Self-care interventions for women's health and well-being

The Perspective frames self-care within the universal human right to health, noting that about half of the world’s population lacks access to essential health services, with women and girls particularly disadvantaged due to social norms, unequal power dynamics, and poverty. It adopts an inclusive definition of “women,” encompassing women, girls and gender-diverse individuals across the life course and diverse lived experiences. The COVID-19 pandemic demonstrated the feasibility and benefits of prioritizing self-care (for example, access to contraception through pharmacies and telehealth counseling), underscoring the need to normalize quality self-care interventions as an integral component of routine healthcare rather than as emergency responses. In response to calls for greater emphasis on self-care as additional options to facility-based care, WHO developed global normative guidance with evidence-based recommendations relevant across economic settings. The article sets out to explore the scope and opportunities of self-care interventions for women’s health, barriers that limit their potential (including stigma, costs, and power inequities), and strategies to sustainably integrate these interventions into health systems using a human rights, gender equality, and equity lens.

The article provides a narrative synthesis of evidence and WHO guidance on self-care interventions:

• Scope and framework: WHO’s definition and conceptual framework for self-care interventions place people and caregivers at the center and emphasize enabling environments, health literacy, and accountability to improve coverage and equity across the life course.
• Healthy behaviors and lifestyle: Strong evidence supports self-care strategies (diet, exercise, smoking cessation, low-sodium diet) in preventing and managing noncommunicable diseases. Women with hypertensive disorders of pregnancy face >2× future CVD risk; maternal obesity increases offspring cardiometabolic risk. Access and adherence barriers (cost, availability, multimorbidity) are noted.
• Contraception: Multiple studies (including RCTs and cohorts) in African settings show that self-administered DMPA-SC improves continuation, reduces costs and resupply burdens, and enhances privacy; nearly 30 countries are introducing or scaling this option per WHO guidance. Training quality and agency affect uptake; initial provider training time and materials are required.
• STIs/HIV: Young women in sub-Saharan Africa face disproportionate HIV risk, often via age-disparate partnerships. Self-testing for HIV and point-of-care STI testing expand reach and prompt treatment, with task sharing to community workers. PrEP is widely available but has modest uptake and limited persistence over 12 months; mobile services and peer outreach may improve uptake. Viral load POC testing and multi-month dispensing support treatment success; evidence for self-administration of monitoring tests in resource-limited settings remains limited.
• Examples across life course and SRH: WHO recommendations include condoms, pregnancy self-testing, lubricants, OTC emergency contraception, self-management of iron/folate, empowerment interventions for women living with HIV, and self-monitoring of blood pressure/glucose in pregnancy; HPV self-sampling for cervical screening.
• Health systems integration: Self-care aligns with primary healthcare and WHO health system building blocks but remains undervalued despite most care occurring at home. Policy, financing, regulation (e.g., OTC switches), and social support are essential.
• Barriers reviewed: Out-of-pocket costs (e.g., menstrual products), provider incentives/attitudes, failure to promote women-initiated methods (female condom), stigma across the life course (adolescence to menopause), intersectional power inequities (criminalization, race/poverty), and regulatory gaps (only 43% of 30 countries had formal OTC reclassification procedures for contraceptives).

• Self-care as a rights-based adjunct to care: Quality self-care interventions can expand access, autonomy and agency for women while complementing facility-based services.
• Magnitude of unmet need: 3.6 billion people lack access to essential health services; women and girls are disproportionately affected. Nearly half of all pregnancies (≈121 million annually) are unintended.
• Effective self-care modalities across the life course: WHO endorses multiple self-care options, including condoms, pregnancy self-testing, lubricants, OTC emergency contraception, self-management of iron/folate, self-monitoring of blood pressure/glucose in pregnancy, HIV self-testing and STI self-sampling, HPV self-sampling for cervical screening, and self-administered DMPA-SC.
• Contraceptive self-injection (DMPA-SC): Consistently improves continuation and reduces costs and resupply trips; offers privacy benefits where home circumstances allow. Nearly 30 countries are introducing or scaling self-administered DMPA-SC. In Uganda facilities where available, over one-third of visits relate to self-injection; training quality, partner support, and client agency influence uptake.
• HIV/STI self-care: HIV self-testing and POC STI testing facilitate timely diagnosis and treatment, reaching underserved groups (e.g., female sex workers, humanitarian settings). PrEP is widely available but uptake and 12-month persistence remain modest; peer outreach/mobile services can help. POC viral load testing and multi-month dispensing enhance treatment success; adherence support can be targeted using POC drug-level testing.
• Undervalued caregiving and social support: Most caregiving is done by women; if unpaid caregiving were paid at minimum wage it would total about US$11 trillion/year (≈9% of global GDP), yet caregiver roles can constrain women’s own self-care.
• Barriers and inequities: Out-of-pocket costs (including menstrual products), provider payment structures that may disincentivize self-care, provider attitudes and knowledge gaps (e.g., emergency contraception), stigma across the life course (adolescence to menopause), and intersectional power inequities (gender norms, criminalization, race/poverty) limit access and use.
• Underutilization of women-initiated methods: Despite efficacy comparable to male condoms, female condoms comprised only 1.6% of global condom distribution in 2015, reflecting challenges in acceptability, social perceptions, cost, and lack of strategic promotion and financing.
• Regulatory gaps: Only 43% of 30 reviewed countries had formal procedures to reclassify prescription-only contraceptives to OTC status, impeding access to self-care options.
• Health system integration: Realizing self-care potential requires re-conceptualizing system boundaries, investing in health literacy, competency-based training for health workers, financing/protection schemes, and strong accountability across sectors, ensuring equity and protection from coercion, stigma, and discrimination.

The Perspective argues that centering self-care within a human rights and gender equality framework can address profound gaps in women’s access to quality health services. By providing additional, acceptable options alongside facility-based care, self-care interventions can improve coverage, autonomy, and health outcomes across the life course, particularly in sexual and reproductive health, chronic disease prevention/management, and HIV/STIs. Evidence summarized shows self-administered contraception can increase continuation and reduce costs; HIV/STI self-testing and POC diagnostics can reach underserved populations and expedite care; and HPV self-sampling can expand cervical cancer screening. However, without deliberate attention to equity, stigma, provider attitudes, out-of-pocket costs, and enabling regulatory/policy environments, self-care risks preferentially benefiting women with greater agency and resources while leaving behind those with the greatest need. The article emphasizes integrating self-care into the WHO health system building blocks, strengthening health literacy, competency-based training for health workers to support self-care, financial protection schemes, and multisectoral investments (education, social services, housing, income maintenance). Regulatory reforms (e.g., OTC access) and social support for caregivers are also pivotal. Collectively, these measures can transform self-care from an emergency response into a sustainable component of routine, people-centered health systems that advance equity and accountability.

Self-care interventions for women can help disrupt, transform and realign access to health options that complement, but do not replace, facility-based care. Healthcare delivered through health and care workers remains a key component of the human right to health, but self-care interventions play an important role in attaining good health for women. To avoid replicating broader health-system discriminations, implementation must focus on both quality and equitable access for all. To fulfill their potential and advance women’s health and well-being, self-care interventions must be centered on people as holders of universal human rights, with all stakeholders held accountable.

• This is a Perspective (narrative synthesis) rather than an empirical study, so it does not present primary data or a formal systematic methodology.
• Evidence gaps noted by the authors include limited data on self-administration of certain monitoring tests (e.g., viral load, drug levels) in resource-limited settings, and limited long-term adherence/persistence for some modalities (e.g., PrEP) among young women.
• Implementation outcomes are context-dependent; factors such as stigma, criminalization, provider attitudes, training quality, and women’s agency/privacy vary across settings, which may limit generalizability of specific examples.
• Economic and regulatory environments differ across countries; cost, financing, and OTC reclassification feasibility may constrain scale-up.