Gray Path and the Mission Under Pressure of a Doctor Who Adheres to Her Principles and Rights
Young Eye (pseudonym), a 16-year-old girl, lies unconscious on a hospital emergency room bed due to hemorrhage. The doctor has no choice but to perform a curettage and treat her infection.
48 hours earlier, she chose to solve her unplanned pregnancy problem by using abortion pills purchased online. Although the 1-2 inch embryo was expelled, the placenta remained. She began to have a fever and heavy bleeding but was afraid to go to the hospital for fear her guardians would find out. She waited until her condition became critical before seeking help…
Information from the records of the Pathway Group staff, who provide counseling on safe and legal abortion, indicates that although Young Eye received treatment and was able to leave the hospital, her infection worsened and she eventually died.
“We are in the healthcare industry and see this kind of thing often. We see many people who have had illegal abortions, many are injured, some die,” said Dr. Worachart Meevasana, a young doctor from Phimai Hospital, Nakhon Ratchasima, during a lecture on his involvement in the RSA (Referral system for Safe abortion) network, which is a coalition of doctors, nurses, and personnel from both the public and private sectors to medically terminate pregnancies using medication or safe uterine aspiration according to the guidelines of the Royal Thai College of Obstetricians and Gynecologists and the World Health Organization.
Stigma / Saint: “Initially, I had the same prejudice as everyone else, thinking that abortion is a sin. This belief was instilled by educational institutions and religion, which is not surprising as everyone believes that. Until around 2008-2009, I went to Khon Kaen for training on using MVA (Manual Vacuum Aspiration) tools for abortion procedures. At that time, I went because I wanted the tools, not for any other reason. I was married and thought abortion was a sin, and the law prohibited it. There were many news stories about doctors being arrested for illegal abortion clinics, and we believed it was wrong.
But when I listened to many pioneering professors in this field, it opened my perspective. I already saw the problem that when there are such cases, if doctors try to persuade patients to continue the pregnancy without considering their circumstances, it’s like sweeping dirt under the rug without looking at their readiness. Ultimately, they go behind the hospital for illegal abortions, using coat hangers or whatever they have.”
Dr. Worachart, one of the RSA network doctors nationwide, to receive and refer pregnancy terminations for women with unplanned pregnancies, shared the different thoughts behind this “precarious” role, saying that despite significant pressure, he always thinks of the “patient” who owns the right to decide about her own body.
“I believe everyone has the right to choose for themselves because they have to bear the consequences. If they choose to terminate, I am willing to do it. If they choose to continue the pregnancy, I am willing to care for them.”
However, not everyone who wants to terminate a pregnancy can just walk up to a doctor and express their intention. The law and safety standards remain strong principles in practice.
According to the Criminal Code, Sections 305 (1) (2) and Sections 276, 277, 282, 283, and 284, Thailand allows women to terminate pregnancies by a doctor in six cases:
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- The pregnancy adversely affects the woman’s physical health
- The pregnancy adversely affects the woman’s mental health
- The fetus has a disability
- The pregnancy resulted from rape
- The pregnancy is in a girl under 15 years old
- The pregnancy resulted from deception, coercion, or threats for sexual exploitation
In the past, although the legal channels provided considerable options for women, prejudice against abortion and feelings of guilt led most doctors to refuse and try to persuade women with unplanned pregnancies to continue. Doctors with different views faced feelings of alienation.
“When we work, are we tired, pressured? I think everyone is, but I’m lucky to have a good director, good nurses, a good wife, and good support on this path. But in reality, there aren’t many newcomers like me.” The young doctor said that even today, people still say… there are kids clinging to your back. “It’s not surprising. I exercise every day. I don’t see any problem.”
However, to reach the point called “Cemented Stake”, he said it must be clear that what he is doing is “merit”, not “sin”
“What we do is okay, in the right direction. We don’t make money from it. We follow legal procedures. Everyone who goes through our process leaves with a smile, through a process called Safe abortion. We are happy.”
Sin / Merit Globally, there are approximately 21.6 million unsafe abortions per year, of which 18.5 million occur in developing countries. Approximately 45,000 women die from unsafe abortions each year, almost all in developing countries (estimated figures in 2014). The average cost of an abortion is 2,654 baht per time, and the average cost of treating complications from abortion is 21,024 baht.
Assoc. Prof. Dr. Kritaya Archavanitkul, coordinator of the network supporting options for women with unplanned pregnancies, presented statistics on women injured and dying from pregnancy and abortion at a meeting on “Share On—To Prevent Thai Women from Dying from Abortion,” and commented that “Thailand has not systematically collected data on injuries and deaths of pregnant women who have abortions, partly because our laws still penalize. How can we bring this iceberg situation to the surface?”
This aligns with the perspective of Dr. Boonrit Sukrat, Assistant Director of the Reproductive Health Bureau, Department of Health, who noted that in the past, we only had estimated figures because most abortions occur outside the system. The numbers come from those who seek hospital treatment for abortion complications. But if evaluated from experience, the doctor said… it’s shockingly high.
“When we catch each seller, their sales (abortion pills) are 2-3 thousand per month. The Department of Health can use the pills for 2-3 years.” The issue is that even though we know the problem, there are still many limitations to bringing all pregnancy terminations into the system, whether for legal or moral reasons.
“The Department of Health is trying to promote the RSA network because, in the past, there were a few doctors in our country providing pregnancy termination services, but very few, as we know. This type of service faces a lot of resistance, both from directors and those around them.” The network not only supports doctors who must perform tasks contrary to the majority’s beliefs but also creates safe opportunities and options for women who need to terminate pregnancies.
“We want society to see this as an honorable matter, not something to hide like before.”
Dr. Boonrit emphasized the importance of changing attitudes to help reduce the loss of life and economic impact from unsafe abortions. Moreover, what society should consider more in the decision-making process of whether to “terminate” or “continue” is the readiness to raise a child to grow up with quality.
“Unsafe abortion is just one part of the problem. There are much more severe parts, such as cases that cannot access services and eventually have to give birth without being ready, leading to child abandonment, abuse, or even murder, which we see in the news every day.” Ultimately, avoiding the stigma of abortion may create “karma” for children born unintentionally.
“We often don’t think about children born and raised without readiness, leading to a population of lower quality. If the proportion of the population raised without readiness increases, it will affect the population structure in terms of quantity and quality for the future Thai population. The problem doesn’t stop at whether to have an abortion or not.”
Her Rights / Morality: The long-standing debate between the Pro-Life group, which upholds the rights of the fetus to live based on religious and moral beliefs, and the opposing view that a woman’s right to privacy in determining her own life is a fundamental right in the name of Pro-Choice, remains an unresolved controversy.
However, the injury and death of women from unsafe abortions is an issue society cannot overlook, especially in this era where abortion pills and illegal services are widely advertised online. The approach to solving the problem must bring hidden issues to light and address them directly.
“I see one of the main problems is that we believe if we allow easy access to abortion, more people will have abortions, negatively affecting the image of our Buddhist country. What do we do? We enact laws to prohibit it, making it not easy to do. Besides enacting laws to prohibit it, those who perform or seek abortions are constrained by the concept of sin and merit. Doctors don’t want to do it because they fear sin, and patients don’t dare to do it because they fear sin. Sometimes they continue the pregnancy and raise the child without being ready. Even when doctors and nurses want to do it, they face social pressure, asking how they can offer such services in a hospital, turning it into an abortion hospital.”
The result is that abortions have not decreased, but society is less aware of them. Meanwhile, illegal abortions have become more accessible, and safe abortions in hospitals have become a secret matter.
“The biggest problem in our country now is access to safe services because there are many unplanned pregnancies each year, but our service units are few, and sometimes those in need don’t know where to get services. The Department of Health, in collaboration with the Path2Health Foundation and Access, has implemented the 1663 project and Love Care Station, with the RSA network to address this. The principle is that when unplanned pregnancy cases call 1663 for consultation, they are advised on initial options. If they want to terminate or continue the pregnancy, there is a network ready to support them.” Dr. Boonrit provided information.
“Caring for unplanned pregnancies is not just about finding a place for abortion. Some want to continue the pregnancy, and some need other assistance. However, cases wanting to terminate may be more because, in the past, access to this was quite limited in our country. When there is a channel for them to call for consultation, most who call are cases that wanted to terminate the pregnancy beforehand.”
Ultimately, regardless of how the choice ends, society still needs to provide a safe path for ‘her,’ including respecting the right to choose her own life path.