Post written by Stephanie Jaffe, FHI 360
On June 24, the World Health Organization (WHO) released its new Consolidated Guideline on Self-Care Interventions for Health: Sexual and Reproductive Health and Rights. With global changes in the organization of health care systems and transitions away from donor funding, self-care interventions and technologies are becoming increasingly important in developing countries. In the sexual and reproductive health (SRH) field specifically, self-care-based approaches can especially help marginalized populations access family planning and reduce access barriers. Existing contraceptive technologies that allow self-administration range from common methods like condoms to subcutaneously-administered depot-medroxyprogesterone acetate (DMPA-SC), an injectable contraception that has the potential to be self-administered by the user herself.
However, many existing contraceptive methods are provider-dependent for administration and/or removal. New contraceptive options are needed to facilitate self-care, especially in low-resource settings where access to healthcare services may be limited due to geographical constraints, a lack of trained providers, or other factors. As contraceptive research and development (R&D) continues to advance, there are several important steps product developers can take to ensure the potential of self-care for new methods is realized, including:
1. Focus on user-centered design for women in low-resource settings
The user’s preferences should always be at the heart of a product’s design. Specifically, user-centered design research should inform technical specifications and decision-making around product development for contraceptives in low-resource settings. Developers must test their assumptions with qualitative user feedback, redesigning and redefining the product as they learn what does and doesn’t work. Designing an acceptable technology does not just mean addressing what is tolerable – it is important to determine what makes a woman want to use a form of contraception at different points in her life, rather than simply choosing from the least inconvenient option. While methods must be effective, they must also be conducive to a positive user experience, from administration to resupply to discontinuation. This is especially true when designing a product for self-care; addressing factors like covert usage in stigmatized environments, ease of self-administration or removal, reducing cultural and societal norms, and side-effect management are all crucial considerations for optimal user-centered design of contraceptives.
2. Include potential for self-administration and/or self-removal in the Target Product Profile
When creating and refining a product’s Target Product Profile (TPP) – a planning tool to help map out product attributes when a method is being developed – it is important to consider the product’s purpose and the context in which it will be used. Details like product storage, duration, shelf-life, and the infrastructure required for successful implementation are all important considerations for any product in an R&D portfolio. For example, if a family planning product is designed to be self-administered, developers must assess whether women in low-resource settings have adequate storage capacities available at home or in their community. Additionally, women who are administering their own contraception may not have the clinical background that healthcare workers have, so products must have a simple design and be easy to use. Developers must also consider any training that may be necessary to use the product safely and effectively. By taking factors like these into account early on in the product development process, research teams can better facilitate self-care in real-world settings.
3. Consider waste management strategies
Another important component of an appropriate design for self-administered products is waste management. Women in low resource settings may not be able to get rid of a product in a safe and environmentally-conscious manner if they are not provided with cost-effective disposal options. Developers may need to create infrastructure to facilitate the disposal of one-time use technologies and should consider the materials used in designing these technologies.
The increasing importance of self-care as a part of a comprehensive SRHR service package points to the need for development of new technologies that can give women in low-resource settings more control over their reproduction. It is important that developers ‘begin with the end in mind’, ensuring that new products align with the needs and contexts of target users to maximize impact and efficiency and help accelerate the future of self-care for SHRH.