Data from 1663 shows that in 2016, there were 11 deaths from unsafe abortion, and the state spent 112 million baht on treating those affected by unsafe abortion. Why do these women have to bear such high costs for decisions about their own bodies? Access to safe abortion services for women is still full of obstacles, especially from the attitudes of healthcare personnel. This resulted in 11 deaths from unsafe abortion in 2016, and the state spent 112 million baht on treating those affected by unsafe abortion. The lack of access to safe abortion services causes women and those around them to bear significant costs, whether financial or emotional, and turns women into guinea pigs for unsafe abortions.
Relevant agencies need to clarify and create a support system for medical personnel in providing safe abortion services. The Penal Code, Sections 301-305, specifies the penalties for abortion and the exceptions for pregnant women with physical or mental health problems or pregnancies resulting from criminal offenses under Sections 276, 277, 282, 283, or 284, such as rape, consensual and non-consensual sex work, or indecent deception. However, in practice, providing abortions for women with unplanned pregnancies is still full of obstacles, especially from societal attitudes.
The World Health Organization estimates that each year there are approximately 46 million abortions worldwide, of which about 20 million are unsafe, resulting in approximately 70,000 women dying from this cause annually. Of these, 95% occur in developing countries, including Thailand, because many women with unplanned pregnancies cannot access safe and legal services.
However, what women have to pay for not accessing services is not just life in terms of life and death, but also other impacts that their lives and those around them have to bear, which harm them for many years.
In 2016, 11 women died because they could not access safe abortion services: 1663 AIDS and Unplanned Pregnancy Hotline held a press conference ‘Unplanned Pregnant Women Denied Abortion Even Under Legal Conditions’ on August 8, 2018, by Nimit Tienudom, Director of the AIDS Access Foundation, stated that from the counseling services of the AIDS and Unplanned Pregnancy Hotline 1663 from August 1, 2017, to July 31, 2018, it was found that there were 28 service recipients who were eligible for abortion under legal and medical criteria but were denied services, such as cases of fetal deformity, pregnancy affecting the physical and mental health of the pregnant woman, service recipients under 15 years old, and pregnancies resulting from abuse. The denial of abortion services led these women to seek non-standard, unsafe services, with some ordering medication from websites to self-abort. According to data from the National Health Security Office (NHSO), in 2016, there were 11 deaths from unsafe abortion, and the state spent 112 million baht on treating those affected by unsafe abortion.
In the past year, the 1663 hotline found that there were 652 service recipients who attempted to self-abort, such as ordering drugs from illegal websites or self-harming to induce miscarriage, indicating that unplanned pregnancies, regardless of the cause, impact women’s mental health. Although abortion is legally permissible, it is denied due to negative attitudes of healthcare personnel towards pregnancy and abortion, resulting in women being injured and dying from unsafe abortions every year. Therefore, all health service units are urged to provide abortion services for women with unplanned pregnancies to access services quickly and safely, as current abortion technology is very safe and uncomplicated. The Ministry of Public Health, through the Department of Health, also has a policy to promote safe abortion services for women with unplanned pregnancies by supporting medication and expenses from the National Health Security Office (NHSO) in providing services.
Doctors and Nurses Refuse to Provide Services: Achara Kaewpradit, Head of Operations for the 1663 Hotline Counseling Service, detailed cases where service recipients were denied abortion services even under legal conditions. One service recipient was pregnant, and the attending doctor initially assessed that the fetus might have abnormal brain development, which could be confirmed in the fifth month of pregnancy, along with a cervical tumor. However, the service recipient did not want to wait because it would be harder to accept if the pregnancy had to be terminated later. She informed the hospital that she wanted to terminate the pregnancy immediately, but the hospital under her rights did not provide the abortion. When the service recipient called the 1663 hotline, she was able to terminate the pregnancy at a clinic in the RSA (Referral system for Safe Abortion) network.
“The worst part is that women’s bodies become guinea pigs for non-standard abortion services because they cannot access this information and may have to go to the hospital afterward because what they received was of poor quality, lacking correct information for self-care or resulting in death.”
Another case involved a service recipient who was 19 weeks pregnant and had an ultrasound at a local clinic, which found fetal abnormalities. The clinic doctor, who was a provincial hospital doctor, referred the service recipient to a hospital in Bangkok for a confirmatory ultrasound. The Bangkok hospital confirmed the fetal abnormalities and issued a referral for the service recipient to terminate the pregnancy at the provincial hospital under her gold card rights. However, the provincial hospital refused, informing the service recipient that the hospital had no policy to terminate pregnancies.
“We feel that the service recipient is very traumatized because having to terminate a pregnancy due to fetal abnormalities is already distressing enough, but being denied treatment by the hospital, even though it is within the criteria for termination, is even more so. Not to mention having to travel back and forth between the province and Bangkok, which is over 300 kilometers, and being repeatedly denied,” Achara said.
Somwong Uraiwattana, responsible for the 1663 project, stated that from the counseling services of the 1663 hotline on unplanned pregnancies from October 1, 2015, to June 30, 2018, there were a total of 52,370 consultations on unplanned pregnancies, with an increasing number of adolescent service recipients under 20 years old each year, accounting for 30.1% of all service recipients. Of these, 89.7% had clear options after counseling, with 6.2% choosing to continue the pregnancy, while 83.5% chose to terminate the pregnancy. The 1663 hotline referred abortion services to both public and private service units under the law and medical council regulations.
“In the past, 1663 has worked with the Department of Health and RSA doctors to help women with unplanned pregnancies receive safe abortion services. However, if this service can be expanded in the normal system of public health service units, it will help women with unplanned pregnancies be safer and access services more conveniently without having to travel far, as RSA doctors are not available in every province. Service recipients and willing doctors are very sympathetic, with some having to travel across regions from the north to the northeast to receive abortion services, while some choose to find ways to self-abort instead because they cannot afford travel expenses or cannot travel far due to family members needing care,” Somwong said.
The Life Costs Women Must Bear: Satrara Hatthirat from the Tam Tang Group, a group providing counseling and advocating for safe and dignified abortion policies, explained the impact on women from not accessing safe abortion services:
“What is the impact on women from not accessing reproductive health services? Firstly, women have to try very hard, using personal resources, time, morale, knowledge, and money, to take risks with whatever they can find at that moment. This leads our population to live a life of poor quality when they face problems, causing many women to try repeatedly, spending money until they have no savings left when they reach safe services, they have no money left to receive services.”
“The worst part is that women’s bodies become guinea pigs for non-standard abortion services because they cannot access this information and may have to go to the hospital afterward because what they received was of poor quality, lacking correct information for self-care or resulting in death. Not knowing where the correct, safe, and open services are makes them insecure when they have to go through this experience.
“Another very important issue is that reproductive health services are linked to sexual rights, women’s bodily rights, and when it involves sex, it cannot be open and transparent. Both we and our families can fully support us, affecting women’s feelings, both the owner of the pregnancy and those around them who love them, making everyone go through a scary experience that should not be. They have to question themselves whether they are doing the right thing, whether it is illegal. These are questions that women should not have to go through, but can access services with dignity and safety, so it does not become an unnecessary nightmare for many years,” Satrara also mentioned the current medical system that creates individuals to adhere to unreal things, with healthcare personnel refusing to provide abortion services because they believe they are doing good and right.
“But we have to think back to who taught them to think this is right. The medical system has become a system that tries to fix illnesses piece by piece, forgetting that it is all part of a person’s life, which is more profound and extensive than individual illnesses. They do not see the pain of women who have to be tossed around and not receive clear support from the medical personnel they turn to. Worse, medicine forgets to support a person as a human being, but only wants to fix some illnesses, making sex and reproductive health, which are sensitive and cause significant mental pain, because it is not just an organ, but an identity, a value that people hold, not being raised to change this paradigm of the medical system,” Satrara believes that society should not expect individual healthcare personnel, but relevant agencies must clarify and create a support system that providing safe abortion services is the right thing to do.
Source: https://prachatai.com/journal/2018/08/78191