A recent report on global maternal mortality by the World Health Organization (WHO) reveals a hard truth: the world has been ignoring the needs of pregnant women. While there have been substantial reductions in maternal death rates since 2000, progress has stalled or been reversed in some countries after 2015, even before COVID-19 exacerbated the situation. Nations affected by humanitarian emergencies, conflicts, and other crises fared the worst.

We need all hands on deck and new approaches to ensure all pregnant women, birthing people, and their babies not only survive, but thrive. Self-care is one such promising approach.

According to WHO, self-care is the ability of individuals, families, and communities to promote their own health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health worker. When supported by providers and equipped with proper information and tools, women can utilize a variety of self-care approaches to promote their health and well-being before, during, and after pregnancy. The WHO Guideline on self-care interventions for health and well-being includes specific self-care recommendations for maternal health to improve care and outcomes across the perinatal period.

A recent webinar, “Me Care, We Care: The Case for Self-Care in Strengthening Maternal and Newborn Health,” convened by White Ribbon Alliance on behalf of the Self-Care Trailblazer Group, explored how self-care can transform the health of pregnant women and their newborns. The discussion also showcased how country leaders and advocates are moving the needle on new self-care strategies.

Self-care for maternal health can include a wide variety of activities. Dr. Özge Tunçalp, a scientist at the Department of Sexual and Reproductive Health and Research at WHO, said that while some of these actions directly address major risk-factors for maternal mortality, many others are more holistic in nature, such as acupuncture to relieve pregnancy-related nausea, attending childbirth education courses, and following a nutritious diet. She emphasized that what is notable about the WHO Self-Care Guideline is that a main focus is promoting a positive pregnancy experience and equipping women with tools and strategies that they can use themselves to address common discomforts and feel their best.  She stressed that while there is a tendency to think of issues like pre-eclampsia/eclampsia or post-partum hemorrhage (PPH), the WHO Self-Care Guideline goes beyond medical conditions and emphasizes person-centered self-care recommendations that promote a more positive pregnancy experience—especially important given that the majority of pregnant persons will face discomfort at some point. 

Applying Self-Care in Varied Settings

The WHO Self-Care Guideline not only provides evidence-based recommendations, but it also gives country leaders a comprehensive way to think about self-care’s role in maternal and newborn health.

Kenya is a country that is moving swiftly to introduce and scale-up self-care. Kenyan officials are in the process of adopting the WHO Self-Care Guideline, but with additional contextualized recommendations specific to its health landscape that take holistic approaches to pregnancy, post-partum, and newborn care. The updated guideline is poised to launch in May, said Karen Owende, Program Officer for the Division of Reproductive and Maternal Health at the Kenya Ministry of Health.

Advocates in other countries are also taking steps to advance self-care for maternal and newborn health, using the WHO Self-Care Guideline or national self-care guidelines as their guidepost. In Pakistan, maternal anemia, a potentially fatal condition for pregnant women, remains a concern for women in rural areas, where iron and folic acid supplements remain out of reach or underused. And in Nigeria, PPH – a severe, life-threatening condition – is a major issue, especially for the large number of women who give birth outside of a health facility. Advance provision of misoprostol to pregnant women is one strategy for preventing and treating PPH after birth, and it is a recommendation that has been included in Nigeria’s National Self-Care Guideline.

In response to these developments, advocates at The Forum for Safe Motherhood (FSM) in Pakistan and the Generation Initiative for Women and Youth Network (GIWYN) in Nigeria have undertaken a series of multifaceted advocacy approaches to create an enabling environment for self-care. FSM’s advocacy efforts focused on direct outreach to decision makers and women alike – working to increase financial investments in health while also ensuring that women understood and were comfortable with self-administration of iron and folic acid tablets to prevent maternal anemia. Among the incredible results were a 26 percent increase in Sindh province’s 2018 health budget and incorporation of nutrition messages in community health worker trainings and even in high school textbooks.

In a similar vein, GIWYN’s advocacy efforts in Nigeria to expand access to and utilization of misoprostol (to prevent and treat PPH) targeted health supply chains, decision-makers, health providers, and women themselves through a variety of methods. One such creative approach is GIWYN’s multilingual hotline, Ms. Rosy, which continues to support women and girls in need of misoprostol for PPH and has already reached over 248,333 people.

Thinking about self-care from the perspective of emergency preparedness is also essential. Sybil Nmezi, Executive Director of GIYWN, observed that there is a need to make sure pregnant women have misoprostol tablets on hand when they go into labor, because crisis, conflict, and disaster can strike anytime, compounding existing challenges with travel and access to health facilities.

Self-Care and Shared Responsibility

More and more attention is also rightfully being paid to the intersection of self-care and crisis settings. For example, the Inter-Agency Working Group on Reproductive Health in Crises and International Rescue Committee recently launched an instructive new report to guide self-care advocates, researchers, and program implementers: Self-Care for Sexual and Reproductive Health in Humanitarian and Fragile Settings: Barriers, Opportunities, and Lessons Learned.

And as the work to implement self-care in every setting continues, it’s important to remember that self-care for maternal and newborn health will only work when women are cared for by supportive and respectful providers within well-functioning primary health care settings. This shared responsibility not only further strengthens health systems and improves maternal health outcomes; it also puts power and autonomy back in the hands of women and girls. Our individual responsibility to care for our health, coupled with our collective responsibility to care for one another, is a powerful and necessary approach to put maternal health back on the right track.