Last updated December 18, 2021

Self-Care Interventions for Health: Sexual and Reproductive Haelth and Rights

RECOMMENDATIONS

1. Improving antenatal, delivery, postpartum and newborn care

REC 1: Health education for women is an essential component of antenatal care.

The following educational interventions and support programmes are recommended to reduce caesarean births only with targeted monitoring and evaluation.

(Context-specific recommendation, low-certainty evidence)
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REC 1a: Childbirth training workshops

Content includes sessions about childbirth fear and pain, pharmacological pain-relief techniques and their effects, non-pharmacological pain-relief methods, advantages and disadvantages of caesarean sections and vaginal delivery, indications and contraindications of caesarean sections, among others.

( Low- to moderate-certainty evidence)
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REC 1b: Nurse-led applied relaxation training programme

Content includes group discussion of anxiety and stress-related issues in pregnancy and purpose of applied relaxation, deep breathing techniques, among other relaxation techniques.

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REC 1c: Psychosocial couple-based prevention programme

Content includes emotional self-management, conflict management, problem solving, communication and mutual support strategies that foster positive joint parenting of an infant). “Couple” in this recommendation includes couples, people in a primary relationship or other close people.

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REC 1d: Psychoeducation

For women with fear of pain; comprising information about fear and anxiety, fear of childbirth, normalization of individual reactions, stages of labour, hospital routines, birth process, and pain relief (led by a therapist and midwife), among other topics.

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REC 2: When considering the educational interventions and support programmes, no specific format (e.g. pamphlet, videos, role play education) is recommended as more effective.

(Not specified)
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Interventions for nausea and vomiting

REC 3: Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for the relief of nausea in early pregnancy, based on a woman’s preferences and available options.

(Not specified)
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Interventions for heartburn

REC 4: Advice on diet and lifestyle is recommended to prevent and relieve heartburn in pregnancy. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification.

(Not specified)
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Interventions for leg cramps

REC 5: Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options.

(Not specified)
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Interventions for low back and pelvic pain

REC 6: Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, support belts and acupuncture, based on a woman’s preferences and available options.

(Not specified)
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Interventions for constipation

REC 7: Wheat bran or other fibre supplements can be used to relieve constipation in pregnancy if the condition fails to respond to dietary modification, based on a woman’s preferences and available options.

(Not specified)
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Interventions for varicose veins and oedema

REC 8: Non-pharmacological options, such as compression stockings, leg elevation and water immersion, can be used for the management of varicose veins and oedema in pregnancy, based on a woman’s preferences and available options.

(Not specified)
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Existing recommendation on self-administered pain relief for prevention of delay in the first stage of labour

REC 9: Pain relief for preventing delay and reducing the use of augmentation in labour is not recommended.

(Weak recommendation, very low-quality evidence)
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2. Providing high-quality services for family planning, including infertility services

New recommendation on self-administration of injectable contraception

REC 10 (NEW): Self-administered injectable contraception should be made available as an additional approach to deliver injectable contraception for individuals of reproductive age.

(Strong recommendation, moderate-certainty evidence)
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New recommendation on self-management of contraceptive use with over-the-counter oral contraceptive pills (OTC OCPs)

REC 11 (NEW): Over-the-counter oral contraceptive pills (OCPs) should be made available without a prescription for individuals using OCPs.

(Strong recommendation, very low-certainty evidence)
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New recommendation on self-screening with ovulation predictor kits (OPKs) for fertility regulation

REC 12 (NEW): Home-based ovulation predictor kits (OPKs) should be made available as an additional approach to fertility management for individuals attempting to become pregnant.

(Strong recommendation, low-certainty evidence)
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Existing recommendation on condoms

REC 13: Consistent and correct use of male and female condoms is highly effective in preventing the sexual transmission of HIV; reducing the risk of HIV transmission both from men to women and women to men in serodiscordant couples; reducing the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer; and preventing unintended pregnancy.

(Not specified)
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REC 14: The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and STIs.

(Strong recommendation, moderate-quality evidence)
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Existing recommendations on the number of progestogen-only pill (POP) and combined oral contraceptive (COC) pill packs that should be provided at initial and return visits

REC 15a: Provide up to one year’s supply of pills, depending on the woman’s preference and anticipated use.

(Not specified)
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REC 15b: Programmes must balance the desirability of giving women maximum access to pills with concerns regarding contraceptive supply and logistics.

(Not specified)
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REC 15c: The re-supply system should be flexible, so that the woman can obtain pills easily in the amount and at the time she requires them.

(Not specified)
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3. Eliminating unsafe abortion

Existing recommendations on self-management of the medical abortion process in the first trimester

REC 16: Self-assessing eligibility [for medical abortion] is recommended in the context of rigorous research.

(Not specified)
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REC 17: Managing the mifepristone and misoprostol medication without direct supervision of a health-care provider is recommended in specific circumstances. We recommend this option in circumstances where women have a source of accurate information and access to a health-care provider should they need or want it at any stage of the process.

(Not specified)

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REC 18: Self-assessing completeness of the abortion process using pregnancy tests and checklists is recommended in specific circumstances. We recommend this option in circumstances where both mifepristone and misoprostol are being used and where women have a source of accurate information and access to a health-care provider should they need or want it at any stage of the process.

(Not specified)

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Existing recommendations on post-abortion hormonal contraception initiation

REC 19: Self-administering injectable contraceptives is recommended in specific circumstances. We recommend this option in contexts where mechanisms to provide the woman with appropriate information and training exist, referral linkages to a health-care provider are strong, and where monitoring and follow-up can be ensured.

(Not specified)

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REC 20: For individuals undergoing medical abortion with the combination mifepristone and misoprostol regimen or the misoprostol-only regimen who desire hormonal contraception (oral contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant or contraceptive injections), we suggest that they be given the option of starting hormonal contraception immediately after the first pill of the medical abortion regimen.

(Not specified)

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4. Combating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities

New recommendation on HPV self-sampling

REC 21 (NEW): HPV self-sampling should be made available as an additional approach to sampling in cervical cancer screening services for individuals aged 30–60 years.

(Strong recommendation, moderate-certainty evidence)
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New recommendation on self-collection of samples for STI testing

REC 22a (NEW): Self-collection of samples for Neisseria gonorrhoeae and Chlamydia trachomatis should be made available as an additional approach to deliver STI testing services for individuals using STI testing services.

(Strong recommendation, moderate-certainty evidence)
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REC 22b (NEW): Self-collection of samples for Treponema pallidum (syphilis) and Trichomonas vaginalis may be considered as an additional approach to deliver STI testing services for individuals using STI testing services.

(Conditional recommendation, low-certainty evidence)
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Existing recommendation on HIV self-testing

REC 23: HIV self-testing should be offered as an additional approach to HIV testing services.

(Strong recommendation, moderate-quality evidence)
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Existing recommendation on self-efficacy and empowerment for women living with

HIV REC 24: For women living with HIV, interventions on self-efficacy and empowerment around sexual and reproductive health and rights should be provided to maximize their health and fulfil their rights.

(Strong recommendation, low-quality evidence)
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5. Promoting sexual health

There are no new or existing recommendations on self-care interventions in this area, but relevant existing WHO guidance is provided in this guideline.


GOOD PRACTICE STATEMENTS

1. Environmental considerations
Adapted good practice statement on safe and sustainable management of health-care waste
GPS 1 (ADAPTED): Safe and secure disposal of waste from self-care products should be promoted at all levels.
Adapted good practice statement on environmentally preferable purchasing (EPP)
GPS 2 (ADAPTED): Countries, donors and relevant stakeholders should work towards environmentally preferable purchasing (EPP) of self-care products by selecting supplies that are less wasteful, or can be recycled, or that produce less-hazardous waste products, or by using smaller quantities.
2. Financing and economic considerations
Adapted good practice statements on economic considerations for access, uptake and equity
GPS 3 (ADAPTED): Good-quality health services and self-care interventions should be made available, accessible, affordable and acceptable to vulnerable populations, based on: the principles of medical ethics; avoidance of stigma, coercion and violence; non-discrimination; and the right to health.
GPS 4 (ADAPTED): All individuals and communities should receive the health services and self-care interventions they need without suffering financial hardship.
3. Training needs of health-care providers
Existing good practice statement on values and competencies of the health workforce to promote self-care interventions
GPS 5: Health-care workers should receive appropriate recurrent training and sensitization to ensure that they have the skills, knowledge and understanding to provide services for adults and adolescents from key populations based on all persons’ right to health, confidentiality and non-discrimination.
4. Implementation considerations for vulnerable populations
New good practice statement on the life-course approach to SRHR
GPS 6 (NEW): Sensitization about self-care interventions, including for SRHR, should be tailored to people’s specific needs across the life course, and across different settings and circumstances, and should recognize their right to sexual and reproductive health across the life course.
New good practice statement on the use of digital health interventions to support the use of self-care interventions
GPS 7 (NEW): Digital health interventions offer opportunities to promote, offer information about and provide discussion forums for self-care interventions, including for SRHR.
New good practice statement on support for self-care interventions in humanitarian settings
GPS 8 (NEW): Provision of tailored and timely support for self-care interventions, including for SRHR, in humanitarian settings should be in accordance with international guidance, form part of emergency preparedness plans and be provided as part of ongoing responses.
Adapted and existing good practice statements relevant to implementation of self-care for vulnerable populations
GPS 9 (ADAPTED): People from vulnerable populations should be able to experience full, pleasurable sex lives and have access to a range and choice of reproductive health options.
GPS 10 (ADAPTED): Countries should work towards implementing and enforcing antidiscrimination and protective laws, derived from human rights standards, to eliminate stigma, discrimination and violence against vulnerable populations.
GPS 11: Countries should work towards decriminalization of behaviours such as drug use/injecting, sex work, same-sex activity and nonconforming gender identities, and towards elimination of the unjust application of civil law and regulations against people who use/inject drugs, sex workers, men who have sex with men and transgender people.
GPS 12: Countries are encouraged to examine their current consent policies and consider revising them to reduce age-related barriers to HIV services and to empower providers to act in the best interests of the adolescent.
GPS 13: It is recommended that sexual and reproductive health services, including contraceptive information and services, be provided for adolescents without mandatory parental and guardian authorization/notification.

 

Recommendation Grading

Overview

Title

Self-Care Interventions for Health: Sexual and Reproductive Health and Rights

Authoring Organization

Publication Month/Year

June 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Counselor

Scope

Counseling, Prevention, Management

Diseases/Conditions (MeSH)

D060728 - Reproductive Health, D000074384 - Sexual Health, D012648 - Self Care

Keywords

Reproductive Health, Self-Care, Self-Testing, Self-awareness