Two young South African women attend a rally to raise awareness of domestic violence.

Eric Miller, Panos Pictures

Women in abusive relationships face hardships from economic insecurity to reproductive health issues, as well as the immediate physical and psychological attacks by their partners or family members. To provide help for this broad range of issues, Ipas South Africa works with the Mosaic Training, Service and Healing Center for Women. This South Africa-based organization began more than a decade ago to help women get out of abusive relationships. Since then, it has grown in scope to help women take hold of a brighter, more secure future.

Mosaic was founded in Cape Town in 1996 to address the high levels of domestic violence women face, particularly those women in poor communities. At the time, although domestic violence was internationally recognized as a human-rights violation, it remained a taboo subject in South Africa. With a cadre of volunteers, Mosaic went into community centers, schools, churches – anywhere they could think of where women gathered – to raise awareness about violence in the home.

Through these community conversations, counselors were able to identify and reach women who were victims of violence and encourage them to take advantage of Mosaic’s counseling services. This counseling helped women see that they were not suffering alone, and look for ways to get out of abusive relationships.

But as their work with female victims of violence grew, the team at Mosaic realized that many women needed more than counseling and psychological support. Clients did not know that they had a right to live free of violence or that they could seek orders of protection from municipal courts. In addition to their counselors, Mosaic added social auxiliary workers to help clients make their way through the court system. Mosaic's clients were also likely to be economically, as well as physically, insecure, so Mosaic created programs to help their clients develop skills that would help them find employment.

After nearly a decade of work, Mosaic identified an area that would take the organization in an entirely new direction. Counselors at Mosaic knew that women who were victims of sexual violence had unmet reproductive health needs. Unwanted pregnancy and sexually transmitted infections were two particularly important threats. Additionally, women in violent situations were often not getting the medical care they needed. Public-health centers offering family planning and other reproductive health services that might have been able to address these issues are often miles away from communities where women do not have cars and only limited access to public transportation.

The team at Mosaic determined that reproductive health services needed to be available where their clients already were. So in 2005, Mosaic began working with Ipas to develop a sexual and reproductive health practice. This practice included community outreach and clinical services, including termination of pregnancy (abortion). Mosaic field staff promoted sexual and reproductive health during their awareness campaigns in the communities where they work. In addition, clinical staff held educational sessions at schools around Cape Town.

“2006 marked a decade of the passing of the Choice on Termination of Pregnancy Act, 50 years of the National Women’s Day, and a decade for the implementation of the Constitution. However, studies indicated that women in many communities still do not know about their rights,” said Mosotho Gabriel, Ipas South Africa Director. “To reach these vulnerable groups with sexual and reproductive health educational and advocacy messages, it became critical to build partnerships with community-based organizations.”

Ipas worked with Mosaic to develop educational brochures, including one brochure on sexual and reproductive rights and contraception, and another to help women understand the actual termination procedure. Ipas also supported Mosaic as it developed its own clinical protocols – protocols that ensure that women will receive high-quality health care, regardless of their income.

For example, all clients at Mosaic’s clinics receive some counseling, regardless of the service they are seeking. The bulk of clinic patients in the 2005-2006 year were seeking contraception and termination of pregnancy services. However, Mosaic also provides basic reproductive health services, including cancer screening and pregnancy tests. In 2005-2006 they implemented a voluntary counseling and testing (VCT) service, in compliance with South African national HIV-screening guidelines.

It is this emphasis on counseling, as well as the integration of services, that makes Mosaic particularly interesting. Dr. Marijke Alblas, an obstetrician-gynecologist who performs terminations at the clinic as well as in government health centers, sees a difference between the patients at the different sites. Clients at Mosaic, she notes, are much more in touch with their emotions than clients at other sites, and Mosaic clients are more likely to be able to bring someone with them to support them throughout the process. Additionally, Alblas said, clients at state-run sites, who do not receive supportive counseling, she said, tend to be more closed off during the procedure itself.

Ipas’s partnership with Mosaic is also particularly interesting. Ipas had previously worked with partners in government health-care services to train abortion providers and help develop practice protocols. Ipas has also supported doctors in private practice to enable them to provide better health care services to their clients. But the partnership with a unique community-based organization that works to meet its clients’ social, mental and physical health needs is another expression of the way Ipas works to extend high-quality abortion care to women at all levels.

“Through this partnership, Mosaic is better equipped to work with vulnerable communities and respond to the realities of their lives,” says Gabriel. “Abused women will benefit from information, education, and group support that people need to be healthy. Women will confront their own situations and practices in their societies and own lives that diminish quality of life and damage sexual and reproductive health. The partnership will contribute to the promotion of human rights in areas where attitudes towards reproductive rights issues and related issues are often still lacking.”

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