Background

Self-care, as defined by the WHO, is the ability of individuals, families and communities to promote health, prevent disease, maintain health and cope with illness and disability with or without the support of a health worker [1]. Self-care interventions, or tools and practices to support self-care, include evidence-based, high-quality medicines, devices, diagnostics and digital tools accessed fully or partially outside formal health facilities, with or without a health worker. Self-care interventions can elevate the role of individuals as stakeholders in their health and wellbeing, and capitalize on the prolific rise of self-administered and self-managed tools that create more opportunities for self-managed health than ever before. Additionally, with global threats, including humanitarian crises and pandemics such as COVID-19 disrupting essential health services, self-care interventions can offer an alternative response for achieving health coverage in settings with limited capacity and resources. The purpose of the WHO consolidated guideline on self-care interventions for health is to provide evidence-based guidance to support individuals, communities and countries with quality health services and self-care interventions based on primary healthcare strategies, with people-centeredness at the core [2].

This newest guidance (published in June 2021) builds on version 1 (published in 2019), and brings together new and existing WHO recommendations, good-practice statements and key considerations on self-care interventions for health. It is intended for national and international policy makers, researchers, program managers, health workers, donors, civil society organizations, product developers, people taking care of themselves, and caretakers. This is considered “living guidance” and will be updated and expanded as new information and evidence become available.

This synthesis brief includes select key messages from the consolidated guidance related to the provision of maternal and newborn health (MNH) care, over-the counter pharmacy provision of pregnancy self-tests, as well as the full individual recommendations related to improving antenatal, intrapartum, and postpartum care (See Annex).


Key Messages from the WHO’s 2021 Consolidated Guidance on Self-Care Interventions

The WHO recommends:
Making self-testing for pregnancy available as an additional option to health worker-led testing for pregnancy, for individuals seeking pregnancy testing.

-The following educational and support programs during pregnancy as non-clinical interventions to reduce caesarean births: childbirth training including pharmacological and non-pharmacological pain relief techniques; relaxation training including deep breathing techniques; psychosocial support for couples including conflict management and problem solving; and psychoeducation that includes the stages of labor, and overcoming a fear of birth.

-Interventions for managing common discomforts of pregnancy based on availability and preference; the use of ginger, chamomile, or acupuncture for nausea and vomiting; making diet and lifestyle modifications for heartburn; the use of magnesium or calcium for leg cramps; exercise or physiotherapy for back and pelvic pain; taking wheat brain or fiber supplements for constipation; and elevating legs for varicose veins and edema.

-That women carry their own case notes to improve quality of care, sense of empowerment, and to ensure greater access to pregnancy and health-related information. Keeping home-based records to complement records maintained by health facilities is recommended for pregnant, laboring and postpartum women, newborns and children.

Self-management of iron and folic acid supplementation during pre-pregnancy, pregnancy and postnatal periods:
a. Use of folic acid supplements up to 12 weeks gestation to prevent neural tube defects.
b. Use of iron and folic acid supplements during pregnancy to reduce anemia, puerperal sepsis, low birthweight and preterm birth.
c. Use of iron supplements in the postpartum period (alone or with folic acid) to reduce the risk of anemia.

For hypertensive disorders of pregnancy, self-monitoring of blood pressure.

Self-testing for proteinuria for individuals with non-proteinuric hypertension.

Self-monitoring of blood glucose levels during pregnancy to monitor effectiveness of lifestyle modifications including diet and exercise, and to inform care in individuals with gestational diabetes

The WHO does not recommend:
WHO does not recommend self-administered pain relief to induce labor or reduce the need for augmentation in the first stage of labor.


References:

[1] Hatch S, Kickbusch I, editors; Self-help and health in Europe: new approaches in health care. Copenhagen: World Health Organization Regional Office for Europe; 1983.  

[2] WHO consolidated guideline on self-care interventions for health. Geneva: World Health Organization; 2021 (https://app.magicapp.org/#/guideline/Lr21gL, accessed 6 July 2021).