“For me, self-care is summed up by three things: having agency, access to accurate information, and resources to preserve my health and rights,” says Olaoluwa Abagun, a feminist and advocate for girls’ rights from Nigeria. For thousands of women like Olaoluwa, self-care represents an opportunity to manage and control their own sexual health and fertility. This translates to greater bodily autonomy and increased power over their lives.
In July this year, global leaders, activists and government ministers from around the world met in Paris for the second Summit of the Generation Equality Forum, a global process focused on advancing gender equality for Africa and the world. One of the solutions critical to achieving gender equality, bodily autonomy and sexual and reproductive health and rights is self-care. Self-care has been around for millennia, but its promise and power have been championed by advocates like Olaoluwa all around the world.
Now, African leaders can sustain our progress towards gender equality by recognising self-care as a global priority for sexual and reproductive healthcare.
‘Self-care’ refers to health services and products that are user-initiated or controlled, often with health provider support, but often outside of a formal healthcare setting. Self-care encompasses a wide spectrum of initiatives, including education and awareness-raising approaches, apps that enable digital access to medical information, and innovative products like self-injectable contraception and HIV self-tests.
Expanding and strengthening self-care availability is a vital component in extending reproductive choice to more women, enabling them to exert more control over their lives and livelihoods.
Tools such as easy-to-use pregnancy test strips, on-demand contraceptive services, including emergency contraceptive pills, and pre-exposure prophylaxis (PrEP) are revolutionising the way individuals access sexual and reproductive healthcare. At the same time, self-care can and should be supported by the formal healthcare system, without discrimination or delay.
One of the greatest advantages of self-care is that it challenges norms about the role of women and girls in healthcare provision. Women’s and girls’ voices and participation are central to a self-care framework, enabling them to act as informed agents of their own health. In practical terms, self-care improves health equity by removing obstacles to care for some of the most vulnerable people in society.
Before the Covid-19 pandemic, 270 million women and girls of reproductive age had an unmet need for contraception, even though they wanted to avoid pregnancy. Curfews, loss of income, reduced clinic hours, and contraceptive stockouts have compounded this situation. Women and girls who cannot access contraception have reduced access to education, income, and professional opportunities, as well as overall poorer health outcomes.
Yet trailblazers are demonstrating that self-care can play a valuable role in restoring sexual and reproductive healthcare provision in the wake of the pandemic and they are seeing results.
In Uganda, national self-care guidelines introduced by the Ministry of Health in 2020 support women to access interventions like self-injectable contraception, helping them to obtain family planning where they want, when they want and reducing disparities in access to contraception. Women in Uganda expressed relief about no longer having to spend time at crowded clinics to get contraception. Instead, they can now use their mobile phones to connect with pharmacies and purchase their chosen contraceptive method that is then delivered to their homes.
In Kenya, organisations in the reproductive health space are working tirelessly to ensure that vulnerable populations have access to affordable quality sexual and reproductive health methods. HIV self-test kits allow health services to reach patients who would not usually attend services in person due to the stigma still associated with HIV.
Elsewhere in the world, pilot self-care programmes have demonstrated the potential of self-care to improve infant health and reduce maternal mortality. In India, birth preparedness work has resulted in safer pregnancies, with women reporting increased knowledge about danger signs during the pregnancy and postpartum period. Couples who participated were also more likely to save for childbirth expenses.
Self-care is here to stay as a model of sexual and reproductive healthcare and a way to promote gender equality. Creating a world where women and girls are better able to manage their sexual and reproductive health and rights will translate to women and girls being able to fully participate in all areas of society with benefits to all.
Each one of us has seen the power that self-care has in transforming lives. We are calling on African nations and global leaders in the coming years to continue to champion self-care as an essential part of their country’s health systems.
By elevating the potential of self-care, removing legal and systemic barriers for women and girls to access services, and investing in critical tools that puts women in control of their reproductive health, we can sow the seeds for broad, constructive change. It is time to put women and girls at the centre of their own healthcare.
Aparajita Gogoi, PhD, is the executive director of Centre for Catalyzing Change and the National Coordinator of the White Ribbon Alliance, India.
Milly Nanyombi Kaggwa, MBBS, is the Senior Clinical Advisor for Africa at Population Services International.
Miles Kemplay, MPH, is the Executive Director of Adolescence at the Children’s Investment Fund Foundation.
Dr Raffaela Schiavon is an Obstetrician and Gynaecologist with an extensive work in clinical, research and advocacy to protect and expand sexual and reproductive health and rights, particularly for children and adolescents.