More to be done for self-care in sexual and reproductive health in India

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India has some distance to go before self-care interventions for sexual and reproductive health becomes freely available to women in need. Unlike home-based pregnancy testing, hurdles remain in accessing abortion pills, pre-exposure prophylaxis for HIV prevention and HIV self-test.

Self-care, which mostly takes place outside the formal health system, is nothing new. What has indeed changed is the deluge of new diagnostics, devices and drugs that are transforming the way common people access care when and where they need them. With the ability to “prevent disease, maintain health, and cope with illness and disability with or without relying on heath-care workers”, self-care interventions are gaining more importance. Particularly so as millions of people across the world, including India, are already facing the twin problems of acute shortage of healthcare workers and lack of access to essential health services.

According to the World Health Organisation, which has recently released self-help guidelines for sexual and reproductive health, over 400 million people across the world already lack access to essential health services and there will be shortage of about 13 million healthcare workers by 2035. Self-help would mean different things for people living in very diverse conditions. While it would mean convenience, privacy, and ease for people belonging to the upper strata who have easy access to healthcare facilities anytime, for those in living in conditions of vulnerability and lack access to healthcare, self-help becomes the primary, timely and reliable form of care.

Not surprisingly, the WHO recognises self-care interventions as a means to expand access to health services. Soon, the WHO would expand the guidelines to include other self-care interventions, including for prevention and treatment of non-communicable diseases.

India has some distance to go before making self-care interventions for sexual and reproductive health freely available to women in need. Home-based pregnancy testing is the most commonly used self-help diagnostics in sexual and reproductive health in India.

The interventions in this category include the self-managed abortion using approved drugs — morning-after pills taken soon after unprotected sex, and mifepristone and misoprostol taken at few weeks into pregnancy — that can be taken without the supervision of a health-care provider. While the morning-after pills are freely available over the counter, mifepristone and misoprostol are scheduled drugs and need a prescription from a medical practitioner, thus defeating the very purpose of the drugs.

The next commonly consumed drug to prevent illness and disease is the pre-exposure prophylaxis (PrEP) for HIV prevention. India is yet to come up with guidelines for PrEP use and include it in the national HIV prevention programme.

Despite the WHO approving the HIV self-test to improve access to HIV diagnosis in 2016, the Pune-based National AIDS Research Institute is still in the process of validating it for HIV screening. One of the reasons why people shy away from getting tested for HIV is stigma and discrimination associated with the infection. The home-based testing provides privacy. India has in principle agreed that rapid HIV test helps to get more people diagnosed and opt for treatment thus reducing the chances of transmission.

Published in The Hindu on July 1, 2019

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