Intended for healthcare professionals

Analysis Self Care Interventions for Sexual and Reproductive Health

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

BMJ 2019; 365 doi: (Published 01 April 2019) Cite this as: BMJ 2019;365:l1228

Self care interventions for SRHR

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  1. Michelle Remme, research fellow1,
  2. Manjulaa Narasimhan, scientist2,
  3. David Wilson, programme director3,
  4. Moazzam Ali, medical officer2,
  5. Lavanya Vijayasingham, research consultant1,
  6. Fatima Ghani, postdoctoral fellow1,
  7. Pascale Allotey, director1
  1. 1United Nations University–International Institute for Global Health, Kuala Lumpur, Malaysia
  2. 2Department of Reproductive Health and Research, and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland
  3. 3World Bank, Washington, DC, USA
  1. Correspondence to: M Remme michelle.remme{at}

Michelle Remme and colleagues argue that if costs to users are considered and their financing is right, self care interventions for sexual and reproductive health can improve equity and efficiency

Globally, most of the 4.3 billion people of reproductive age in the world will lack access to adequate sexual and reproductive health services at some time in their life.1 Despite progress towards universal health coverage, the unmet need for sexual and reproductive health interventions is substantial and requires urgent attention and innovative solutions. For decades, self care products, such as the contraceptive pill, condoms, and sanitary products, have had a considerable effect on health and society.2 Technological developments have made self care products increasingly accessible, with a growing range of self administered medicines, diagnostic tests, devices, and apps.

Self care interventions include self awareness interventions for health promotion; self testing, screening, and diagnosis for disease prevention; and self management for better treatment outcomes.3 In sexual and reproductive health, tools are available for fertility management (ovulation predictors, pregnancy tests, and phone based apps), contraception (vaginal barrier methods, oral emergency contraception, and self administered medical abortion), and diagnosis of sexually transmitted infections (self tests for HIV and tests on self samples for human papillomavirus).2

Self care can increase people’s engagement with and autonomy over their health and provide an opportunity for health systems to improve equitable access to healthcare, quality of care, and financial protection for users (fig 1). Self care could improve the efficiency of healthcare delivery by including users as lay health workers, thereby increasing people’s access to essential health services. Self care could also increase the use of preventive services and adoption of preventive behaviours, improve adherence to treatment, and reduce the need for healthcare services.5

Fig 1

Self care within the healthcare pyramid. Adapted from …

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