Sexual & Reproductive Health Programme
Mosaic understands that sexual and reproductive health (SRH) is an important part of the healing process. Our organization now provides two clinic centres where clients may access free SRH services in a private, safe, and confidential space.

You have the right to: 

• Enjoy sexual health
• Make choices about your own body Decide if and when to have sex
• Say no or yes to sex Choose your partner
• Choose a contraceptive that you think will be right for you Access to contraceptives for safe sex and other reproductive health services
• Choose whether or not, and when, to have children A sexual relationship free of violence and coercion
• Access to unbiased information about reproductive health and sexuality education in order to make informed choices
• Be treated in a dignified and confidential manner when seeking reproductive advice

Check out our services at the Wynberg Clinic below, or click on the Simelela Centre to see what SRH services are offered at each location.

Sexual and Reproductive Health: Wynberg Clinic
Mosaic’s Clinic was opened full-time in July 2005 with the aim of delivering client-friendly reproductive health care to its clients. Services are available Monday to Friday and Saturday mornings until 13:00. The following principles form the basis of services in the clinic:

• Mosaic’s services are free of charge
• Booking of appointment is essential Clients are made to feel comfortable and welcome in a private environment with staff who are friendly and caring
• All clients’decisions are supported non-judgementally All services are linked with counselling so that decisions are well informed
• Clinic staff (professional registered nurse and counsellors) are highly skilled Department of Health officials contribute to the efficient and professional operation of the clinic

We offer the following reproductive health care services:

• Pregnancy Tests Contraception (pills and injections)
• Treatment for Sexually Transmitted Infections (STI’s) Pap Smears
• IUCD Insertion Check and Removal Rape forensic examination and counselling
• Abortion / Termination of Pregnancy (first trimester only), pre and post counselling
• VCT/HIV Counselling and Testing
• Emergency Contraception
• Breast Examination and referrals when necessary

Below is additional information about some of the services we provide:

Emergency Contraception
Emergency contraception is a way of preventing pregnancy after a woman has either: had consensual sexual intercourse with no contraceptive protection, incorrect use of contraceptive protection, or accidental failure of a method (such as failed coitus interruptus, condom breakage or slippage, etc.); or when a woman has been a victim of sexual violence where no contraceptive protection was used.

Two main methods of emergency contraception exist:
1. The Pill Postinor-2 [0.75 mg of levonorgestrel, 1 tablet as soon as convenient but no later than 72 hours after unprotected intercourse, followed by 1 second dose 12 hours later]
2. A Copper IUD can be inserted by a trained health worker within 5 days after unprotected sex. IUDs are included in Subkit 7.

Emergency contraception does not interrupt an ongoing pregnancy, so it is not a form of abortion. Rather, emergency contraception aims to prevent ovulation, fertilisation, or implantation. The success rate of emergency contraception is 98% in women who use it correctly.

Side effects from emergency contraception do occur in 5-20% of women, with slight nausea or vomiting (for a maximum of 24 hours). In some cases, irregular bleeding or spotting, menses a few days early or late, breast tenderness, headache, dizziness may occur.

Emergency contraception is considered safe for women who do have contraindications to long term use of hormonal contraceptives, including women who generally should not take estrogens.

Abortion
Abortion is a method of ending or terminating a pregnancy.

An incomplete abortion happens when part of the contents of your womb are left behind. This is more common with a medical abortion (pills) than a surgical abortion. If this happens, surgery is required to remove the remaining contents of your womb. About 2 in 100 women who have a medical abortion need surgery afterwards.

If an abortion has not worked at all, then a woman may decide to try another abortion procedure or go ahead with the pregnancy. However, in this case, it is important to know that if you had a medical abortion and it did not work, the drugs taken during the first attempt could possibly have harmed the fetus.

Approximately 1 in 10 women suffer from an infection after an abortion. Infections are known to lead to more serious problems, such as pelvic inflammatory disease, if they are not treated quickly and effectively. Such disease could lead to the inability to become pregnant again in the future. Properly taking antibiotics after your abortion will reduce the risk of infection.

Some women continue to experience signs of pregnancy such as morning sickness and breast tenderness after an abortion. These symptoms will gradually disappear as your hormone levels return to normal. If these signs continue 2-3 weeks after the abortion, you should visit your doctor. A pharmacy-bought pregnancy test will not be able to tell you if you are still pregnant, because the hormone that it measures may take up to a month to return to normal after the abortion.

If you have any other questions about abortion, please contact Mosaic's Executive Director, Marieta de Vos at mdevos@mosaic.org.za

Choice on Termination of Pregnancy (TOP) Act 92 of 1996 (as amended)
The aim of the Act is to give women with unwanted pregnancies access to free and safe TOP, with the state having an obligation to deliver the service. TOP is not a family planning method, but a last resort for managing unwanted pregnancy.

Circumstances under which termination of pregnancy (TOP) may take place
I. Upon the request of a woman during the first 12 weeks of pregnancy
II. From the 13th week up to the 20th week if the doctor, with the woman is of the opinion that the pregnancy will affect the woman; if there is a risk of fetal abnormality; if rape of incest occurred; if the pregnancy would socially or economically affect the woman.
III. After the 20th week, if 2 doctors or a doctor and a trained professional, is of the opinion that the pregnancy could endanger the woman's life, it could result in abnormalities of the fetus, or pose a risk of injury to the fetus.

Only a trained healthcare professional may perform the TOP in a designated facility up to 12 weeks of pregnancy. Only doctors may perform terminations from the 13th week onwards. Untrained persons performing a TOP and any person obstructing access to a facility is guilty of an offence.

Counselling and information about her rights must be offered to the client before and after the termination. If the client refuses counselling, the TOP cannot be refused.

Only the informed consent of the pregnant woman is required, regardless of her age, marital state, culture or religion. A minor must be advised to consult with her parents or guardian, family or friends, but access to a TOP cannot be denied. A mentally challenged or unconscious woman's pregnancy may be terminated under special conditions.

Mosaic TOP Program
Termination of Pregnancy (TOP)
Every woman with an unplanned and unwanted pregnancy has her own particular circumstances why she can’t continue with her pregnancy. To have a pregnancy terminated is not an easy decision to make; you might have mixed feelings about your decision. We understand this and if you wish to talk about your personal situation, let us know.

If you want to make an appointment for an abortion at Mosaic, please call the office at 021-761 7585 and tell the receptionist that you want to make an appointment for termination of pregnancy. The receptionist will ask you if you know how far along you are in your pregnancy. Give an estimate if you are unsure or have not yet been to a doctor or clinic to find out. The receptionist will then give you a date for your first appointment. This service is available at our Wynberg Clinic but will also be available at the Lentegeur Hospital in Mitchells Plain in mid-August 2009.

Before the TOP
When you visit Mosaic’s clinic, a file will be opened with your particulars. Your information is kept CONFIDENTIAL at all times. The clinic will use it ONLY in regard to your personal health.

Please bring a letter if a doctor or another clinic referred you to us.
The following process will take place before the TOP is performed:

• The doctor or nurse will ask questions about your health, illnesses and reproductive history. Some of this information is personal but is needed to make the procedure as SAFE as possible for you.
• The nurse will then take your observations: blood pressure, temperature, pulse, respiration, urine test and haemoglobin value. This information is necessary to determine the state of your physical health.
• To make a final decision regarding the TOP, the nurse will do a physical examination which will include an abdominal and vaginal exam to determine the size of the pregnancy. If the pregnancy is12 weeks and under, the nurse will discuss the TOP with you and explain what will happen on the day of the procedure. If the pregnancy is over 12 weeks but less than 20 weeks, you will be referred to a hospital that will be able to help you.
  
• You will then see a counsellor who will talk to you about the implications of the TOP and the other options that are available to you. This is to make sure that you have made a decision that you are comfortable with. S/he will also reassure you and invite you to seek help if needed after the procedure.
  
• Once you understand your options and have made a final decision about the TOP procedure, the nurse will ask you to sign a consent form. This consent is needed for the nurse to perform the TOP. Only YOU need to sign the form. You DO NOT need permission from anybody else, regardless of your age.
  
• Lastly, the nurse will book you for the procedure on the day decided. It is IMPORTANT to adhere to this date as TOPs are only performed on certain days at the clinic.

The TOP Procedure
During a termination, the pregnancy is removed from the uterus.

• Do not take any medication (especially aspirin) before your appointment unless you are advised to by the doctor of nurse.
  
• Do not take any alcohol for 24 hours before your appointment.
  
• Do not eat for 2 hours before your appointment.

We encourage you to bring a family member or friend with you to the clinic for support. The family member or friend may not be allowed in some areas of the clinic.
The TOP is done under local anesthesia (injection to numb the womb) which means that you are not going to sleep. Two hours before the procedure is started, you will be given tablets that will open the mouth of the womb and make it possible for the nurse to perform the suction procedure. This is done with a small plastic tube which is connected to a handheld aspirator with which the nurse sucks out the contents of the womb (blood clots and products from the pregnancy).

The actual TOP takes between 5-10 minutes, depending on how far advanced the pregnancy is. You will be given injections for the pain but, you may still experience some cramps as the womb contracts (gets smaller). After completion of the TOP, the nurse will observe you while you recover (this is usually for about 1 hour).

After the TOP
Bleeding and cramping: There will be some bleeding similar to or less than a menstrual period. The bleeding differs from person to person. The bleeding or spotting can last between 10-14 days. Some women experience no bleeding which is also normal. Pregnancy symptoms should subside within 10-14 days.

If you experience severe pain or very heavy bleeding (consistently soaking a maxi pad in less than one hour), contact Mosaic’s clinic or your closest clinic immediately.

Prevention of Infection            
Personal hygiene should be maintained. Take all of your prescribed medications as instructed. Do NOT use tampons or have sex until the bleeding has stopped. Use a condom if you are forced to have sex. If you develop a discharge or temperature or cramps that won’t go away, you may be developing an infection and should contact the nearest clinic immediately. Strenuous exercise should be avoided for 1-2 weeks after the TOP.

Complications
Complications are very rare when TOP is performed by competent trained nurses and doctors. In fact, the risks are less than those experienced by healthy women during a full term delivery. However, complications from TOP can occur. Injury to the womb and to the neck of the womb can cause infection and bleeding.

It is important to immediately report any of the following complications to the clinic nearest you:

• consistently soaking a maxi pad in less than one hour
• a temperature above 38°C for more than 4 hours cramps that become more severe
• headache, shivers, feeling poorly

Contraception            
After the TOP, the family planning nurse will explain the various methods of contraception that are available and give you the method you have chosen. Please note that you can get pregnant again immediately after the TOP. Your menstrual cycle will begin within 4-8 weeks. So, it is important to decide what contraceptive method you want to use if you do not wish to become pregnant immediately.

If you experience any problems or side effects from the contraceptive method that you have chosen, DO NOT stop taking it; rather, make an appointment with the nurse again to discuss the symptoms and to review a new method.

DUAL Protection
This is when a couple uses both a condom and another contraceptive method to protect themselves against pregnancy, STI’s and HIV/AIDS. This double protection is beneficial and if condoms are used every time and in the right manner together with another contraceptive method, they help to prevent the spread of sexually transmitted infections (STI’s).

Emotional Support
You may experience a wide range of emotions (relief, sadness, etc.) after the TOP. Please make an appointment with Mosaic for counselling whenever you feel the need to talk about your experience.

Post TOP Counselling / Next Appointment
A return to the clinic for a check-up Is not necessary. However, if you experience any discomfort or you need additional counselling, you may phone the clinic for an appointment. Feel free to ask questions if any of the above information is not clear to you, and remember that TOP is NOT a contraceptive method – responsible family planning is very important.