Thai society should have a more understanding perspective towards women with unplanned pregnancies rather than condemning them, as this forces women to face problems in hiding, lacking information, and not accessing services, leading to unsafe abortions, severe blood infections, and high mortality rates among those who undergo abortions.
A woman’s body is a battleground for various ideologies, including sexual ideology, appropriate age for sexual activity, marriage, male dominance, acceptance of male influence in social life, the ideology of a complete family emphasizing birth/children with both parents, without considering a woman’s intention or readiness to become pregnant as a fundamental factor in decision-making. The ideology of reproductive health rights offers hope and opportunity for women to have the right to decide on their sexual life and reproductive health. Intentional pregnancies should allow women to make their own decisions.
The issue of illegal abortions highlights that unplanned pregnancies remain a societal problem in Thailand, lacking comprehensive and sustainable prevention and resolution measures. Safe abortion services are a contentious topic with endless debates and diverse opinions.
Unwanted Pregnancy: At the 36th meeting of the Network for Supporting Women’s Choices with Unplanned Pregnancies in early 2015, organized by the Network for Supporting Women’s Choices with Unplanned Pregnancies in collaboration with the National Health Security Office (NHSO), there were reports on the progress of policy advocacy regarding women’s choices with unplanned pregnancies, NHSO’s policies and measures to support contraception for women under 20, and guidelines for expanding services to cover women over 20.
Dr. Krit Leethongin, Director of the Health Promotion and Disease Prevention Service Support Program at NHSO, provided information that the Health Promotion and Disease Prevention Service Support Program at NHSO has a subcommittee on health promotion and disease prevention that focuses on adolescent pregnancy or unwanted pregnancy, which is a nationally managed program. The NHSO’s role involves organizing adolescent pregnancy services, with a budget and a proposed framework for preventing and controlling adolescent and unwanted pregnancies over a 3-year period (2015-2017).
Initially targeting the under-20 age group, as the national budget is around 200 million baht and covers various issues, it is expected that by mid-2015, the program will expand to women aged 20 and above, with a framework in four areas:
- Supporting the provision of services by having service units provide contraceptive implants or IUDs for adolescent pregnant women under 20, covering all rights after childbirth, abortion, or voluntary choice, and supporting service/drug and medical supply costs for preventing and controlling unwanted pregnancies. Efforts are being made to include medical abortion drugs in the national essential drug list and support NHSO regional networks in providing safe abortion prevention services at the regional level. However, payment for abortion services is not yet provided, except in cases of fetal abnormalities, such as severe thalassemia, where a special payment of 3,000 baht is made to service units for pregnancy termination.
- Developing personnel capacity to have knowledge and skills in inserting IUDs/contraceptive implants and providing counseling, with a national-level system development budget of about 60 million baht paid to the Department of Health.
- Supporting the participation of private/non-profit organizations, as proposed by the subcommittee, to effectively manage adolescent pregnancy issues, private sector service providers should also be supported, currently supporting the Planned Parenthood Association of Thailand.
- Monitoring and evaluating the overall work according to the above framework during the 4-5 months of the 2014 fiscal year, with a total of 1,973 cases nationwide, including 1,664 implant cases and 309 IUD cases.
In Thailand, organizations working on women’s issues/reproductive health rights have continuously called for open discussions on safe abortion, legal changes, and practice adjustments to allow women with unplanned pregnancies to access safe abortion services. If the voices of women with unplanned pregnancies are allowed to be heard, society should not impose personal values or experiences to judge these women’s lives. It is said that we can save many women in distress.
‘Stigma’ of Women with Unplanned Pregnancies: In an academic discussion on the topic “Where is the Women’s Voice?” Kulapa Wajanasara, a researcher from the Institute for Population and Social Research, Mahidol University, speaking on the topic “Why Women with Unplanned Pregnancies are Voiceless,” stated that Thai society has certain management systems that prevent women from discussing abortion.
“Research on barriers to accessing safe abortion conducted a year or two ago found that women who choose to terminate their unplanned pregnancies are stigmatized for abortion, extending to the staff providing abortion services. The use of stigma is highly effective because it silences individual women’s voices both at the personal and societal relationship levels.”
Kulapa pointed out that the stigma of women with unplanned pregnancies is one of the ways society punishes women who deviate from societal norms, whether it be sexual relations allowed only within marriage, at an appropriate age, in heterosexual relationships, etc., or the role of women valuing being a wife and mother. Women with unplanned pregnancies who choose to have an abortion face the silent suffering of their decision for life, just to avoid harsher social punishment.
Social stigma for women with unplanned pregnancies and abortions takes three forms: (1) Stereotyping, such as labeling women with unplanned pregnancies as irresponsible young girls who cannot be good mothers, bringing shame to their families, etc. (2) Discrimination and exclusion of women with unplanned pregnancies, such as considering women who have had abortions as sinful, unable to succeed, and should not be associated with. (3) Involvement in abortion brings collateral stigma, etc.
Such biases prevent Thai society from recognizing the value of these women’s lives and do not consider that denying women access to safe abortion services is a form of discrimination against women.
“The voices of 35 women with unplanned pregnancies who chose to have abortions reveal experiences of shame, leading to secrecy and attempts to terminate quietly, feeling guilty. The stigma of abortion has a significant dimension: no one wants to be visibly marked as tainted, so most women with unplanned pregnancies do not want to be seen in society, silently accepting that they are different from other women and keeping it a secret for life.”
Silence helps reduce the risk of rejection, non-acceptance, or discrimination, as being silent can mitigate the severity of stigma and social punishment. Importantly, the silence and invisibility of these women help them maintain their previous status. Kulapa stated that women who remain silent are not socially isolated, not separated, and not cut off from their social relationships, whether from family, relatives, or friends.
“Therefore, it is not surprising that almost every woman who has an abortion tries her best to conceal the reasons and decisions regarding her body. The consequence is self-punishment with guilt, enduring the stigma embedded in their consciousness for life. This is the punishment of stigma in the societal ideal that dictates women must be mothers.”
The voices from the other side of unsafe abortion services, collected from counselors, social workers, and psychologists in various levels of state hospitals, including doctors, nurses, medical instructors, and mental health activists, reveal that those who help women with unplanned pregnancies and want abortions also face the stigma of abortion, known as “collateral stigma,” meaning being tainted by association with abortion and being seen as accomplices, supporting, advising, and assisting women in having abortions, whether through counseling or merely working in clinics or hospitals providing services.
Kulapa stated that “collateral stigma” in the research is divided into three groups: The first group sees abortion as killing, harming life, and considers it a serious religious offense. If involved, they are seen as sinful clinics, tarnished, and will not provide abortion services.
The second group views abortion as addressing the root cause of unplanned pregnancies. If involved, they feel guilty. If they have a choice, they prefer not to be involved, only providing abortions in truly necessary cases. This group is often not sensitive to the different reasons of each woman with an unplanned pregnancy. Some provide services because it is their duty, but it conflicts with their moral beliefs.
The third group sees it as fulfilling their duty, helping those in distress with good intentions, not sinful. They view abortion as a service and treatment that allows women with unplanned pregnancies to receive safe services without risking their lives elsewhere, without expecting any benefits in return.
“This group uses two explanations to manage collateral stigma: negotiating with their own guilt by prioritizing good intentions, believing in their role in helping women in distress receive safe services. They see abortion as a woman’s choice, a right, not their duty to judge right or wrong or sinfulness.
Using personal feelings to create hatred and judge others’ actions is not acceptable, nor is placing personal beliefs above duty. They clearly separate personal values from their responsibilities as reproductive health service providers for women and do not let their beliefs prevent women from receiving services when needed,” Kulapa emphasized that stigma and collateral stigma from abortion make hearing and seeing these women’s voices difficult.
“To hear these voices, we must reduce the tools of stigma, which requires a different perspective and heart. Therefore, the final voice is what we hear from discussions with religious and mental health practitioners who suggest that hearing the suffering of women is not difficult if we prioritize certain moral principles over others.
“From being accustomed to the principle of non-killing (abstaining from taking life) as a major principle, we must expand our thinking that morality has multiple dimensions, compromising with various principles, using wisdom to minimize harm, and using compassion as a driving force for selfless help. At the same time, we should use the Four Noble Truths to broaden our perspective, seeing it as a matter of suffering, birth, and cessation of suffering, seeing women’s suffering, and alleviating it with good intentions, not with anger or hatred, to reduce guilt. Finally, let women choose how to manage their suffering by providing comprehensive information on options, pros and cons, equipping them with intellectual tools, and focusing on the present moment, not past or future lives.”
Allowing women to undergo unsafe abortions, resulting in severe complications and death, is not because we cannot address unplanned pregnancies, but because society has already judged whether their lives are worth saving.
Amid concerns about the demographic shift in Thailand towards an aging society, declining birth rates, and increasing teenage pregnancy statistics, leading to questions about quality births in Thai society, one thing to consider in evaluating options is how to ensure that every pregnancy in Thai society is not wrong, and abortion is not illegal, but can access appropriate safe service standards, so that living in Thai society is a life of quality, as no woman intends to become pregnant to have an abortion.
Source: https://www.posttoday.com/life/life/396388