare Providers ◽

Self Care ◽

Reproductive Health Services ◽

New Paradigm ◽

Remote Care

Abstract Self-care interventions and remote care offer innovative and equitable ways to strengthen access to sexual and reproductive health services. Self-isolation during COVID-19 provided the opportunity for obstetric facilities and healthcare providers to integrate and increase the usage of interventions for self-care and remote care for pregnant women and to improve the quality of care overall.

Download Full-text

Sexual and reproductive health self-care: a theory-based intervention

Health Education ◽

10.1108/he-04-2020-0024 ◽

2021 ◽

Vol 121 (1) ◽

pp. 111-124

Author(s):

Marjan Havaei ◽

Sara Esmaelzadeh Saeieh ◽

Leili Salehi

Keyword(s):

Reproductive Health ◽

Sexual And Reproductive Health ◽

Intervention Group ◽

Self Care ◽

Female Students ◽

Control Group ◽

Size Estimation ◽

Medical Sciences ◽

Content Type ◽

Counseling Intervention

PurposeThis study, a theory-based interventional study, aims to promote self-care behaviors regarding sexual and reproductive health in adolescents (female) in Karaj, Iran.Design/methodology/approachThis study was conducted on 90 female students of the Alborz University of Medical Sciences in Iran. For selecting subjects, the researchers went to two girls' dormitories on working days and tried to observe the proportion of students with different fields. Initially, 200 eligible female students were identified in the dormitories of Alborz University of Medical Sciences. Based on the sample size estimation, 100 research units were divided into two groups of receiving counseling (intervention group) and not receiving counseling (control group) by four-digit block randomization. Sexual and reproductive health self-care questionnaire was used as a tool for data collection before, after and one month after intervention. Data were analyzed by using X2 and ANOVA tests using SPSS (16).FindingsBoth groups were homogeneous in terms of demographic characteristics before the intervention. The results of the study indicated that after education, sexual and reproductive knowledge (p < 0.001), self-care of sexual health (p < 0.001), self-care of menstrual and genital health (p < 0.001) increased significantly. But, regarding parents' communications (p = 0.11), conversation barriers with parents (p = 0.83), interaction with (p = 0.79) and the perceptions of sexual risk behaviors relationships (p = 0.61) differences are not significant.Research limitations/implicationsFailure of parents to participate in this study and the implementation of this study only on the female sex were main limitations of the present study.Practical implicationsTheory-based education can improve sexual and reproductive health in adolescents' girls.Originality/valueAll Authors declare the manuscript entitled “Sexual and reproductive health self-care: a theory-based intervention” is original work of the author. All data, tables, figures, etc. used in the manuscript are prepared originally by authors; otherwise, the sources are cited and reprint permission is attached.

Download Full-text

Prioritising gender, equity, and human rights in a GRADE-based framework to inform future research on self care for sexual and reproductive health and rights

BMJ Global Health ◽

10.1136/bmjgh-2019-002128 ◽

2020 ◽

Vol 5 (3) ◽

pp. e002128

Author(s):

Nandi Siegfried ◽

Manjulaa Narasimhan ◽

Carmen H Logie ◽

Rebekah Thomas ◽

Laura Ferguson ◽

...

Keyword(s):

Human Rights ◽

Reproductive Health ◽

Gender Equity ◽

Sexual And Reproductive Health ◽

Self Care ◽

Future Research ◽

Methodological Challenges ◽

Guidelines Development ◽

Study Results ◽

Research Questions

IntroductionIn January 2019, the WHO reviewed evidence to develop global recommendations on self-care interventions for sexual and reproductive health and rights (SRHR). Identification of research gaps is part of the WHO guidelines development process, but reliable methods to do so are currently lacking with gender, equity and human rights (GER) infrequently prioritised.MethodsWe expanded a prior framework based on Grading of Evidence, Assessment, Development and Evaluation (GRADE) to include GER. The revised framework is applied systematically during the formulation of research questions and comprises: (1) assessment of the GRADE strength and quality rating of recommendations; (2) mandatory inclusion of research questions identified from a global stakeholder survey; and (3) selection of the GER standards and principles most relevant to the question through discussion and consensus. For each question, we articulated: (1) the most appropriate and robust study design; (2) an alternative pragmatic design if the ideal design was not feasible; and (3) the methodological challenges facing researchers through identifying potential biases.ResultsWe identified 39 research questions, 7 overarching research approaches and 13 discrete feasible study designs. Availability and accessibility were most frequently identified as the GER standards and principles to consider when planning studies, followed by privacy and confidentiality. Selection and detection bias were the primary methodological challenges across mixed methods, quantitative and qualitative studies. A lack of generalisability potentially limits the use of study results with non-participation in research potentially highest in more vulnerable populations.ConclusionA framework based on GRADE that includes stakeholders’ values and identification of core GER standards and principles provides a practical, systematic approach to identifying research questions from a WHO guideline. Clear guidance for future studies will contribute to an anticipated ‘living guidelines’ approach within WHO. Foregrounding GER as a separate component of the framework is innovative but further elaboration to operationalise appropriate indicators for SRHR self-care interventions is required.

Download Full-text