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Abortion is legal in South Africa for women of any age. Parental permission is not needed. The decision to end or keep the pregnancy is yours, no-one can force you. Please go to a proper clinic… ‘backstreet abortions’ are dangerous and could kill you. Anyone can ask for an abortion in the first 3 months of pregnancy. After that, it’s legal to 5 months under certain circumstances. Don’t wait – seek help and advice the earlier, the better.

• • Where?

You can go to a GP or an organisation such as Marie Stopes; there you’ll pay a fee. It’s available free at some government healthcare facilities. Access to safe comprehensive abortion services is your right.

• • What happens?

Medical abortion: Pills to end an early pregnancy up until the 9th week of pregnancy. Causes bleeding like a period (can be heavier).

Surgical abortion: The pregnancy is removed, usually through vacuum aspiration

• • Future pregnancy

Post-abortion problems are rare if the abortion is done by a legal provider in a legal facility. You will be counselled on your options and advised to start contraception straight away.

Male and female condoms prevent pregnancy by stopping sperm from entering the vagina, so it can’t reach and fertilise the egg. Condoms also protect against STIs, including HIV, cause they act as a barrier. (The penis and vagina don’t touch each other directly so infections can’t be passed on.) But… they must be stored and used CORRECTLY.

You must always use a new condom when having sex. Just remember – one condom, one round. You have to interrupt sex to put on a condom, but feeling safe and protected is worth it! Learning about using condoms and helping your partner to put it on can make the effort enjoyable.

Safety tips

• With the male condom, he must withdraw with the condom on, immediately after sex, otherwise the condom could come loose and leak inside the woman.
• Do not use a male and female condom at the same time as they can break.
• Do not use hand and body lotions, any oils or vaseline as lubricants. They will cause the condoms to break. If the condom breaks you should immediately get emergency contraception.
• Check the expiry date of condoms. Store away from heat and light.

If you have had unprotected sex, or have a condom breaking or been sexually assaulted – you should take the emergency contraceptive pill (the morning after pill). These pills should be taken as soon as possible after unprotetced sex. They can be taken up to 5 days after sex, but it becomes less effective with each day that passes. If taken within 24 hours of unprotected sex they are over 90% effective.

You should get your period within 3 weeks. If it is more than 1 week late, do a pregnancy test.

Side-effects

Nausea and vomiting.

Caution! Think about this

• • The sooner the better! Take it as soon as possible after having unprotected sex, so that it can be more effective.
  • These pills do not protect against STIs. If you have been sexually assaulted you can get post-exposure prophylaxis (PEP) which works against HIV infection.
  • It’s not good for you to use emergency contraception too often. It’s really only for emergencies.
  • Where to get it

The pills are available at family planning clinics, GPs, private medical clinics and pharmacies.

Most important: when making the decision to use contraception make sure your healthcare practitioner knows you’re HIV+. HIV affects your contraception choices, and if you’re on anti-retrovirals (ARVs), they can affect your contraception. It’s also important to use condoms all the time. Even if you’re both HIV+ you must use them – you can infect each other with different kinds of HIV, which will make it harder for you to live healthy.

If you’re on ARVs, the contraceptive methods which work BEST are condoms, IUD, Depo Provera injection and the pill. ARVs that contain ritonavir-boosted protease inhibitors can affect Depo Provera and the pill so check this carefully with your doctor.

If you are on ARVS and use emergency contraception, you need to double the dose.

Implants are small plastic rods or capsules (just the size of a matchstick!) that get put under the skin on the inside of a woman’s upper arm.

They work really well and they last a long time – 3 years! And they can reduce period pain.

You can get them at most government family planning clinics, and from private doctors.

Caution! Think about this

If you are living with HIV, TB, or epilepsy and taking medicines for these conditions, the implant called Implanon may not be right for you. Talk to the nurse or doctor about your condition before starting Implanon.

• • Side effects

Many people get irregular bleeding over the first year. Then lighter, more regular bleeding or infrequent bleeding.

Can make your skin better or worse.

Can give you tender breasts, dizziness, mood changes, nauseau (these aren’t so common and usually only last a month or so).

• • How it works

Implants work in 2 ways:

• • • Blocking sperm from meeting an egg (by thickening cervical mucus).
    • Changing your periods, including stopping ovulation (the release of eggs from the ovaries).
  • Myths

You can get pregnant after having them taken out – you can get pregnant straight away.

Implants can stop your periods, but it’s not bad for you.

They can’t move around your body.

A sexually transmitted infection (STI) is an infection that spreads through sexual contact (where the genitals touch) so you don’t have to only have sex to get one.

Some people don’t show symptoms so you or your partner could have one without knowing. If you have any doubts, get tested for STIs. You can get tested free of charge at any government clinic and your test results are confidential.

And use either female or male condoms! They protect against most STIs.

• • Symptoms

Symptoms of STIs differ, but if you have any of these you should consult a doctor or go to the clinic for STI testing/screening:

• • • Itchy genitals
    • Unusual discharge from vagina, penis or anus
    • Genital sores
    • Rashes and warts
    • Pain when you wee
    • Pain during sex
    • You often will not see symptoms but if you are sexually active you should arrange for regular STI screenings
  • How are they treated?

Some STIs are cured with medicine or an injection, others like herpes and HIV are incurable but treatment can help with symptoms. Even if you go to a traditional doctor or use medication from the pharmacy, it is important you get tested and treated at a clinic. Other medicine can treat the symptoms without getting rid of the infection, which can make the infection worse.

• • Health problems & STIs

Untreated STIs can cause:

• • • Cancer
    • Pelvic inflammatory disease
    • Infertility, pregnancy problems
    • Pregnant women can pass an infection onto their baby
    • Widespread infection to other parts of the body
    • Organ damage
    • Death
    • Greater risk of getting HIV
    • Infecting your sexual partner(s)
  • Common STIs

Read about symptoms and how you get them. Remember – not everyone shows symptoms, even if they’re infected and can pass the STI on. So if you’re worried, get tested. And use condoms correctly and consistently!

Some common STIs are listed below:

• • • BV

BV is a very common vaginal infection. It’s normal to have some bacteria in the vagina, but with BV it increases to more than the usual level.

• • • • Itching of the vagina
      • Pain when you wee
      • A lot of discharge with a fishy smell from the vagina

How do you get it?

• • • • Unprotected sex with someone who’s infected
      • A change in the normal levels of bacteria can be caused by:
      • Stress
      • Having frequent sex
      • Certain antibiotics
      • Some forms of contraceptives
    • Chlamydia

Very common amongst teenagers and young adults and is caused by bacteria.

Symptoms

• • • • Abnormal vaginal discharge
      • Bleeding between menstrual periods
      • Burning when you urinate
      • Needing to urinate often
      • Watery discharge from penis
      • Pain in the testicles
      • Lower abdominal pain
      • Low back pain
      • Nausea
      • Fever
      • Pain during sex.

How do you get it?

• • • • By having unprotected vaginal, anal, or oral sex with someone who has it.
      • The infection can spread if you touch the genitals of someone who has it and then touch your face or eyes.
    • Genital herpes

There are 2 types:

• • • • Type 1 – causes sores on or near the mouth (cold sores)
      • Type 2 – usually causes sores on the genitals. There is no cure.

Symptoms

• • • • Small red bumps, blisters, or open sores on the penis, vagina, or mouth
      • Vaginal discharge
      • Fever
      • Headache
      • Muscle aches
      • Pain when you urinate
      • Itching, burning, or swollen glands in genital area
      • Pain in legs, buttocks, or genital area
      • Symptoms may go away and come back. Sores heal after 2 to 4 weeks. The infection stills remains in the body and may cause symptoms again at a later date.

How do you get it?

• • • • Kissing (on the mouth) someone who is infected
      • Unprotected vaginal, anal or oral sex with someone who is infected.
    • Gonorrhoea

It’s also called ‘the clap’. It’s caused by bacteria.

Symptoms

If symptoms are present, they most often appear within 10 days of becoming infected.

• • • • Pain or burning when you urinate
      • Yellowish/bloody vaginal discharge
      • Bleeding between menstrual periods
      • Heavy bleeding during menstrual periods
      • Pain during sex
      • Thick white or yellow discharge from the penis
      • Needing to urinate often
      • Burning or itching around the tip of the penis
      • Painful or swollen testicles
      • Infection in the throat, eye, or anus.

How do you get it?

• • • • Unprotected vaginal, anal or oral sex with someone who is infected.
    • Hepatitis B

Hepatitis B is a virus that can cause a serious infection of the liver.

Symptoms

• • • • Fever
      • Headache and muscle aches
      • Tiredness
      • Loss of appetite
      • Upset stomach, vomiting, stomach pain
      • Diarrhoea
      • Dark urine
      • Skin and whites of eyes turning yellow.

How do you get it?

• • • • Having contact with the blood, semen, vaginal fluids, and other body fluids of someone who has it.
      • Sex with an infected person
      • Tattoo or acupuncture with unclean needles or instruments
      • Shared needles during drug use
      • Sharing toothbrushes, razors, and nail clippers with an infected person.
    • Hepatitis C (HCV)

HCV is one of the viruses that cause hepatitis. It can lead to chronic liver disease like cirrhosis (scarring) of the liver, liver cancer and liver failure.

Symptoms

• • • • Nausea and vomiting
      • A yellowish tinge to the skin or eyes, mucous membrane
      • Weight loss
      • Joint and muscle aches
      • Tiredness
      • Loss of appetite

How do you get it?

• • • • Sharing needles, spoons, straws and other drug-related equipment
      • Getting tattoos or body parts pierced with used or non-sterile needles
      • Unprotected sex with an infected person
    • HPV/genital warts

Human papillomaviris (HPV) is also called genital warts. Warts may grow on the penis, anus, and on the inside or outside of the vagina.

Symptoms

• • • • Visible warts in the genital area, including the thighs.
      • Warts can be raised or flat, alone or in groups, small or large, and sometimes they are cauliflower- shaped.
      • Growths on the cervix and vagina that are often invisible.
      • Itchiness around warts.

How do you get it?

• • • • Direct skin contact of the genitals during vaginal, anal or oral sex with a person who has it.
    • Pubic lice/crabs

They are a form of lice which are flat-backed, wingless, and greyish-white or reddish-brown in colour. They attach to short, coarse pubic hair but may also be found in the underarms, moustaches, beards, eyebrows and eyelashes.

Symptoms

• • • • Itching in the genital area
      • Finding lice or lice eggs
      • Tiny red spots where they have bitten
      • They look like dandruff flakes at the base of your pubic hair – these are actually crab nits (eggs).

How do you get it?

• • • • Unprotected sex with someone who has public lice/crabs.
      • Sharing a bed, towel, or clothing with someone who has it.
    • Syphilis

It’s caused by bacteria that gets into the blood through the eyes, mouth, broken skin, vagina or anus. If left untreated, syphilis can cause serious health problems.

Symptoms

Primary – a single, painless sore appearing 10 to 90 days after infection:

• • • • Primary – a single, painless sore appearing 10 to 90 days after infection:
      • In the genital area, mouth, or other parts of the body.
      • Goes away on its own.

Secondary stage – starts 3 to 6 weeks after the sore appears:

• • • • Skin rash with rough, red or reddish-brown spots on the hands and feet
      • Fever
      • Sore throat and swollen glands
      • Patchy hair loss
      • Headaches and muscle aches
      • Weight loss
      • Tiredness

How do you get it?

• • • • By having oral, vaginal or anal sex with someone who is infected.
    • Trichomoniasis/trich

Symptoms

Symptoms usually appear 5 to 28 days after exposure:

• • • • Yellow, green, or gray vaginal discharge (sometimes foamy) with a strong smell.
      • Discomfort during sex.
      • Itching or discomfort in the genital area.
      • Discharge from the penis.
      • Burning when you urinate.
      • Irritation around the tip of the penis.
      • Lower abdominal pain (rare).

How do you get it?

• • • • Unprotected sex with someone who has it.
    • Yeast infections

Yeast is a common fungus that lives in small amounts inside a woman’s vagina. Painful symptoms arise when the amount increases. Men do not always have symptoms but may develop the infection.

Symptoms

• • • • White, thick discharge from the vagina
      • Sore, red labia/vaginal lips
      • Pain during sex
      • Itching, swelling, redness or dry flakey skin at the tip of the penis or under the foreskin
      • Pain when you urinate.

How do you get it?

• • • Unprotected sex with someone who is infected
    • Some antibiotics
    • Douching (washing inside the vagina with water or other mixtures of fluids)
    • Some contraceptive pills
    • Menstruation
    • Pregnancy
    • Being diabetic or overweight can lead to frequent yeast infections due to high blood sugar levels.

There are 2 types of injections:

• Nur-Isterate – inject every 2 months
• Depo-Provera – inject every 3 months.

IMPORTANT! Make sure that you go back for your repeat injection at the right time! A time lapse between injections could mean the injection won’t work properly to prevent pregnancy.

Side effects

With the injection, you may have irregular bleeding like light spotting, or you may have heavier periods at first. Later on, you may have no monthly bleeding at all. Not getting your period doesn’t mean that blood is collecting in your body or that you can’t get pregnant in future.

Some people may gain some weight at first as your body gets used to the injection, but this doesn’t last long, and doesn’t happen to everyone.

Some people also get headaches, dizziness, bloating, acne, tender breasts and mood changes. It may also make heavy periods lighter, or relieve premenstrual symptoms (PMT) for some.

Caution: think about this!

If you want to get pregnant after having the injection, you might have to wait up to 10 months for your body to become fertile again.

• • How it works

The injection prevents pregnancy by preventing ovulation. That is, it stops the egg from leaving the ovary. It thickens the cervical mucous, making it difficult for sperm to penetrate the womb (uterus).

The IUD is a small plastic or copper T-shaped device, with 2 soft threads attached. It’s inserted into a woman’s uterus by a trained healthcare provider. It can continue working for a long time, either 5 or 10 years for the different types of IUD, and can be removed whenever you want.

The IUD is safe for most women to use. If you have an STI, it must be treated before the IUD is inserted.

Side effects

• • You could get changes to your menstrual cycle like longer and heavier periods. You may also have more cramps and pain during periods.
  • You should not use the IUD if you have reactions like bleeding, abdominal pain, fever or chills after it is inserted.
  • How does the IUD work?

It mainly works by preventing the sperm from joining with the egg. It may also stop ovulation by stopping egg production. It is very safe, effective and does not need much effort from you. It is easy to put in and take out, and you will quickly become fertile again (be able to fall pregnant) when it’s taken out. You will be shown how to do a monthly check whether the IUD is in place, by feeling the 2 soft strings.

• • Myths

The IUD will not leave the uterus and travel around the body.

It will not get in the way while you’re having sex, though a man can sometimes feel the strings – but this is not uncomfortable.

It doesn’t rust inside the body, even after many years.

And it’s not like a door that closes off your uterus – yuck!

These are not very safe – they rely on you knowing when a woman is fertile, and not having sex or using a condom 100% correctly during that time. The woman has to be prepared to monitor when she is fertile, by maintaining a calendar, or watching her discharge (stuff that comes out of the vagina) very carefully – every month.

You and your partner need to be very committed to stick to these methods, and prepared to deal with the woman becoming pregnant if it fails. And these methods don’t protect against STIs and HIV at all!

If you want to use natural family planning, please go and get training from a doctor or nurse.

• • When is a woman fertile?

The most fertile time in a woman’s menstruation cycle is about 2 weeks before she gets her period. There are 2 ways to figure out when the fertile time is:

• • • Calendar method
    • Symptoms-based methods (like watching her discharge, ie the stuff that comes out of the vagina).

Please get training from a doctor or nurse if you want to use natural methods – you need to understand exactly how to monitor when you’re fertile.

For women, the fallopian tubes that carry eggs to the uterus are tied. For men it’s a vasectomy, where the tubes that carry the sperm to the testicles (balls) are cut and tied. This is done under local anaesthetic and is IRREVERSIBLE, it cannot be undone.

It works as the egg and sperm cannot reach other, so pregnancy is permanently prevented.

Caution: think about this!

This is sterilisation and is available only if you’re over 18. You have to think carefully about this as it’s forever. It’s not recommended for young people because you may change your mind later and want children. It is recommended if you do not want any more children or have reached a decision to never have children.

THERE ARE SOME THINGS TO THINK ABOUT WHEN CHOOSING WHAT FAMILY PLANNING TO CHOOSE:

There are some things to think about when choosing what family planning to use:

1. 1. Effectiveness

No method works 100% of the time. Think about how important it is for you to prevent pregnancy. Keep reading…

1. 1. Most effective: sterilisation, implants and IUD

Sterilisation: If you know for sure that you don’t want any more children this can be good. Implants: Last for 3 years. Just remember to replace after 3 years! IUD: Many people like it cause once it’s in, it works for 5 years. You can ask for one without hormones if you want. (But remember condoms to protect against infection!)

1. 1. Some methods – effectiveness depends on the woman

For injectables to work, a woman must get a repeat injection ON TIME. Pills must be taken about the same time every day.

1. 1. Some methods – it takes 2

Male condoms and sterilisation depend on the man. He also has to cooperate to use the female condom. Nice thing about condoms: they protect against pregnancy AND infection. Safe!

1. 1. Seriously not safe: withdrawal

Some people think that it’s OK for the man to pull out of the vagina before he comes. NO! There can be sperm in the fluid that comes out before he comes – leading to pregnancy or infection.

IMPORTANT! You need to take the pill EVERY DAY. If you can’t manage that, don’t use this method. There are 2 types:

1. The combined oral contraceptives (OCs) are more popular. Contain 2 hormones, estrogen and progestogen. Most commonly used ones.
2. The progestogen-only pills, called Mini Pills. Must be taken at the SAME TIME EVERY DAY

Caution: think about this!

These pills may not work if you go under general anaesthetic or use antibiotics.

OCs cannot be used when breastfeeding – and shouldn’t be used if you are over 35 years old, if you smoke, have high blood pressure, migraine or diabetes.

The Mini Pill should not be used if you are over 35 years and smoke, or if you have high blood pressure or migraines.

• • How does the pill work?

They prevent pregnancy by preventing ovulation. That is, stopping the egg from leaving the ovary. They also thicken the cervical mucus, making it difficult for sperm to get to the uterus, or the womb.

• • Side effects

OCs: At first, your monthly period may become irregular, then when it becomes regular it will be shorter, lighter and you may have less pain. This pill may have other good effects like healing acne and reducing anaemia. However, short term side-effects could include an increase in acne, weight gain, breast tenderness, mood changes, nausea and bleeding between periods.

Mini Pill: Can be used while breastfeeding. It does not contain estrogen so the side-effects will be mild. Monthly periods may stop completely. You can get pregnant quickly after stopping the Mini Pill.

• • If you miss an OC pill

Always take a pill as soon as you remember, and continue taking pills, 1 each day.

If you miss pills for 3 or more days in a row, or you start your next pack more than 3 days late, use condoms or avoid sex for the next 14 days. If you do have unprotected sex, consider using emergency contraception.

If those missed days are in the 3rd week of the pack, do as above AND skip the non-hormonal pills at the end of the pack (or the pill-free week), and start your new pack straight away instead.

If you miss any of the non-hormonal pills at the end of the pack, throw away the missed pills and keep taking the others as usual.

Also read the instructions you get in the box carefully should you miss a pill!

• • If you miss a Mini Pill

If you are more than 3 hours late you must:

• • • Take the one you missed as soon as possible. You can take 2 pills at the same time or on the same day.
    • Keep taking the pills as usual, 1 each day.
    • Use emergency contraception if you’ve had sex in the last 5 days as sperm can live that long inside the body!

Also read the instructions you get in the box carefully should you miss a pill!