Women and Girls Must Spark Self-Care Movement
By Tariah Adams, Communications & Advocacy Officer, White Ribbon Alliance Nigeria
Ushafa is a community in Abuja, Nigeria home to many farmers, petty traders and low-income earners. In the community, around 40% of the 1,000 residents are women and girls between the ages of 15 to 49 years. The community has one government primary health care centre where community members access care. In a community dialogue hosted by WRA Nigeria, 30 girls identified barriers to accessing Sexual Reproductive Health (SRH) services. The girls cited challenges such as the attitude of health workers to young people, lack of awareness of their sexual reproductive health rights and negative social norms within the community. They also described coping practices. One participant, Aisha*, travels to a community five miles away to procure SRH services to maintain her privacy and avoid gossip. Other girls described using harmful practices ranging from the use of soda and salt after sex to using iron hangers as a means of abortion and drinking lime and potash to avoid pregnancy.
The stories shared by these girls are contributory factors to Nigeria’s maternal mortality rate where 145 girls and women of reproductive age die daily from pregnancy-related complications. Around 214 million women and girls in low and middle-income countries who wish to avoid pregnancy are currently unable to access modern contraceptive methods when they need it and globally an estimated 44% of pregnancies are unintended. This is the situation for a large number of Nigeria’s 40 million women of childbearing age, between 15 and 49 years. The COVID-19 pandemic has disrupted an already fragile health system, exacerbating the situation.
Self-care has the potential to significantly contribute to improving access to SRH care for millions of women and girls. The World Health Organization (WHO) describes self-care as “the ability of individuals, families and communities to promote health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health-care provider.” WHO recognized the increasing importance of self-care in improving global health outcomes, and launched a guideline on self-care interventions for health. The guideline promotes a people-centered approach and supports health literacy so that people can take charge of their health.
For example, self-administration of injectable contraceptives can improve access to contraceptives for millions of women and girls who want to avoid pregnancy but encounter barriers to utilizing modern contraceptive methods for varying reasons. In another example, “HPV self-sampling can improve screening for cervical cancer and can contribute towards eliminating cervical cancer. Self-collection of samples for STI testing can contribute towards eliminating the global burden of about 357 million new infections of four curable sexually transmitted infections.” Self-care can expand access to devices, diagnostics, drugs and digital tools that support people to become active decision-makers in their health.
Self-care will be a deterrent to harmful sexual reproductive health practices of young girls and women in Ushafa. Aisha will no longer have to walk five miles to another community to obtain contraceptives anonymously; she would be able to administer an injectable contraceptive in a self-care pack in the comfort of her own home. However, when self-care is not a positive choice, but necessitated from a lack of alternatives, it can be counter-productive, leading to more harm than good. Thus, promoting self-care in Nigeria for the benefit of women and girls requires the adoption of WHO guidelines to the country context as a starting point. To realize the full potential of self-care as an integral part of the national health system, advocates must help ignite a broad-base movement in support of self-care. Effectively institutionalizing self-care requires a consultative approach centered around women and girls. When women and girls lead, directing their own health, we can achieve critical changes in health attitudes, policies and systems, ultimately achieving progress towards Universal Health Coverage.
*Name has been changed to protect privacy