A midwife shares her experience in championing the self-injectable contraception
July 24, or 24/7, is International Self-Care Day, symbolising the idea that self-care happens 24 hours per day, 7 days per week. The World Health Organization defines self-care 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 healthcare provider.
To celebrate Self-Care Month, ICM spoke to Harriet Nabuwufu, a Ugandan midwife and self-care advocate, about the key role of midwives in promoting self-care for sexual and reproductive health and rights (SRHR). Her insights into current practices, challenges, and strategies for improving self-care initiatives highlight the crucial advocacy role midwives play in this area.
Can you describe some of the self-care practices you currently promote among women in your community?
Self-care is crucial for women’s reproductive health. At my facility, I mainly promote self-injected contraception*. This self-injection empowers women to take control of their health, ensures their privacy, and saves them time and transport costs. As midwives, we monitor women’s cycles for any signs of side effects and follow up with them regularly. We provide patient information, instruction sheets, and calendars to ensure they are correctly following all the necessary steps for self-administering the injectable contraception.
We also promote HIV self-testing for people who are reluctant to visit health facilities for testing. This approach helps to increase accessibility and privacy, ultimately improving health outcomes in our community.
How do you integrate education about self-care into your daily interactions with clients?
We promote self-care in several ways. At our young child clinics, where mothers come for immunisation services, we take the opportunity to talk to them about self-care. We also conduct outreach, community dialogues, and awareness-raising events. Additionally, we mobilise people through community radio and with the help of Village Health Teams (VHTs), volunteers who are selected by their communities to provide accurate health information and link community members with available health services.
During health education and awareness sessions, we discuss the advantages and benefits of self-injectable contraception, highlight potential side effects that some women may experience and emphasise the importance of regular follow-up. VHTs also take part in health education sessions at our facilities. Clients trust them because of their strong grassroots presence, which helps them to effectively communicate our messages and encourage self-care practices.
What strategies have you found most effective in advocating for the self-injectable contraceptive within the community?
Addressing myths and misconceptions, promoting the availability and accessibility of self-injectable contraception, and educating the community about the benefits of self-care have proven highly effective. We use VHTs, peer mothers selected from the community to counsel women, and satisfied users to advocate for self-injection. These strategies help build trust and acceptance within the community, encouraging more women to adopt self-care practices.
Engaging local and opinion leaders who support family planning has also been helpful. Involving men in accompanying women to appointments encourages open, non-threatening discussions about potential side effects. In addition, using empathetic counselling approaches helps clients feel understood and supported.
How do you meet the diverse needs of women from different backgrounds and age groups?
We meet specific groups such as young people or adolescents in their dedicated safe spaces, to ensure their comfort and engagement. Here, we work with implementing partners who facilitate these meetings/engagements of young people in their groups, and they invite us to speak to them. We also use relatable examples, such as stories of diabetics injecting themselves, to build confidence and show that self-injection is possible for everyone.
What role do you see for other healthcare professionals and community leaders playing in promoting the self-injectable contraceptive?
Health professionals and community leaders should become more knowledgeable about self-care practices so that they can address myths and misconceptions and support women in monitoring their health while using DMPA-SC. Counselling and provision of accurate information are essential.
How can other healthcare professionals and community leaders help promote self-injectable contraceptives?
In addition to working with VHTs and opinion leaders, we work with implementing partners (IPs) such as the Program for Appropriate Technology in Health (PATH), Population Services International Uganda (PSIU) and Mildmay . These partners support the redistribution of self-injectable contraceptives from facilities with excess stock to those in need, ensure access to Unijects (pre-filled, single-use injection devices for easy and safe administration of vaccines and drugs, designed for easy use in low-resource settings) and data collection tools. Each IP has facilities that they support, increasing our ability to effectively promote self-care practices.
What are the common challenges women face when using self-injectable contraceptives for their sexual and reproductive health, and how do you address them?
One major problem is stock shortages. To address this, we place emergency orders with Joint Medical Stores to ensure availability and provide women with supplies for longer periods, such as six months or even a year, when available.
Another challenge is the stigma and misconceptions surrounding self-injection in the community. We address these through education and awareness campaigns, compassionate counselling and by maintaining a positive attitude towards clients. We also use VHTs, who are trusted by the community, to help bring women to health services and overcome reluctance and cultural barriers.
Some women may experience side effects such as; increased menstrual bleeding, headache, dizziness, decreased sex drive, vomiting and abdominal bloating. To address these, we have increased our counselling and education efforts to inform women about the benefits of self-care and the side effects mentioned above. We inform them that if they experience any of the side effects, they should return to the service providers for management. These strategies promote understanding, acceptance and continued use of self-injection contraceptives.
Many women also have low levels of education and tend to question their ability to inject. We try to address these concerns through counselling sessions aimed at dispelling myths and misconceptions. We provide comprehensive training on how to use the Uniject system.
How can midwives be better trained or supported to champion self-care for SRHR?
Midwives can be better trained and supported through education on the benefits of self-care and continuing professional development. Ongoing support from implementing partners and training programmes, including training of trainers, can improve midwives’ skills.
Other resources that would enhance midwives’ ability to promote self-care include job aids with step-by-step instructions, visual aids displayed around health facilities, and the use of community and public radio. Using videos and booklets and translating materials into local languages can further support their training and support. In addition, providing information on potential side effects can help clients make informed decisions.
What advice would you give to new midwives or those looking to strengthen their role in promoting self-care for SRHR?
It’s beneficial to work closely with people who are knowledgeable about self-care. Incorporating self-care practices can reduce the workload of public health facilities, especially where staffing is limited. Many districts in Uganda already have dedicated self-care staff in most facilities.
Midwives should keep up to date with the latest practices and research related to self-injection through ongoing training and practice, and by regularly reading new editions of manuals such as the family planning global handbook. Midwives can learn from women who use self-injectable contraceptives; they often come back before their scheduled appointments to share their experiences and stories with friends. By actively listening to their feedback and addressing their concerns, we empower them to become advocates for self-care.
*In this article, “self-injected contraception” specifically refers to self-injecting DMPA-SC. For more information, click here.
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