Safe abortions are available, did you know?

Which is the best solution to address teenage pregnancy? (O-net exam 2010 Health and Physical Education)

1. Take a break from school to give birth (go to option A)
2. Have an abortion because you can’t raise the child (go to option B)
3. Drop out of school and find a job for the child (go to the score at the National Institute of Educational Testing Service)
4. Report to find someone responsible (go to the police station)

A What happens after taking a break from school?

Did you know that Narakorn Laihrang, the director of Triam Udom Suksa Pattanakarn Nonthaburi School, stated that over 90% of female students who take a break from school to give birth never return to school, or if they do, they don’t stay long and have to transfer due to embarrassment. However, most female students who have had an abortion have a better chance of returning to their normal lives than those who drop out to give birth.

B How to have an abortion

B1 Go to a hospital or clinic for a doctor to perform an abortion
B2 Buy pills online

B1 Go to a hospital or clinic
Did you know that nowadays, doctors no longer perform abortions using curettage tools like in the sex education videos we watched in high school? Instead, they use an MVA machine or Manual Vacuum Aspiration, which is specifically designed for this purpose and is certainly safer than using metal instruments for curettage.

However, after treatment with the MVA method, women must immediately take birth control pills and should take antibiotics such as doxycycline or metronidazole alongside the MVA abortion.

The MVA abortion method is usually used during 12-14 weeks of pregnancy or according to the practitioner’s expertise. If the pregnancy is over 12 weeks, services must be sought at a hospital only.

Currently, some doctors provide abortion services using mifepristone and misoprostol pills because it is convenient and safe, without affecting future fertility (for more information on the pills, go to option B1.1).

When seeking services at a hospital or clinic, doctors will perform the procedure if the woman meets the following conditions:
1. The pregnancy adversely affects the physical health of the pregnant woman
2. The pregnancy adversely affects the mental health of the pregnant woman
3. The fetus is severely deformed
4. The pregnancy resulted from rape
5. The pregnancy resulted from coercion, threats
6. The pregnant woman is under 15 years old, even if she consented to sexual intercourse

Information referenced from:
Volunteer Medical and Nursing Network (Referral system for Safe Abortion: RSA)

Q: If an 18-year-old woman has intercourse with her boyfriend and becomes unintentionally pregnant, with a pregnancy of about 12 weeks, and she is in the process of university entrance exams, feeling that being pregnant during school is a major obstacle in life, can she walk into the gynecology department and ask the doctor to perform an abortion for her?

A: It is possible, as the doctor will diagnose according to the criteria of the Department of Mental Health that the patient is depressed and does not want to be pregnant, or this pregnancy may adversely affect mental health (according to condition 2).

However, the main problem that prevents safe abortion in hospitals or clinics is that doctors often refuse to perform abortions for patients because they are ‘afraid of sin.’

B1.1 What are the pills, and are they safe?
Dr. Sanya Patrachai from the Department of Obstetrics and Gynecology, Ramathibodi Hospital, stated that this pill is a hormone-stimulating drug similar to birth control pills, with the same potency, also known as a menstrual regulation pill. After use, women will have their period as usual in the following month.

Reports from around the world indicate that this pill is safe and is on the World Health Organization’s essential medicines list. It was registered in Thailand in December 2014, but the Food and Drug Administration (FDA) requires the Department of Health to control the distribution of the drug and classify it as a special controlled drug, meaning it is not available for sale in general pharmacies. If someone requests this drug, the doctor must write a detailed report of the drug distribution to the Department of Health.

In addition to obtaining this drug from a doctor at Ramathibodi Hospital, if you are not convenient to receive services there, there is another option to access safe abortion pills from abroad (go to option B2).

Herbal medicine does not help terminate pregnancy!
The Women on Web team, an organization providing medical services and supporting abortion rights, stated that no research has been found discussing the successful use of herbal medicine for abortion. However, many women who used herbal medicine to terminate a pregnancy were unsuccessful and came to request mifepristone and misoprostol pills, with some taking 3-4 bottles of herbal medicine without success.

How to use the pills effectively
Initially, women wishing to terminate a pregnancy will receive two types of pills: one 200 mg mifepristone tablet and 4-6 200 mcg misoprostol tablets. When taking the pills, a long sanitary pad should be used.

If after taking the pills, there are still symptoms similar to being pregnant or no vaginal bleeding, it may be that the abortion was unsuccessful. A gynecologist should be consulted for an MVA, or if there is excessive bleeding (filling two long sanitary pads), a gynecologist should also be consulted.

For pregnancies less than 10 weeks
1) Take one mifepristone tablet
2) Wait 24-48 hours
3) Place 4 misoprostol tablets under the tongue or in the cheek pouch, or insert them into the vagina at once

For pregnancies 10-24 weeks
1) Take one mifepristone tablet
2) Wait 36-48 hours
3) Insert 4 misoprostol tablets into the vagina
*4) If not yet aborted, place 2 misoprostol tablets under the tongue, using this method no more than 5 times

Warning: For pregnancies 12 weeks or more, complications may occur. It is advisable to be under medical supervision while using the pills. If you have financial problems and cannot go to the hospital, the hotline 1663 can assist you.

Side effects of the pills
Using misoprostol by placing it under the tongue has more side effects than using it vaginally, which may cause fever, chills, abdominal pain, vomiting, and diarrhea, but not severe enough to prevent self-care.

Who should not use the pills
1. Chronic adrenal gland failure
2. Allergic or sensitive to mifepristone and misoprostol
3. Allergic to prostaglandins
4. Severe asthma
5. Inherited porphyria
6. Ectopic pregnancy

B2 Buy pills online
Did you know that even though we see many news reports about illegal abortion pill websites being shut down, we do not deny this fact, but currently, there are legal and safe abortion pill websites, such as Women On Web (womenonweb.org).

Where did this website come from?
Women On Web is a non-profit organization from the Netherlands that collaborates with various countries to provide telemedicine services, with the main objective of helping women in countries where abortion is difficult to access, allowing women to terminate pregnancies safely. This website has been operating for 10 years and also disseminates knowledge and research related to abortion.

Requesting pills is easy by filling out a mental health and depression test, which is a set of questions similar to those patients answer when seeking an abortion at a hospital. Once the test is completed, the medical team from the Western Hemisphere will diagnose and provide mifepristone and misoprostol pills to the woman, sending them by mail.

Is using pills from abroad illegal?
Although in some countries mifepristone is not yet registered, many countries allow the receipt of the drug for personal use. Therefore, possessing a small amount of this drug is not illegal, and the organization only requests a donation of 70-90 euros. The pills distributed by Women On Web are manufactured in India, where abortion is a woman’s right, and are standard export-quality pills.

Conditions for service recipients
Not seriously ill or allergic to mifepristone and misoprostol (refer back to option B1.2) and pregnancy not exceeding 9 weeks. If possible, a pregnancy test or ultrasound should be performed to confirm, and of course, the medical team will keep the pregnancy age and treatment information confidential. For safety, service users should be near a hospital or clinic that can be reached within an hour.

How to know who ordered the pills
All doctors who prescribe the pills have a medical license. Every package sent to the service recipient will have a prescription with the doctor’s name attached. If the women who receive the service want to consult the prescribing doctor directly, they can do so, with a helpdesk acting as an interpreter to communicate and explain information.

What to do if you don’t understand how to use the pills
Pills from Women on Web will be sent in a small white envelope, with the pills wrapped in bubble wrap. If the label is not understood, a photo can be taken and inquired about on the website.

How long to wait after ordering the pills
Approximately 5-10 days, with the Women on Web team processing after receiving donation confirmation and sending the package out of the country in about 3-5 days.

Can I request the pills a second time?
The organization states that they are willing to provide pills to repeat service users because they are a medical service organization and should not judge service users. They understand that no contraceptive method is 100% effective, but if the request is made within a short period, there may be questions about whether contraception was used, and contraceptive methods may be recommended.

Additionally, the website provides answers and advice on various issues, such as what to do if the recipient has Rh- blood or if the pills were not taken in full doses, as well as sharing stories from women in other countries.

Abortion is a right, not a sin

Auyaporn Khueankaeo, a representative from the Women’s Center for Peace and Justice, expressed opinions on the discourse of abortion in Buddhist society. She analyzed this issue according to the Four Noble Truths, stating that the reason these women choose to have an abortion is not because it is an option in life, but because they are forced to choose. These women know well that this suffering is severe, and they cannot raise the child.

With the values that Thai society does not teach men to use contraception, when men do not take responsibility, the suffering falls on women. These women have to find a way to solve the problem alone, without any system in society to help. They are stigmatized from the moment they become pregnant and are not responsible, pushed out of school, and when they go to the hospital, the hospital may not support them and may stigmatize them further, and they may also be pushed away by family members.

The Buddha would say that destroying life and harming is a sin, meaning that from the moment a man makes a woman pregnant and does not take responsibility, he is harming, and this man is already sinful. The school system that pushes this child out and does not support them during pregnancy is sinful. The family that pushes them away is also sinful because sin is harming and not supporting. Therefore, all of us who stigmatize these women are harming them mentally and spiritually, and that is also sinful.

Auyaporn believes that stigmatizing these women as heartless or sinful mothers is stigmatizing behavior, which does not bring intellectual understanding to empathize with the suffering of women.

One reality in life that we must accept is that everyone has different life resources, different choices, or some may have none at all. Another set of sex education knowledge that has been blocked in society for a long time is finding solutions when there is an unwanted pregnancy. Everyone knows that a pregnancy that cannot be responsibly handled is undesirable. Almost every Thai textbook teaches not to be premature, but few books say what to do when the problem arises to minimize the impact on the body and mind.

Because of the sincere belief that every woman has the right to manage her own life and deserves to live under safety to live a quality life.

Abortion is not easy, and what many women who decide to have an abortion lose may not just be the child in the womb, but they also lose their morale and self-worth. Therefore, what we should be aware of is the knowledge and understanding from another perspective that we may not have received from sex education classes when we were students.

Information referenced from:

Guidelines for Termination of Pregnancy to Prevent Unsafe Abortion by the Royal Thai College of Obstetricians and Gynecologists (rtcog.or.th) womenonweb.org
Discussion ‘Talking about Abortion: New Thoughts, New Perspectives’