Durban

South Africa / Durban

OVERVIEW

In South Africa, you will find a range of health care resources. Contraception is legal although a prescription is required and, generally-speaking, many women may be unaware of the full range of contraceptives available to them. The South African government is keenly interested in improving general usage and awareness among women of reproductive age. Emergency contraception (the morning after pill) is available without prescription if you're over 16 years old. If you're under 16 years old, you'll probably need to consult with a doctor and obtain a prescription.

Globally, South Africa is known to have a large HIV epidemic, and the country is trying to fight the issue with educational programs. There are many sites at which you can get tested for STIs, and there are especially many support and healthcare-related groups for people affected by HIV/AIDS.

If you become pregnant in South Africa, maternity leave is honored but companies are not required to pay you during this time.

Abortion is fully legal for up to 12 weeks of pregnancy. After 12 weeks, you can still obtain an abortion but only for certain reasons. In all cases, you must get approval from two physicians before getting an abortion and they can't be the physician performing the abortion. Legally, physicians are allowed to turn down your request. However, you will find that there are many abortion facilities in Johannesburg and, if they are public, abortion is typically free of charge for the first 12 weeks of pregnancy. If you are interested in private facilities, Marie Stopes' facilities are especially recommended, which can be found throughout South Africa.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In South Africa, you need a prescription to obtain birth control.

According to a 2015 UN report, it was estimated that about 65% of women in South Africa (who were married/in unions and between the ages of 15 and 49) used any form of contraception, including traditional methods. It was estimated that about 12% of women had unmet family planning needs. The most common forms of contraception were contraceptive injectables (about 30%). This was followed by female sterilization (about 15%), birth control pills (about 12%), and condoms (about 5%). There were low rates of usage for IUDs (about 1%) and male sterilization (less than 1%). There was practically no usage of contraceptive implants (0.0%) or vaginal barrier methods (0.0%).

Generally speaking, South African women do receive education related to contraception. However, they may have limited knowledge of the range of contraceptive options available.

In 2014, the South African government revealed a new family planning strategy. Under this new plan, contraception options were expanded, including the introduction of Implanon Nxt (contraceptive implant). The government also sought to increase demand for less popular contraceptives, like IUDs and condoms.

As reported by Bhekisisa: "According to Thompson, 'the central challenge we see women face around contraception is pushback from partners. A great many of the abortion clients we see are survivors of gender-based violence, a struggle that keeps many women from accessing the contraception they may well wish for.' Manyonga says the government's new contraception and fertility planning policy, which was launched earlier this year, is a significant improvement on the previous 2001 policy. It recognises 'power imbalances that make it difficult for some women to negotiate condom use and seeks to make contraceptive services available that will not fuel women's vulnerability to HIV infection'."

What to Get & Where to Get It

• Marie Stopes South Africa: "We have a wide range of contraceptive methods for you to choose from. Whether you’re interested in a monthly option like the pill or patch or a long acting method like an implant or IUD we can help find something that suits your lifestyle. We offer: • Tablets • Injectables • Patches • Implants • IUDs and IUSs “loop” • Emergency contraception If you are starting to use contraception for the first time, or looking into a new method it’s a good idea to make time for a full consultation. Schedule time with one our friendly nurses who can give you a run down of all of your options." Questions or Bookings: 0800 11 77 85

Here are some of the oral contraceptives you can expect to see in South Africa:

Monophasic Low Dose: Minesse®, Mirelle® 15mcg or 60mcg, Femodene ED®, Harmonet®, Melodene®, Minulette® 15-30mcg or 75mcg, Marvelon®, Mercilon® 20-30mcg or 150mcg, Yasmin®, Yaz 20-30mcg or 3mg, Cilest® 35mcg 250mcg, Diane-35®, Ginette®, Minerva®, Diva-35®, Adco-Fem 35®,, Cyprene 35-ED® 35mcg or 2mg,

Triphasic High Dose: Nordiol®, Norinyl-1/28®, Ovral® 50mcg or 250mcg-1mg

Low Dose: Tri-minulet®, Trioden®e, Logynon ED®, Triphasil® 30-40mcg or 50-125mcg, Tricelest® 35mcg or 180-250mcg, Trinovum® 35mcg or 500-1000 mcg

High Dose: Biphasil® 50mcg or 180-250mcg

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In South Africa, you can purchase emergency contraception (the morning after pill) without a prescription if you're over 16 years old. If you're under 16 years old, you'll probably need to obtain a prescription or visit a family planning clinic. It's reported that 19.6% of South African women of reproductive age have knowledge of EC and .5% have ever used EC.

This needs to be verified -- but it appears that you need to be female (i.e. the person who is assumed to need the EC) to purchase emergency contraceptives. Friends or partners cannot purchase EC for you.

Warning: There are some street peddlers in South Africa who sell emergency contraceptives. Some claim that they're off-duty nurses, pharmacists or pharmacy assistants. Do NOT buy EC from them. The pills they sell may be defective, counterfeit or low-quality. The pills may also be overpriced. You can easily purchase EC in pharmacies in South Africa at reasonable and standardized prices, so there's no reason to buy EC pills from street peddlers.

What to Get & Where to Get It

Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

Information Provided by Princeton EC Website.

Dedicated Products / Progestin Only Take 1 pill within 120 hours after unprotected sex:

• Escapelle (available from a pharmacist without a prescription)

Take 2 pills within 120 hours after unprotected sex:

• NorLevo 0.75 mg (available from a pharmacist without a prescription)

Oral Contraceptives used for EC / Progestin Only Take 50 pills within 120 hours after unprotected sex:

• Microval

Oral Contraceptives used for EC / Progestin-Estrogen Combined Note: in 28-day packs, only the first 21 pills can be used Take 2 pills within 120 hours after unprotected sex and take 2 more pills 12 hours later:

• Nordiol
• Ovral

Take 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later:

• Nordette

Costs

The price of LNG EC ranges from $5.30 - $5.97, as of 2013.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In South Africa, it is estimated that 19% of the population is HIV+. In some regions, the rates are higher than others. For example, in Kwazulu Natal, it's estimated that 40% of the population is HIV+, while in Northern Cape and Western Cape, it's 18% of the population.

As reported by AVERT, "A survey in 2012 found that HIV prevalence among women was nearly twice as high as men. Rates of new infections among young women aged 15-24 were more than four times greater than that of men in the same age range, and this age group accounted for 25% of new infections in South Africa. Poverty, the low status of women and gender-based violence have also been cited as reasons for the disparity in HIV prevalence between men and women in South Africa. Despite these barriers, HIV prevalence among women aged 15-24 is thought to have declined between 2002 and 2012."

Often times, doctors have struggled to identify suitable preventative measures for South African women. In studies, PrEP and preventative vaginal rings have not had massive success. This is perhaps partially due to the fact that the women may feel uncomfortable with the vaginal rings, which are less popular in South Africa than in the United States or European countries. Furthermore, many women did not stick with the regimen of taking PrEP pills every day. As reported in the Scientific American, “In the face of this unexpected setback scientists are now trying to develop new, less invasive products as well as giving more forethought into the social circumstances surrounding PrEP use. 'If women feel they cannot control their exposure to the virus, if they’ve seen their mothers get infected or their family members die from AIDS and they are afraid of that, we want to offer them protection,' says microbiologist Zeda Rosenberg, chief executive of the nonprofit organization developing the ring, the International Partnership for Microbicides."

In June 2016, the South African government launched a national campaign to reduce HIV infection among young girls. The campaign "seeks to reduce the interlinked problems of HIV, school dropout, teenage pregnancy and gender-based violence and to maximize health, education and economic opportunities for young women and adolescent girls."

What to Get & Where to Get It

Testing Facilities

• Better2Know: "If you are worried you may have an STI (Sexually Transmitted Infection) Better2Know can help you to get tested in Johannesburg. Whether you are concerned about HIV or another STI you can choose a test to suit your needs. Better2Know offers individual tests for specific STIs or you can choose one of our comprehensive sexual health screens. Our service in Johannesburg is available 7 days a week. Your highly accurate test results will be available quickly by telephone, email or SMS or you can view them by logging in to our secure patient area. Should your result show an infection, do not worry. Better2Know will ensure that you have access to the best advice and treatment." Locations throughout Johannesburg. Click here to view locations.
• Marie Stopes: "At Marie Stopes you will have a confidential consultation with a nurse who will discuss your concerns and recommend any tests. We recommend making an appointment for a comprehensive sexual health screening with includes HIV and STI testing for both women and men, as well as a pap smear for women. Marie Stopes has 14 centres across South Africa, to make an appointment for an HIV test, STI screening or comprehensive sexual health screening book online or call us on 0800 11 77 85."

Support

For herpes, here's an article from the Health Society of South Africa about treatment.

HIV/AIDS Organizations (credit to TheBody.com for much of this information):

• National Association of People living with HIV/AIDS (NAPWA): "Provides counseling, destigmatization programs, advocacy, assistance in organizing and awareness." PO Box 66, Germiston 1400, E-mail: napnat@sn.apc.org, Phone: +27 11 872 0975, Fax: +27 011 872 1343
• AIDS & Rights Alliance for Southern Africa (ARASA): A regional partnership of non-governmental organizations working together to promote a human rights based approach to
• Red Ribbon: "Provides general information, advice on living with HIV, and information on legal issues surrounding HIV."
• Southern Africa HIV and AIDS Information Dissemination Service: "Provides policy analysis, outreach, capacity-building assistance, and current information in the field of HIV/AIDS research."
• AIDSDATA: "Database of South African HIV/AIDS organizations."
• HIV/AIDS Update: A South African Information and Service Centre: "Newsletters and support in South Africa."
• Soul City Institute of Health & Development Communication
• The Centre for HIV/AIDS Networking: "A Web site showcasing approaches to the fight against HIV/AIDS in the KwaZulu-Natal region of South Africa."

Medications & Vaccines

What to Get & Where to Get It

In South Africa, you can access PrEP, which is included in the National Strategic Plan (NSP) for HIV, STIs and TB (2012-2016). As stated by PrEPWatch, "Prevention advocates are actively engaging with researchers and policy makers around revising PrEP guidelines, following the planned and ongoing PrEP demonstrations studies and discussing possible rollout plans."

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

• In South Africa, you can find pads, pantyliners, tampons and menstrual cups. One recommended store to buy menstrual products is Clicks (a store that has toiletries, pharmacy, etc).
• The local brand Mpower Menstrual Cups sells a standard and light flow menstrual cup which can be bought on takealot.com

Costs

You can buy a Mpower Mentrual Cup for R279 on takealot.com

Pregnancy

Laws & Social Stigmas

"Maternity leave is provided and regulated under the Basic Conditions of Employment Act. Female workers are entitled to at least four consecutive months of maternity leave. The worker may commence maternity leave four weeks prior to the expected date of confinement or earlier if a medical practitioner certifies that it is necessary for the health of worker or her child. Also, a worker is not allowed to work within six weeks of child's birth unless a medical practitioner certifies her to do so. In the event of a miscarriage in the third trimester of pregnancy or a stillbirth, the woman is entitled to six weeks of leave from the date of the miscarriage or stillbirth whether or not she has commenced maternity leave at the time of miscarriage or stillbirth. The pregnant worker must notify her employer in writing at least four weeks prior to the date of commencement of maternity leave and when she intends returning to work from maternity leave.

It is not a requirement that employers pay workers during maternity leave. However, some companies may offer maternity benefit packages. In some workplaces, collective bargaining agreements allow for fully paid maternity leave for several months, or partly paid maternity leave for some months. For example, Pick n Pay allows their employees up to 11 months maternity leave, and pays their employees a portion of their salary for the period they are on maternity leave. Workers on maternity leave may claim from their UIF (Unemployment Insurance Fund) if they have contributed to the fund for more than four months. A worker, contributing to UIF, is eligible for a maternity benefit of 38% to 60% of their average earnings in the last six months, depending on the insured person's level of income. Maternity benefits are paid for a total of 17.32 weeks (six weeks in the event of a miscarriage or a stillborn child).Workers who work for less than 24 hours a week are not entitled to sign up for UIF, and thus cannot access maternity benefits."

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

In South Africa, abortion is fully legal with no age restrictions during the first 12 weeks of pregnancy. For the first twelve weeks, all primary reasons for an abortion are permitted, including to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment, economic or social reasons or available on request. From the thirteenth to twentieth week of pregnancy, an abortion may be performed under the following circumstances: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment and economic or social reasons. After the twentieth week of pregnancy, an abortion may be performed "if two medical practitioners or one medical practitioner and a midwife are of the opinion that the continued pregnancy would endanger the woman’s life, would result in severe malformation of the foetus or would pose a risk of injury to the foetus."

To obtain an abortion, the South African government recommends that women seek counseling, but it's not required. If a woman is under 18 years old, she will be advised to consult her parents but she's not legally required to do so. If a woman is married or in a life-partner relationship, she will also be advised to consult her partner, but she's not required to do so. However, if a woman is intellectually-disabled or has been unconscious for a long time, the physicians will need approval from guardians, parents, life partners or spouses.

While the government typically doesn't require parental or spousal consent, it does require consent from physicians. For the abortion to be legal, the woman must first get approval from two independent physicians (not including the physician who will perform the abortion). One of the consulting physicians must have practiced medicine for at least four years. If the abortion is being performed to preserve the woman's mental health, a psychiatrist must be one of the consulting physicians. If the abortion is being performed due to unlawful intercourse, a district surgeon must approve of the abortion. Furthermore, if the abortion is being performed due to rape, incest or intercourse with an intellectually-disabled woman, there will typically need to be a certificate issued by a local magistrate to authorize the abortion on such grounds.

You should be aware that South African health workers are not legally required to assist abortions. If they have any personal, professional or moral objections, they can decide to take no part in an abortion. However, they are required by law to assist in abortions that are performed to save the life of a woman. Furthermore, if you approach a health care worker in order to obtain an abortion, they may decline to offer you services but they are legally required to inform you of your rights and refer you to health care workers/facilities where you can obtain an abortion.

When a legal abortion is performed, it cannot be performed by any of the consulting physicians. During the first twelve weeks of pregnancy, a physician or midwife may perform the abortion. After twelve weeks of pregnancy, only a medical practitioner can perform the abortion. The abortion must be performed at a government hospital (or another approved institution) by a physician. The hospital superintendent must approve the abortion.

Historically, abortion law in South Africa was under Roman-Dutch Common Law until 1975, which only permitted abortion if the life of the woman was endangered by pregnancy. Then, in 1975, The Abortion and Sterilization Act of 1975 was passed, which expanded abortion availability to include women whose mental/physical health was endangered by the pregnancy, women who were victims of rape or incest or were intellectually-disabled (or, as the law called it "idiot or imbecile"), or if the fetus was at risk of being born with a mental/physical defect. The Act required that three physicians approve of the abortion. Since the Act was still fairly restrictive, most women at the time did not seek legal abortions and the majority of abortions (200,000 per year) were performed illegally.

As written in a UN Report, "This legal situation was dramatically altered in 1994 after the transition from the apartheid regime to full democracy and the victory of the African National Congress (ANC) in the first fully democratic elections in South Africa. The ANC had campaigned on a platform of liberalized abortion and, once it came to power, it proceeded to fulfill its campaign pledge on this issue. After receiving the report of the Ad Hoc Select Committee on Abortion and Sterilisation, appointed to review this matter, the Government introduced draft legislation in Parliament to allow abortions to be performed on request during the first fourteen weeks of pregnancy. The proposed legislation provoked a heated debate between pro-choice and pro-life groups, and the latter held numerous rallies to protest suggested changes. Despite polls indicating that the great majority of the population did not support the legislation and considerable opposition among legislators both within and without the ruling ANC party, the legislation (the Choice on Termination of Pregnancy Act) was enacted in 1996, with almost one quarter of the legislators absent."

The report later states: "The 1996 abortion law is now the most liberal in Africa and, indeed, the world, authorizing the performance of abortions not only during the first trimester of pregnancy on request, but also through the twentieth week of pregnancy on very broad grounds, including socio-economic grounds. Although the preamble to the law stresses that abortion is not considered a form of contraception or population control, it also makes clear that the law is firmly based on a notion of individual human rights."

While the 1996 Abortion Law has been challenged by South African conservatives, it remains in place today.

What to Get & Where to Get It

If you would like to get Misoprostol (the abortion pill), it's available under the brand names Cytotec and Arthrotec in South Africa.

You can get an abortion at a government hospital (which will be free in the first 12 weeks of pregnancy). You can also choose to go to a private facility. Here's a list of some private facilities:

• Marie Stopes South Africa: "We offer safe abortion (also called Termination of Pregnancy or TOP) for women who are up to 20 weeks pregnant. Depending on the gestation (stage of the pregnancy), we have two services available: the Marie Stopes Medical Process (often called the abortion pill) and the Marie Stopes Procedure (a minor, same day treatment). Our nurses and doctors are accredited professionals and experts in reproductive healthcare. Our work is strictly governed the Choice on Termination of Pregnancy Act (amended 2008) and we adhere to World Health Organisation Guidelines and protocols set out by Marie Stopes International."
• Abortion Clinic Johannesburg: "Abortion Clinic Johannesburg is a legal Women’s Clinic in South-Africa offering same day legal termination of pregnancy at affordale rates. Termination of pregnancy is when a pregnancy is terminated before it results into the birth of a child. With several years of experience in termination of pregnancy, our abortion doctors make sure that all abortion procedures are performed with great care. Our Abortion prices are affordable and start from R499."
• Dr. Eve Women Abortion Clinic: "This clinic is South Africa's top Abortion clinic facility, with state of the art facilities complimented by registered and experienced Medical professionals. We have made it possible for 100's of women who have had an unwanted pregnancies to have a Safe and Private Abortion."

Costs

"Abortions are free at government hospitals and clinics during the first three months of pregnancy. The Marie Stopes Clinics also do abortions. These nine clinics are situated in the areas surrounding Johannesburg, Cape Town and Durban. Their abortions are subsidised and much cheaper. Whereas private clinic abortions can cost between R470 and R1 460. The cost of the abortion depends on how far the pregnancy has progressed and also on where the clinic is situated."

Advocacy & Counseling

What to Get & Where to Get It

• Lifeline Southern Africa: Provides 24 hour suicide/crisis hotline: 0861 322 322. Address: 10th Floor, North City House, Cnr Melle & Jorrisen Street, Fraamfontein, Johannesburg, 2001
• The House Group: "Shelter for Abused, Abandoned & Destitute girls under 19 years of age, who are using/exposed to addictive substances or runaways." Address: 60 & 62 Olivia Road, Berea. Phone: 0110279190 or 0828102726
• Usindiso Ministries - A Kingdom Ministry: "Usindiso Ministries provides temporary accommodation for abused women and their children on our First Floor. The Second Floor is set aside for ladies who are training on the Skills to Furnish Programme. Each floor is registered to accommodate 60 persons, which gives the shelter a capacity for 120 persons including their children. Usindiso Ministries provides basic needs for each woman and child, which includes accommodation, food, toiletries, nappies and clothing, when they are available. These women are referred to us by the police, nearby hospitals, other institutions or they hear about us by word of mouth and arrive on their own." Phone: +27 11 334 1143. Email: contact@usindisoministries.co.za

List of Additional Resources

• National Council of Women of South Africa: "NCWSA aims to bring together women of all ages and all walks of life in South Africa, to learn more about local, national and international affairs that affect us all." P.O. Box 1242, Johannesburg 2000, South Africa, Tel: 011-834-1366. Email: info@ncswa.org.