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Table 1 Self-care interventions aligned with the MISP for SRH in humanitarian settings

From: Sexual and reproductive health self-care in humanitarian and fragile settings: where should we start?

MISP objectives and activities Self-care interventions that align with the MISP
1. Coordination: Ensure the health sector/cluster identifies an organization to lead the implementation of the MISP Not applicable. However, the implementation of self-care interventions should be the fruit of concerted policy and programmatic efforts at all levels.
2. Gender-based violence: Prevent sexual violence and respond to the needs of survivors. Activities:
 • Establish measures to prevent sexual violence
 • Provide clinical care for survivors of sexual violence (treatment of injuries, post-rape care, mental health and psychosocial support, safety planning, referrals)
• Care of injuries
• Over the counter oral contraceptive pills (WHO Rec 11)
• Emergency contraception
• HIV post-exposure prophylaxis
• STI presumptive treatment
• Positive coping methods
3. HIV/STI: Prevent the transmission and reduce morbidity and mortality due to HIV and other STIs. Activities:
 • Safe and rational blood transfusion
 • Ensure standard precautions
 • Provide condoms
 • Continue treatment for people enrolled in antiretroviral therapy (ART), including women enrolled in PMTCT
 • Provide post-exposure prophylaxis (PEP) for survivors of sexual violence
 • Provide cotrimoxazole prophylaxis for opportunistic infections for patients already diagnosed with HIV
• Condom use (WHO Rec 12–13)
• HIV post-exposure prophylaxis for survivors of sexual violence
• ART treatment, for people already enrolled including pregnant and postpartum women
• Cotrimoxazole prophylaxis
4. Maternal and newborn health: Prevent excess maternal and newborn morbidity and mortality. Activities:
 • Safe and clean delivery
 • Essential newborn care
 • Provide emergency obstetric and newborn care
 • Provide post-abortion care
• Misoprostol for prevention of postpartum hemorrhage
• Chlorhexidine for neonatal cord care
• Other components essential newborn care (thermal care, breastfeeding, etc.)
• Post-abortion hormonal contraception initiation (WHO Rec 19–20)
5. Contraception: Prevent unintended pregnancies. Activities:
 • Ensure a range of long-acting and short-acting contraceptive methods
 • Provide information and ensure awareness of the availability of contraceptives
• Self-administration of injectable contraception (WHO Rec 10)
• Over the counter oral contraceptive pills (WHO Rec 11) including emergency contraception
• Up to 1-year supply oral contraceptive pills (WHO Rec 15)
• Condom use (WHO Rec 12–13)
• Post-abortion hormonal contraception initiation (WHO Rec 19–20)
• Postpartum contraception initiation
• Lactational amenorrhea method
• Fertility awareness-based / standard day methods• Traditional methods (e.g., withdrawal)
Other priority: Safe abortion care. Ensure safe abortion care is available in health centers and hospitals, to the full extent of the law • Self-management of medical abortion process in the first trimester (WHO Rec 16–18)
• Post-abortion hormonal contraception initiation (WHO Rec 19–20)
6. Transition to comprehensive SRH: Plan for comprehensive SRH services, integrated into primary care as soon as possible. Activities:
 • Work with the health sector/cluster to address the six health system building blocks
SRH Self-Care Interventions beyond the MISP
• HIV self-testing (WHO Rec 23)
• ART programming for new enrollees
• HIV pre-exposure prophylaxis (oral PrEP)
• Self-collection of samples for STI testing (WHO Rec 22)
• Self-administered pain relief for prevention of delay in the first stage of labor (WHO Rec 9)
• Self-administered interventions for common physiological symptoms of pregnancy (WHO Rec 3–8)
• Non-clinical interventions to reduce unnecessary cesarean sections (WHO Rec 1 & 2)
• Cancer: Self-sampling for HPV testing (WHO Rec 21), breast cancer self-exam, testicular self-exam
• Fertility: Home-based ovulation predictor kits (WHO Rec 11), home-based pregnancy tests, menstrual health management
• Sexual health: Sexuality education
• Mental health: Positive coping, self-help
  1. Where relevant, the recommendation numbers from the WHO guideline on SRH self-care are reported for ease of reference (“WHO Rec + number”) [24]. The listed interventions in the right column should be locally contextualized and implemented as part of a continuum of care within a whole-system approach
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