This is my first article appearing in the Obstetrician and Gynecologist Association newsletter, discussing abortion.
On February 20-22, 2006, I had the opportunity to attend the evaluation meeting of the “Women’s Health Care Project on Abortion,” organized by the Department of Reproductive Health in collaboration with the Royal College of Obstetricians and Gynecologists of Thailand at Cabbages & Condoms Resort, Pattaya City.
At this conference, we discussed the good news that we obstetricians have been waiting for a long time, which is the announcement in the Royal Gazette of the Medical Council’s regulations on the criteria for medical termination of pregnancy under Section 305 of the Penal Code. This means that the heavy-hearted concerns of many can be somewhat alleviated. I must emphasize that this is only to a certain extent, as long as the attitudes or perspectives of doctors towards pregnant women facing problems and seeking to terminate their pregnancies due to any issues do not change, the Medical Council’s regulations will be of no use in preventing unsafe abortions.
At this point, it made me reflect on myself back when I was just starting to learn and train to become an obstetrician. In that context of being a student, we tried to gather knowledge from reading, practice, and following in the footsteps of our respected medical teachers, whom we wanted to emulate. I remember that at that time, I, or perhaps many others, were taught that abortion is a sin. We could only perform it in two cases according to the law, and one case according to the general medical practice of obstetricians, which is when the fetus has severe abnormalities (don’t wonder how severe, as each person may define it differently). Beyond that, we should avoid it.
At that time, there was a question: if we don’t perform it, they would probably go elsewhere for an abortion anyway. Why not just do it, since we are obstetricians and can do it better than others? Who knows the uterus better than us? The answer at that time made it clear that obstetricians are not the ones to decide for anyone whether to continue the pregnancy or have an abortion.
Pregnancy has its causes. If they don’t protect themselves, they should face the consequences of their actions. If we help them every time, it will never end. Referring them to another doctor for an abortion is like hiring someone else or borrowing someone else’s hand to do it. It’s no different from performing the abortion ourselves. Our duty is to treat any complications that arise, as a good obstetrician should. We were taught to remain indifferent (equanimity without compassion and kindness).
Many can imagine the atmosphere in the antenatal care room or gynecological examination room where doctors are asked to terminate a pregnancy when the person is not ready to have a child. Some doctors speak sarcastically, and some patients may be scolded. Many women leave in tears, not from physical pain.
Some doctors punish women who have had abortions in various ways (emphasizing that they just had an abortion), such as writing in the antenatal care book “had an abortion,” “illegal abortion,” “criminal abortion,” as if it were a proclamation for the pregnant woman to carry with her. Or imagine the atmosphere in the emergency room where consultations are held for patients who have had illegal abortions and developed complications. The doctor’s words are not sweet, and the history-taking is like Judge Bao of the Kaifeng Court. Sarcastic remarks like “You said you never had sex, so did you get pregnant by the wind?” may be made. Curettage may be done with minimal pain relief to teach a lesson. We cannot deny that we have encountered these situations to some extent.
I am a medical teacher. My practice in caring for women seeking to terminate their pregnancies is no different from during my training. The difference is that I have to teach and supervise students as one of my main tasks. Until three years ago, I started participating in the “Women’s Health Care Project on Abortion” and had the opportunity to discuss and exchange views on abortion with many senior medical professors, as well as other professors who are not doctors but are lawyers, researchers, and members of various independent organizations.
It was like a frog coming out of a coconut shell, trying to change perspectives, using intelligence, and bringing equanimity with compassion and kindness. I began to think about what those who ask doctors for an abortion think and feel, how their partners feel, who is heartbroken, and who is physically hurt.
When severe complications arise, who should share the responsibility? Many start to think that “karma is the result of actions.” That’s fine, but lately, I’ve been thinking that we are part of the responsibility. We don’t take care of our women (remember, we are obstetricians). We don’t protect them from going for illegal abortions, even though we know it can cause significant problems. Then who is left to deal with the aftermath? It’s us again. We know that treating septic abortion is clearly more exhausting.
I started to look at people with pregnancy-related problems with more empathy and understanding than satisfaction. It’s true that I don’t perform abortions and don’t want to, but I started looking for those who are willing and able to do it instead. I can talk to women seeking to terminate their pregnancies for longer, advising them on their options, whether their pregnancy ends in abortion or continues to childbirth. But if they leave my examination room with a smile, it means that equanimity with compassion and kindness has helped make both the provider and the recipient of the service satisfied.
In the context of being a medical teacher now, it is about teaching them to look at patients with empathy and understanding. In medical ethics classes on abortion, we see that our students are still hesitant to speak up or express their opinions because they fear the teacher will target those who agree with abortion.
The conclusion from attending the class (let’s call it a discussion) is that we will not perform abortions in cases… everything remains the same. Then it starts again. This time, try to have them look inward and consider if that woman were someone they know, a friend, a sibling, a relative, or even themselves, would they change their mind? Listen carefully, and you’ll find that the answers are diverse. Some say they would never perform an abortion, some would do it without conditions, and some would even ask the teacher to help. Some medical students say that there is always a double standard. That’s another thought that comes from teacher-student discussions.
Nowadays, changes are starting to be seen. Students (including medical students, interns, and residents) are beginning to have a better attitude towards patients who have had abortions or want to terminate their pregnancies. We no longer see the writing of illegal abortion history in antenatal care records. They record it as an abortion or the need for curettage instead of “criminal abortion.” They view colleagues or senior doctors who provide abortion services more positively. They know that without those providers, we would be more exhausted from dealing with abortion complications.
Thais often say that the age of 25 is a critical age, often associated with bad events or life turning points. But in the profession of obstetrics and gynecology related to abortion, my critical age is 30. Before 30, it was hatred and retribution. After 30, it is empathy and collaboration to solve problems. What doctors should do is look at problems holistically and help patients, not exacerbate them.
Source: https://www.gotoknow.org/posts/112049 by Asst. Prof. Dr. Thanapan Chubun