Empowering women through self-care: A leap towards health equity

In a recent perspective piece published in Nature Medicine, researchers explored the potential of self-care interventions to improve the health and well-being of girls and women to promote equity, gender equality, and human rights.

Study: Self-care interventions for women’s health and well-being. Image Credit: PeopleImages.com – Yuri A/Shutterstock.com

Background

Everyone has the right to good health, but an estimated half of the global population cannot access essential healthcare services.

Women are often disproportionately affected, with many living in poverty or beyond the reach of public health systems, and thus unable to afford healthcare.

Those who have been displaced by war or conflict, live with human immunodeficiency virus (HIV), are incarcerated or institutionalized, experience homelessness, or belong to indigenous communities or other minority groups are particularly vulnerable.

Importance of self-care interventions

The coronavirus disease 2019 (COVID-19) pandemic demonstrated how prioritizing self-care intervention access, including the distribution of contraception without the need for prescriptions or telehealth services for pregnant people, could empower women to take charge of their health.

While these interventions were initiated during a global crisis, experts call for integration into routine healthcare to promote women’s health and well-being within supportive and safe enabling environments.

To this end, the World Health Organization (WHO) has developed evidence-based global guidelines emphasizing the importance of self-care interventions alongside facility-based healthcare services across economic settings with detailed monitoring frameworks and indicators.

The building blocks of this system are institutions, organizations, healthcare workers, and resources that come together to ensure financial and social risk protection, responsive services, improved efficiency, and equitable and better health outcomes.

Integration into traditional healthcare

Long before modern formal health systems existed, people engaged in various forms of self-care to manage illness or disability, maintain good health, or prevent disease; they continue to do so either by themselves or with the support of their families or health workers.

Their practices vary with context and are influenced by their social environment, agency, and health literacy, as well as what information they have access to.

Increasing health literacy can mobilize communities and improve the agency of citizens to take charge of their health.

Effective self-care interventions strengthen health services that support communities throughout the life course and address determinants of health beyond curative care. This is done through a people-centric approach regardless of whether people care for themselves or others.

Populations should be able to access relevant information and technology, and interventions should be inexpensive and effective. The health workforce must be trained to promote self-care through capacity-building and competency-based training.

Some promising avenues for interventions are reproductive and sexual health, mental health, chronic disease, and COVID-19. Noncommunicable diseases can be significantly reduced by self-care strategies, including exercise, low-sodium and heart-healthy diets, avoidance of obesity, and not smoking.

Self-injectable contraceptives are another cost-effective strategy in remote, rural areas, as women do not need to travel to distant healthcare facilities and benefit from increased privacy and agency; once trained, they can practice this form of self-care with minimal support from providers.

Self-testing for HIV and other sexually transmitted infections has also allowed many women to learn about their status and seek out treatment.

Barriers to effective self-care

Ensuring that interventions increase access among underserved communities and reduce inequity instead of reinforcing existing power structures is critical.

Different age groups may require different guidance; for example, older women may have interacting conditions, including hypertension, diabetes, and arthritis, which each require distinct actions.

The costs of interventions to users must also be considered. If accessing an intervention involves out-of-pocket expenditures, efficiency, and equity can be improved by instituting financial protection or subsidy schemes.

Beyond the health system, affordability is also a challenge. For example, low-income mothers may be unable to afford healthier diets in fiber, vegetables, and fruits. Menstrual management also involves costs such as purchasing menstrual cups, tampons, and pads.

Due to inadequate promotion, female condoms have not been widely used despite their demonstrated efficacy. In regions of Senegal, Nigeria, and India, knowledge related to emergency contraception is limited, and many respondents believe that prescriptions should be required to access them.

Women’s healthcare decisions continue to be affected by social stigma, including the blame and judgment young women face because they are sexually active, which may prevent them from accessing pregnancy tests.

Similarly, there is a lack of awareness around the sexual health of older women, including regarding menopause, which can lead to stigma and suboptimal care. In the United States, abortion access has become a politically charged issue.

Conclusions

Self-care interventions have the potential to disrupt and strengthen traditional healthcare systems, improving outcomes for women and other underserved populations.

They are not intended to replace healthcare provided through facilities but rather complement it. However, care must be taken to ensure these interventions reduce inequalities instead of exacerbating them.