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WHO SRH 22.2 Eng
WHO SRH 22.2 Eng
WHO SRH 22.2 Eng
self-care interventions
Self-administration of injectable
contraception, 2022 update
S
What is self-care? WHO guideline on self-care interventions
for health and well-being
WHO’s definition of self-care is the ability
of individuals, families and communities • There is an estimated shortage of 18 million health
workers by 2030, mainly in low-middle income
to promote health, prevent disease,
countries.
maintain health, and cope with illness
• At least 400 million people worldwide lack access to
and disability with or without the support the most essential health services.
of a health worker. • During humanitarian emergencies, including
pandemics, routine health services are disrupted
and existing health systems can be over-stretched.
What are self-care interventions? For certain health services, incorporating self-care
interventions can be an innovative strategy to strengthen
primary health care, improve universal health coverage
Self-care interventions are evidence-based, (UHC) and help ensure continuity of health services
quality medicines, devices, diagnostics which may otherwise be disrupted due to health
and/or digital products which can be emergencies. In 2022, WHO revised the global normative
provided fully or partially outside of formal guidance on self-care interventions for health and well-
health services and can be used with or being, with each recommendation
WHO guideline on self-care
without the direct supervision of health care interventions for health and
based on extensive consultations
personnel. well-being, 2022 revision and a review of existing evidence.
DMPA
• The most widely-used progestogen-only Current challenges to health
injectable is depot medroxyprogesterone
acetate (DMPA). DMPA is effective for up to four
systems to provide family planning/
months. The injectable can be delivered into the contraception services
muscle (intramuscular injection), or just under
the skin (subcutaneous injection). Following • 214 million women of reproductive age
either kind of injection, the hormone is released in developing countries who want to
slowly into the bloodstream. avoid pregnancy are not using a modern
contraceptive method.
• DMPA is a very effective contraceptive. When
individuals are injected on time, fewer than 1 • Reasons for not using contraception include:
pregnancy per 100 users will occur. limited choice of methods; fear or experience
of side-effects; cultural or religious opposition;
poor quality of available services; user and
health worker bias; gender-based barriers.
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injectable-contraception
WHO recommends that self-administered injectable
contraception (depot medroxyprogesterone acetate
in its subcutaneous form – DMPA SC) should be made
available as an additional approach to deliver injectable
contraception for individuals of reproductive age.
5. Dispose of the
needle safely
1. Choose a correct 2. Mix the solution. 3. Push the cap and 4. Pinch your skin into
injection site. Either Hold the device by the port together to a “tent”. Put the
the belly or front of the port (not the cap) close the gap needle into the skin,
thigh and shake for and squeeze the 6. Plan for your
30 seconds reservoir slowly next injection
2
Eligibility should be verified according to the WHO Medical eligibility criteria for contraceptive use
Two controlled cohort studies showed increased injection site reactions with self-administered DMPA-SC. S
Considerations for success for Enabling access to self-administered
self-administration of injectable injectable contraception
contraception
Programme managers and policymakers should
• Information and support – Individuals must be ensure that users are able to procure injectable
provided with clear information related to self- contraceptives on a regular basis without needing
administration (including appropriate and safe to repeatedly visit a health-care facility. Additionally,
arrangements for storing sharps at home). DMPA in its intramuscular and subcutaneous form,
including the delivery system for self-administration,
• Supportive health system – Self-injection is are included in WHO’s Essential Medicines List.
recommended where mechanisms to provide the
woman with appropriate information and training Countries can enable greater access if they include
exist, referral linkages to health workers are strong, self-administered DMPA-SC on their Essential
and where monitoring and follow-up can be ensured. Medicines List, work towards procurement of the
medication, and allow them to be sold or distributed
• Quality products – Relevant regulatory agencies through pharmacies.
should ensure that quality products are available in
adequate quantities and appropriate dosages. SELF-CARE
INTERVENTIONS FOR
Self care
3 Technical resources
Learn more:
resources
Academic
5 resources
References:
WHO guideline on self-care interventions for health and Task sharing to improve access to Family Planning/
well-being, 2022 revision Contraception – Summary Brief
https://www.who.int/publications/i/item/9789240052192 https://apps.who.int/iris/bitstream/handle/10665/259633/WHO-RHR-
17.20-eng.pdf?sequence=1
Self-administration of injectable contraception: a systematic
review and meta-analysis Contraception – Evidence Brief
https://gh.bmj.com/content/bmjgh/4/2/e001350.full.pdf https://apps.who.int/iris/bitstream/handle/10665/329884/WHO-RHR-
19.18-eng.pdf?ua=1
Family planning: A global handbook for providers (2018
Edition) Family planning/Contraception Overview – WHO website
https://apps.who.int/iris/bitstream/hand https://www.who.int/reproductivehealth/topics/family_planning
le/10665/260156/9780999203705-eng.pdf?sequence=1
WHO Model List of Essential Medicines (21st List – 2019)
Family planning/Contraception Key Facts – WHO website https://apps.who.int/iris/bitstream/handle/10665/325771/WHO-MVP-
https://www.who.int/news-room/fact-sheets/detail/family-planning- EMP-IAU-2019.06-eng.pdf?ua=1
contraception