"Advancing Gender Equity through Self-Care.” Examining critical questions and evidence gaps in the self-care space.

Author : Archiford Matarino

Abstract

Self-care within the public health domain has been a reasonably new phenomenon that is attracting debate among academics, researchers and public health practitioners. Such interest on the topic is due to its ability to advance the status of women in the health sector. In the light of this backdrop, this article aimed to dissect the role of self-care in advancing gender equity. It is anchored on the notion that self-care facilitates the development and growth of social and behaviour change directed at promoting gender equity in the health realm. In the article, the intersection between self-care and gender equity will thus be scrutinized in the frame of opportunities and activities that facilitate the realisation of improved health outcomes. The article took a purely qualitative outlook making use of documentary research which is analysed and presented through content analysis.

Key words: gender, gender equity, self-care, social and behavior change

1. Introduction

Self-care and its associated interventions have been noted as the most promising and exciting new approaches to improve health and well-being, in the context of both health systems and for people that make use of these interventions. The World Health Organisation (2019) outlines the scope of self-care as including “health promotion; disease prevention and control; self-medication; providing care to dependent persons; seeking hospital/specialist/primary care if necessary; and rehabilitation, including palliative care.” Despite self-care not being a new phenomenon, self-care interventions have been noted to have the possibility to increase choice, when they are accessible and affordable, and they can also provide more opportunities for individuals to make informed decisions regarding their health and health care in improving health-related outcomes.

On the basis that self-care facilitates the development and growth of social and behaviour change, this article argues that such development and growth helps to advance gender equity in the health jurisdiction. The article therefore, scrutinizes the intersection between self-care and gender equity in the context of opportunities and activities that facilitate the realisation of improved health outcomes.

2. Defining the Key Concepts

Under this section, a conceptualisation of the terms gender, gender equity and self-care is made.

2.1 Gender and gender equity

The UNFPA (2021) has defined the term gender as making reference to “the economic, social and cultural attributes and opportunities associated with being male or female.” This points to the view that the characteristic of being either male or female is socially constructed and goes beyond the dissimilar biological and physical characteristics. Significantly, the expectations face by men and women are different for instance in relation to how they ought to dress, conduct themselves or carry out work. In addition, the relations between men and women, in any set up is reflective of the comprehensions of the talents, characteristics and conduct that is deemed by society as appropriate to women and to men (UNFPA, 2021). An analysis of the above perspectives on gender thus show that gender is at variance with sex given that gender speaks to the social and cultural aspects compared to the biological aspects underlined by sex. In addition, the attributes and characteristics of gender such as male and female roles differ from one society to another and are dynamic. On the basis of such view, the dynamism of gender means that it is open to changing in ways that can make a society more just and equitable an angle which this article subscribes to.

On the other hand, gender equity is viewed as the process of ensuring the fairness in dealing with women and men (UNFPA, 2021). Such fairness is ensured through the institutionalization of strategies and measures that are focused on compensating for women’s historical and social disadvantages that prevent women and men from otherwise operating on a level playing field. It such equity that results in gender equality. The ideas of gender equality need equal enjoyment by women and men of socially-valued goods, opportunities, resources and rewards for them to succeed.

2.2 Self-care

The concept of self-care has been defined by the World Health Organization (WHO) (2019) as “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-care provider.” The WHO conceptual framework for self-care interventions for health is “grounded upon key principles of human rights, gender equity and equality and a life course perspective, and considers the enabling environment as inclusive of trained healthcare providers, psychosocial support, education and information, access to justice, and freedom from violence, stigma and discrimination,” (Narasimhan et al., 2019). Such self-care in the health comprise the self-management of medication, treatment, examination, injection and administration; self-testing, ranging from sampling and screening to diagnosis, collection and monitoring; and self-awareness, spanning self-help, self-education, self-regulation, self-efficacy and self-determination.

For the above, self-care is about entrusting people to manage parts of their own healthcare if they choose to do so (Médecins Sans Frontières (MSF), 2021). This is in contrast to the view that it is about people having to do all their own healthcare without support. Simplified tests and treatments, point-of-care devices and mobile technology have all made self-care more possible in recent years – with great potential benefit for women and girls. For instance, within the health sector, MSF as a medical-humanitarian organisation, has been adopting self-care within a patient-centred approach, supporting people with the knowledge and skills to undertake self-care safely but retain access to formal health services when they need or wish.

3. Intersection between gender equity and self-care

In the international sphere, the majority of women are failing to have access to essential healthcare, and struggle with managing sexual and reproductive health issues that may be stigmatized and in the majority of cases undermined by the prevailing gender dynamics such as the absence of gender equity and equality. MSF (2021) has shown that an approximate one in four women of reproductive age are failing to access modern contraception, which is vital for them to plan or limit their pregnancies. In addition, MSF (2021) shows that women constitute half of the people living with HIV globally aged over 15. Owing to the absence of gender equity, they end up engaging in unsafe abortion which is a foremost cause of death in pregnant women globally as they are not able to access a safe alternative.

There has been cited numerous social, economic, logistical and other barriers to accessing healthcare which are worsened by violence in the homes as well as discrimination and gender inequalities (MSF, 2021). In humanitarian crises, the position of women is further affected. For instance, with the current set up of COVID-19, there have been amplified health service discrepancies, resulting in the undermining of the sexual and reproductive health outcomes of women. The absence of gender equity particularly in the context of the lockdowns (which have however, been initiated to keep people safe), the SRHR of women have been endangered as they remain confined to the home environment. It is therefore, difficult for women to neither come nor ask for care, even if they need it. As such, self-care is an opportunity to redress this scenario.

4. Advancing Gender Equity through Self-care

As noted earlier in the article, gender equity is facilitated through the institutionalization of strategies and measures that are focused on compensating for women’s historical and social disadvantages that prevent women and men from otherwise operating on a level playing field. According to Narasimhan (2019) the equal enjoyment by women and men of socially-valued goods, opportunities, resources and rewards for them to succeed can be realised through the self-care programmes that are established in a nation’s health system. It is the argument of this paper that self-care can facilitate the expansion of healthcare access even in the remotest of locations, in unstable contexts or areas with poor health infrastructure such as rural areas. This is because of its ability to “extend healthcare outside the hospital or the clinic, beyond the doctor or the nurse,” (MSF, 2021). This has prompted views that self-care can be a realistic response in areas where resources in healthcare are limited, as well as allowing for links to care where they did not exist prior.?

In the frame of the foregoing discussion, it can be argued that self-care interventions can facilitate the delivery of evidence-based and low-risk healthcare alternatives explicitly or covertly subtly in the community or the homes of individual as the example of self-injectable contraception. Given that they offer greater convenience or more confidentiality, self-care approaches have been argued to allow for the early diagnosis and more timely medical care as the example of HIV self-testing kits. Other arguments that have been made are that the self-care interventions help to improve the quality of care that she receives: care that is appropriate, respectful and built on trust on the basis of their focus on women’s individual needs. The MSF (2021) observed that self-care may be the only safe alternative for some women, and in its absence, they may be forced to seek unsafe services or give up hope of care altogether. By the virtue that self-care allows women to control their health needs and health outcomes, self-care can thus facilitate the realisation of gender equity within societies.

In exploring the link between self-care gender equity and SRHR of women, there is need to understand that self-care is strongly influenced by the social, cultural, and structural context in which men and women live (Narasimhan, 2019). Therefore, social and behavioral determinants including health literacy, motivation, agency, social norms, laws, access, social policies, and provider training and attitudes all influence demand for and use of self-care products and behaviors. Therefore, social and behavior change (SBC) is uniquely placed to identify, understand, and address those factors. Narasimhan et al (2020) argue that SBC can support sexual and reproductive self-care initiatives and contribute to improved health outcomes. Their framework is designed for use by policymakers and government representatives, donors, and self-care program implementers. The framework helps these users understand what drives self-care behavior and make policy and programmatic decisions that use SBC to enable sexual and reproductive health self-care behaviors. Specifically, the framework: Illustrates the factors and groups that influence self-care behavior; highlights the impact of using SBC within self-care; and provides guidance and examples of how SBC can be used at various levels of the system to encourage self-care practice.

5. Conclusion and Policy Implication

This paper has advanced that self-care can be leveraged as a way to facilitate gender equity within societies. This is because it facilitates the empowerment of women in health spaces which empowerment brings about gender equity. Through self-care, women are able to pragmatic decisions on their SRHR based on the alternatives made available to them under self-care spaces.

There is need to link implementation strategies to clear outcomes in order to better understand the effects of self-care interventions in people’s lives. Successful mainstreaming of self-care interventions will therefore require monitoring and evaluation early on. While monitoring and evaluation is common practice for programme implementation of focused health topics or interventions, such as the number of antenatal care visits for maternal health or use of antiretroviral for HIV treatment, it is far less common in fields where policies and programmes are aimed at an organisational change.

The introduction of quality self-care interventions is a true shift in the way health care is delivered. Its potential to bridge people and communities through primary health care to reach universal health needs is underexplored. Moving forward, researchers, policy makers, and practitioners can consider the participant narratives regarding the need to consider both the heterogeneity of self-care interventions for SRHR as well as the needs and lived experiences of diverse populations (Narasimhan et al., 2020). These persons’ and healthcare providers’ perspectives underscore the urgent need to increase access, reduce stigma and discrimination, and improve knowledge of self-care SRHR interventions to increase access to health in order for individuals and communities to realise their SRHR and for countries to achieve the Sustainable Development Goals.

Therefore, there is need to integrate self-care into the daily activities of society and within the policy measures and directives of governments in relation to health matters. This has the advantage that it will potentially to expand quality, patient-centred care for women and girls through the self-care approaches, especially in contexts of conflict areas or remote areas. The paper however, advances that self-care should always be linked to more formal care, but it can play a particularly useful role where there is little health infrastructure or few health workers, or marginalised people needing care outside of a formal system. It is within such settings, the capacity to integrate self-care, and allow women and girls to contribute to their own health and wellbeing can be realised. As well, this will allow for the involvement of health authorities, local organisations and grassroots communities in the advancement of gender equity through self-care initiatives.

References

Médecins Sans Frontières (MSF) (2021). Practicing self-care: empowering women to manage their own health. Available from: https://www.msf.org/empowering-women-practice-self-care. (Accessed on 20 March 2022).

World Health Organization (WHO) (2019). WHO Consolidated Guideline on Self-Care Interventions for Health Sexual and Reproductive Health and Rights. Geneva: WHO.

United Nations Population Fund (UNFPA) (2021). Frequently asked questions about gender equality. Available from: https://www.unfpa.org/resources/frequently-asked-questions-about-gender-equality. (Accessed on 20 March 2022).

Narasimhan, M., Logie, C. H., Gauntley, A., de Leon, R. G. P., Gholbzouri, K., and Siegfried, N. (2020). Self-care interventions for sexual and reproductive health and rights for advancing universal health coverage, Sexual and Reproductive Health Matters. 28(2).

Narasimhan, M., Iongh, A., Askew I., et al. (2019). It is time to recognise self-care as an integral component of health systems. British Medical Journal. 1: 365.

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