Illegal abortion is one of the causes that lead to injuries for women with unplanned pregnancies and may result in complications from unsafe abortions. According to the situation report and abortion statistics in Thailand, it is found that there are approximately 300,000 abortions per year, and about 300 women per 100,000 suffer from abortion-related injuries in 2009. It is estimated that the medical expenses for treating complications from abortion amount to 123.3 million baht, not including psychological losses.
Moreover, the Unplanned Pregnancy Network, together with the RSA Volunteer Network, reveals numerical data that 80-90 percent of women with unplanned pregnancies who decide to terminate their pregnancies do so due to failed prevention and unpreparedness for having children. In some cases, it may be due to the male partner’s refusal to use protection and take responsibility for the unborn child, or economic problems that prevent them from taking care of a new member with quality. Safe termination of pregnancy using medication for women with a gestational age of no more than 9 weeks is an option that should be seriously studied or discussed as part of learning and understanding women’s rights over their own lives and bodies, whether women should have the right to choose what happens to their own bodies.
Abortion under the Thai legal system: According to Thai law, terminating a pregnancy or abortion is a criminal offense. A woman who causes herself to have an abortion or allows someone else to cause her to have an abortion is guilty under Section 301 of the Penal Code and is subject to imprisonment for not more than three years or a fine of not more than 6,000 baht, or both.
At the same time, a person who causes a woman to have an abortion with her consent is guilty under Section 302 of the Penal Code and is subject to imprisonment for not more than five years, a fine of not more than 10,000 baht, or both. If the abortion causes the woman to suffer serious harm, the person who caused the abortion is subject to imprisonment for not more than seven years or a fine of not more than 14,000 baht, or both. If the abortion causes the woman’s death, the person who caused the abortion is subject to imprisonment for not more than ten years and a fine of not more than 20,000 baht.
However, Section 305 of the Penal Code exempts the offense of abortion for women and abortion providers in cases where the abortion is performed by a licensed physician and is necessary for the woman’s health. This includes cases where the pregnancy is due to rape, cases where the pregnant woman is under 15 years old, and cases where the pregnancy is the result of deception, coercion, or threats for sexual exploitation.
In addition to the Penal Code, the Medical Council regulations on the criteria for medical termination of pregnancy specify conditions under which a physician can perform an abortion without being guilty. Besides abortions that comply with the provisions of Section 305 (1) and (2) of the Penal Code, in cases where the woman has mental health problems or severe stress due to the fetus having or being at risk of severe disability or being or at risk of severe genetic disease, an abortion can be performed legally without the physician or the woman being guilty.
Termination of pregnancy, a “shared” responsibility often borne solely by women
In general understanding, terminating a pregnancy is not only seen as wrong in the legal dimension but also in the moral dimension. When there is news of a woman terminating a pregnancy, it is often followed by condemnation, labeling the woman as a “heartless mother,” “reckless mother,” “sinful mother”, which has become a myth controlling societal behavior. Additionally, ghost stories or karma correction programs often bring up stories of women who terminated pregnancies and were haunted by the spirits of the unborn, with moral lessons implying “abortion is a sin”.
Amidst the condemnation or moral lessons, the reasons that lead a woman to endure the physical pain during the termination of pregnancy or the emotional pain of destroying ‘a part’ of life are complex and varied. Some Thai women who choose to terminate their pregnancies share their experiences and reasons on the women on web website, which collects experiences of women who decide to terminate pregnancies using medication from around the world.
The reasons that lead these Thai women to decide to terminate their pregnancies include societal and family expectations that view pregnancy during studies as inappropriate, unprotected sexual intercourse, and many decide and undergo the termination process alone because the male partner refuses to take responsibility, such as:
“Pee” (pseudonym) shared her experience on the website, saying that her boyfriend refused to use protection during sex. After she became pregnant, her boyfriend denied responsibility and refused to acknowledge anything. “Pee,” who was studying and pressured by her family’s social status, decided to terminate the pregnancy and undergo the process alone. “I am one of the women with an unplanned pregnancy. The reason is education and the family’s social status, which is quite prominent. I couldn’t even tell my parents.”
“Ying” (pseudonym), another woman who experienced pregnancy termination, said she was raped by a friend without protection and had sex with her boyfriend while drunk. About two weeks later, she felt fatigued, dizzy, and nauseous. After buying a pregnancy test, she found out she was pregnant. Amidst confusion and abandonment by her boyfriend, she decided to terminate the pregnancy. “I didn’t know who the father was, confused about my life, and didn’t want to disappoint my parents. Ultimately, I wasn’t ready to change my life’s destiny.”
Medication abortion, an option that should be heard: For women facing unplanned pregnancies and deciding to terminate, one option that can be done at home but for their safety should be under the supervision of medical professionals is medication abortion for pregnancies less than 9 weeks.
The abortion medication is called Mifepristone and Misoprostol. Currently, there is a combined pill called Metabole, which has been registered as a core drug by the World Health Organization (WHO) and can be used safely for pregnancies less than 9 weeks. In Thailand, this drug formula was registered as MeFi-Miso in December 2014, and most recently in June 2016, MeFi-Miso was included in the core drug list (1), meaning the general public can access Mifepristone, Misoprostol, and Metabole, but it must be within special programs of ministries, departments, or government agencies that monitor and evaluate drug use. Currently, there are 85 state and private hospitals and clinics across Thailand where women seeking to terminate pregnancies can access these drugs. Generally, these drugs are not sold in pharmacies or hospitals and clinics not participating in the program.
Additionally, 1663 is a confidential hotline for unplanned pregnancy and anonymous AIDS counseling, keeping the information of those seeking advice confidential. 1663 works with the Path2Health Foundation and the AIDS Access Foundation and partners, supported by the Health Promotion Fund (HPF), providing services to women facing “unplanned pregnancy” issues. They can call for advice. In 2014, approximately 22,866 people used the counseling service, stating:
“The 1663 hotline does not support self-abortion because many people buy drugs and do it incorrectly, using too much or too little, not suitable for the gestational age, causing many consequences. Therefore, 1663 supports those with unplanned pregnancy issues to call for advice, and if they wish to terminate the pregnancy, 1663 is ready to refer them to a network of doctors we guarantee safety.”
There are two methods of pregnancy termination: using medical instruments (called vacuum aspiration) and using medication (currently, there is a combined pill called Metabole). Both methods are recognized by the World Health Organization as highly safe and successful for abortion. The use of instruments can be applied for pregnancies not exceeding 12 weeks, while medication can be used up to 24 weeks, but it is safer for pregnancies less than 9 weeks. Additionally, if the pregnancy exceeds 24 weeks, it can be terminated through a medical procedure called induction of labor.
According to 1663 criteria, the cost of medication abortion ranges from 3,900-5,000 baht. Those wishing to terminate a pregnancy must go to a safe termination location prepared by 1663. For more information, they can call the hotline, and the conversation will be kept confidential with no identity disclosure.
“The decision to terminate a pregnancy is their right because the pregnancy they have to carry for 9 months is theirs. For 1663, medically, a woman’s life is safety.” concluded a volunteer from the 1663 hotline.
However, 1663 does not propose pregnancy termination as the only option for women with unplanned pregnancies. There is still the option for women to continue the pregnancy. Therefore, during the waiting period for childbirth, essential services such as shelter and postnatal support are important. 1663 provides places for women and children to stay during and after pregnancy, with medical and nursing staff on hand. Additionally, there are childcare facilities if a woman with an unplanned pregnancy gives birth and cannot provide a quality life for the child.