Abortion remains a stigma in Thailand

BANGKOK, 17 Feb 2023:

Two years after Thailand joined a small group of Southeast Asian countries in legalising abortion, ending an unwanted pregnancy remains taboo in the Buddhist-majority nation – due to factors such as religious dogmas and lack of medical guidance.

In February 2021, Thailand legalised abortion up to 12 weeks gestation, and in September last year it extended the term to 20 weeks. However, access to abortion is still a challenge amid the scarcity of specialised help and the refusal of medical professionals to perform procedures due to personal beliefs.

“Religion plays a very important role since many doctors and health workers believe it’s a sin that can interfere in their karma,” says Choices Network Thailand NGO coordinator Kritaya Archavanitkul, who has been a women’s rights activist for three decades.

Every year in Thailand, an estimated 300,000 women undergo an abortion, many through clandestine arrangements due to difficulty accessing the procedure through legal channels – according to data from the Referral System for Safe Abortion (RSA), an independent association recognised by the Ministry of Health.

RSA estimates that about 30,000 of these cases end in injury or death to women.

Thus, the 2021 law, with which Thailand joins other Southeast Asian countries that allow the elective termination of pregnancy – such as Vietnam, Cambodia and Singapore – is considered an important framework for the rights of women in the region.

“This is quite a progressive law for upholding women’s rights … because it means to open the opportunity to a woman to choose for her own body whether she is pregnant,” says Kritaya.

However, she points out that, despite the regulations, little has changed in practice since “despite of the law, getting an abortion is still considered an underground activity,” in the midst of the moral, social and legal obstacles that prevail in society.

“In principle, she can walk into a public hospital and ask for pills and medical help for free,” she says, but in practice “most hospitals would say they don’t offer this kind of service.”

Today, Thailand has about 100 clinics or hospitals, most of them public but some private, that perform terminations, distributed across 38 of the 77 provinces of the country – covering less than half of the country.

Added to the scarcity of centres that perform the procedure are difficulties such as the fact that some are limited to providing assistance only to local residents, leaving women living in provinces that lack the service without options, says Kritaya.

In the absence of official medical support, many resort to unsafe practices, such as clandestine abortions and use of pills bought online, or have to pay a lot of money – sometimes beyond their means – to have the procedure.

This is the case of 19-year-old BM, who travelled with her boyfriend to seek an abortion at a private clinic in Bangkok after her request was denied at three health centres in her eastern province.

On condition of anonymity, BM said in the last nine weeks she has been living a “nightmare” because, in addition to hiding the pregnancy from her family, who are “all very traditional and would never understand it,” she did not know if he would be able to raise the funds needed for the trip and the procedure in Bangkok.

The cost of terminating a pregnancy in a private centre in the Thai capital is around 5,000 baht (about US$150), although the figure can go up to 20,000 baht, depending on how advanced the pregnancy is.

“I was running out of time and of options. So I met some friends, they gave me the money and we could come, but I still don’t know how I’m going to pay it back,” says BM.

The young woman says that she came to the clinic, located a few meters from the busy downtown commercial district of Asok, thanks to the advice of an acquaintance, because “nobody talks about it, but this is like an open secret.”

It is a maxim repeated even among doctors and health professionals, since it is not unusual for them to provide assistance about the practice in a veiled manner.

“There are some private hospitals that offer it but they don’t want to go public – they don’t want to be known as ‘the abortion hospital,’” Kritaya says.

A gynaecologist from Bangkok’s renowned private Bumrungrad International Hospital, who asked to remain anonymous, acknowledged that, despite the fact it is a right recognised by law, many professionals still refuse to perform abortions for fear of tarnishing their reputation.

“My patients always ask for my help and orientation, so even though I don’t perform it myself, I always end up telling them where they can go and seek help,” she says.

But despite the difficulties that remain, Thailand is beginning to see a paradigm shift, thanks to the creation of telephone and internet services to help women, increased awareness, and new generations of professionals more willing to carry out the procedure.

“It’s changing the stigma, but quite slowly,” Kritaya says, as she notes the number of doctors and centres offering the service are increasing, along with a change in mentality as many come to understand they are helping women.