| 1. Improving antenatal, delivery, postpartum and newborn care |
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| Existing recommendations on non-clinical interventions targeted at women to reduce unnecessary caesarean sections |
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| REC 1: Health education for women is an essential component of antenatal care. The following educational interventions and support programmes are recommended to reduce caesarean births only with targeted monitoring and evaluation. | Context-specific recommendation, low-certainty evidence |
| REC 1a: Childbirth training workshops (content includes sessions about childbirth fear and pain, pharmacological pain-relief techniques and their effects, non-pharmacological pain-relief methods, advantages and disadvantages of caesarean sections and vaginal delivery, indications and contraindications of caesarean sections, among others). | Low- to moderate-certainty evidence |
| REC 1b: Nurse-led applied relaxation training programme (content includes group discussion of anxiety and stress-related issues in pregnancy and purpose of applied relaxation, deep breathing techniques, among other relaxation techniques). |
| REC 1c: Psychosocial couple-based prevention programme (content includes emotional self-management, conflict management, problem solving, communication and mutual support strategies that foster positive joint parenting of an infant). “Couple” in this recommendation includes couples, people in a primary relationship or other close people. |
| REC 1d: Psychoeducation (for women with fear of pain; comprising information about fear and anxiety, fear of childbirth, normalization of individual reactions, stages of labour, hospital routines, birth process, and pain relief [led by a therapist and midwife], among other topics). |
| Existing recommendations on antenatal care for a positive pregnancy experience – self-administered interventions for common physiological symptoms |
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| REC 2: When considering the educational interventions and support programmes, no specific format (e.g. pamphlet, videos, role play education) is recommended as more effective. | Not specified |
| Interventions for nausea and vomiting |
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| REC 3: Ginger, chamomile, vitamin B6 and/or acupuncture are recommended for the relief of nausea in early pregnancy, based on a woman’s preferences and available options. | Not specified |
| Interventions for heartburn |
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| REC 4: Advice on diet and lifestyle is recommended to prevent and relieve heartburn in pregnancy. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification. | Not specified |
| Interventions for leg cramps |
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| REC 5: Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options. | Not specified |
| Interventions for low back and pelvic pain |
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| REC 6: Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, support belts and acupuncture, based on a woman’s preferences and available options. | Not specified |
| Interventions for constipation |
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| REC 7: Wheat bran or other fibre supplements can be used to relieve constipation in pregnancy if the condition fails to respond to dietary modification, based on a woman’s preferences and available options. | Not specified |
| Interventions for varicose veins and oedema |
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| REC 8: Non-pharmacological options, such as compression stockings, leg elevation and water immersion, can be used for the management of varicose veins and oedema in pregnancy, based on a woman’s preferences and available options. | Not specified |
| Existing recommendation on self-administered pain relief for prevention of delay in the first stage of labour |
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| REC 9: Pain relief for preventing delay and reducing the use of augmentation in labour is not recommended. | Weak recommendation, very low-quality evidence |
| 2. Providing high-quality services for family planning, including infertility services |
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| New recommendation on self-administration of injectable contraception |
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| REC 10 (NEW): Self-administered injectable contraception should be made available as an additional approach to deliver injectable contraception for individuals of reproductive age. | Strong recommendation, moderate-certainty evidence |
| New recommendation on self-management of contraceptive use with over-the-counter oral contraceptive pills (OTC OCPs) |
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| REC 11 (NEW): Over-the-counter oral contraceptive pills (OCPs) should be made available without a prescription for individuals using OCPs. | Strong recommendation, very low-certainty evidence |
| New recommendation on self-screening with ovulation predictor kits (OPKs) for fertility regulation |
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| REC 12 (NEW): Home-based ovulation predictor kits (OPKs) should be made available as an additional approach to fertility management for individuals attempting to become pregnant. | Strong recommendation, low-certainty evidence |
| Existing recommendation on condoms |
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| REC 13: Consistent and correct use of male and female condoms is highly effective in preventing the sexual transmission of HIV; reducing the risk of HIV transmission both from men to women and women to men in serodiscordant couples; reducing the risk of acquiring other STIs and associated conditions, including genital warts and cervical cancer; and preventing unintended pregnancy. | Not specified |
| REC 14: The correct and consistent use of condoms with condom-compatible lubricants is recommended for all key populations to prevent sexual transmission of HIV and STIs. | Strong recommendation, moderate-quality evidence |
| Existing recommendations on the number of progestogen-only pill (POP) and combined oral contraceptive (COC) pill packs that should be provided at initial and return visits |
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| REC 15a: Provide up to one year’s supply of pills, depending on the woman’s preference and anticipated use. | Not specified |
| REC 15b: Programmes must balance the desirability of giving women maximum access to pills with concerns regarding contraceptive supply and logistics. | Not specified |
| REC 15c: The re-supply system should be flexible, so that the woman can obtain pills easily in the amount and at the time she requires them. | Not specified |
| 3. Eliminating unsafe abortion |
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| Existing recommendations on self-management of the medical abortion process in the first trimester |
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| REC 16: Self-assessing eligibility [for medical abortion] is recommended in the context of rigorous research. | Not specified |
| REC 17: Managing the mifepristone and misoprostol medication without direct supervision of a health-care provider is recommended in specific circumstances. We recommend this option in circumstances where women have a source of accurate information and access to a health-care provider should they need or want it at any stage of the process. | Not specified |
| REC 18: Self-assessing completeness of the abortion process using pregnancy tests and checklists is recommended in specific circumstances. We recommend this option in circumstances where both mifepristone and misoprostol are being used and where women have a source of accurate information and access to a health-care provider should they need or want it at any stage of the process. | Not specified |
| Existing recommendations on post-abortion hormonal contraception initiation |
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| REC 19: Self-administering injectable contraceptives is recommended in specific circumstances. We recommend this option in contexts where mechanisms to provide the woman with appropriate information and training exist, referral linkages to a health-care provider are strong, and where monitoring and follow-up can be ensured. | Not specified |
| REC 20: For individuals undergoing medical abortion with the combination mifepristone and misoprostol regimen or the misoprostol-only regimen who desire hormonal contraception (oral contraceptive pills, contraceptive patch, contraceptive ring, contraceptive implant or contraceptive injections), we suggest that they be given the option of starting hormonal contraception immediately after the first pill of the medical abortion regimen. | Not specified |
| 4. C ombating sexually transmitted infections, including HIV, reproductive tract infections, cervical cancer and other gynaecological morbidities |
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| New recommendation on HPV self-sampling |
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| REC 21 (NEW): HPV self-sampling should be made available as an additional approach to sampling in cervical cancer screening services for individuals aged 30–60 years. | Strong recommendation, moderate-certainty evidence |
| New recommendation on self-collection of samples for STI testing |
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| REC 22a (NEW): Self-collection of samples for Neisseria gonorrhoeae and Chlamydia trachomatis should be made available as an additional approach to deliver STI testing services for individuals using STI testing services. | Strong recommendation, moderate-certainty evidence |
| REC 22b (NEW): Self-collection of samples for Treponema pallidum (syphilis) and Trichomonas vaginalis may be considered as an additional approach to deliver STI testing services for individuals using STI testing services. | Conditional recommendation, low-certainty evidence |
| Existing recommendation on HIV self-testing |
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| REC 23: HIV self-testing should be offered as an additional approach to HIV testing services. | Strong recommendation, moderate-quality evidence |
| Existing recommendation on self-efficacy and empowerment for women living with HIV |
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| REC 24: For women living with HIV, interventions on self-efficacy and empowerment around sexual and reproductive health and rights should be provided to maximize their health and fulfil their rights. | Strong recommendation, low-quality evidence |
| 5. Promoting sexual health |
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| There are no new or existing recommendations on self-care interventions in this area, but relevant existing WHO guidance is provided in this guideline. | |
