Thai abortions: stigma, ignorance, and arbitrary rules cause policy to fall short in practice

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When two blue lines appeared on a pregnancy test in April 2021, K* knew that she and her partner were not ready for a baby and that she was entitled to a choice.

But in a consultation room at Sakon Nakhon Hospital, the university student recalls how a nurse pushed the ultrasound probe so hard into her abdomen it hurt. She says the doctor berated her decision to abort, complaining that women like her faced a lack of consequences for their actions, before threatening to tell her professors. His words reduced her to tears. “Then, on my way out, the nurse turned to me and said, ‘You’re just afraid of getting fat and ruining your figure, aren’t you?’” says K. “Even when I think about it now, my voice starts to shake.”

Abortion within 12 weeks of gestation might have been legalised with little fanfare in late-January 2021, but terminating a pregnancy in this Buddhist-majority country is still taboo. Many believe in karma and that those who choose to undergo abortions – including those who help them – are committing an immoral sin

But for pro-choice activists like Supecha Baotip, the Thai medical community’s resistance is a symptom of a much larger problem. “Imagine that anti-abortion attitudes are like a tent,” she says, “There are many poles that hold up a tent, but the tallest pole is the government in the middle. If you take out the middle pole, the others will lose stability too. By not vocally standing by the abortion law, the government continues to imply that abortion is not right.”

Ignorance of the law

While a government spokesperson was reported to have given assurances about plans to advertise the new rules over a year ago, progress has been slow. Volunteer pro-abortion advocacy group Tamtang has been particularly critical about how little both state and medical professionals have communicated the change in the law to the public, and lack of clarity around where patients can go, what options they might have, or the abortion referral system.

The moment L*, a half-Thai woman living in Bangkok, realized she was unintentionally pregnant in February 2022, she reached out to Bumrungrad Hospital via the social messaging app Line to ask if they provided abortion services. Bumrungrad was recently ranked as the top hospital in Thailand for the second year running, yet L was misinformed that abortion in Thailand was still illegal unless there is a “medical emergency where the mother’s life is at risk.” When she told them that the law had in fact changed, L received no further response.

Without clear and consistent communication, medical staff ignorance risks patients’ health. Women and pregnant people may resort to underground practices such as seeking out abortion pills on the internet, undergoing abortion procedures with unlicensed practitioners, or attempting to induce abortion themselves. While there are no clear numbers for exactly how many abortions are performed in Thailand each year, the mortality rate for unsafe abortions is estimated to be 300 times higher than safe abortions.

Stigma influences quality of service

After many frustrating hours of online research, L* decided to go to Planned Parenthood’s Bangkok branch. “When I walked in, the staff were shouting at a some Burmese women who were trying to get an abortion. And they were nasty… They were making fun of one of them because she couldn’t understand Thai,” says L. 

She described how a nurse showed her the fetus on an ultrasound but who then refused to provide her with the medical abortion pill. She says the nurse claimed that the fetus was ‘too small’, and instructed L to wait another week. “Obviously I panicked,” says L. “I have a scientific background and I know you should abort as early as possible.” She also felt staff were pushing her towards getting the vacuum procedure (also known as ‘surgical abortion’) despite her repeatedly saying she was uncomfortable with this option.

When asked about their quality of service, Warunee Tungsiri, Deputy Executive Director of Northeast Region Office and Manager of Khonkaen Clinic at Planned Parenthood said, “We serve and accept women regardless of their social background… Staff at Planned Parenthood have annual Quality of Care training which provides them with guidance on how to communicate with clients, and how to understand and accept whatever the woman decides to do.” 

In February 2021, E* began experiencing complications with her medical abortion. She became anxious about how much blood she was losing and went to the emergency department at Bhumibol Adulyadej Hospital in Sai Mai District, Bangkok, Thailand. As a Belgian national, E does not speak Thai. She describes being instructed to sit on a chair with stirrups before medical staff began scooping biological matter out of her. “Nobody seemed to care and ask me how I was, and they gave no information about what was happening… [I was thinking] is there something bad inside of me? Is there something ripped out? Am I having a hemorrhage? Am I going to die? But they didn’t tell me anything that was going on.” E says the experience has left her traumatized. 

Arbitrary rules

Unwilling to wait another week, L decided to visit Khlongtun Hospital in central Bangkok instead. Here, she says she was told that she needed her partner present to provide mutual consent, and that she could only receive the abortion pill if she stayed overnight in a hospital room, costing around 20,000 baht. After arguing that she was within her rights to make a decision without a partner present and to abort at home, staff finally provided her with the medication and let her go.

The rules around abortion are split into two Articles (301 and 305), which together list criteria in which abortion will not be criminalised, such as if the fetus faces a significant risk of developing physical or mental disorder or disability, or if the a woman is impregnated due to rape. A representative from the Association of the Thai Referral System for Safe Abortion (RSA Thailand) told Thai Enquirer that abortion service providers are able to cherry-pick which criteria from these Articles they feel ethically comfortable with. For example, some hospitals might only wish to support survivors of rape. Unlike any other medically necessary procedure, Thai doctors are also able to refuse to conduct abortions on moral grounds, as long as they refer patients to another provider.

While there is a state-issued Standards of Practice for Safe Termination by the Ministry of Public Health, this guideline provides clinical recommendations which are not legally binding. This means service providers can enforce their own arbitrary criteria, creating unnecessary barriers to access. Tamtang has heard cases in which hospitals have demanded that patients under 20 be accompanied by a parent or guardian, for example, even though patients over 15 years of age are legally able to access reproductive information and services without parental consent. RSA Thailand reported that some hospitals only provide abortions for gestation up to 8 weeks, even though the law permits a 12 week limit.

Supecha Baotip described knowing of women uncomfortable with visiting their primary care provider, only to be refused care at other government hospitals. These hospitals claimed that the state would only subsidize treatment for patients registered within their provincial jurisdiction. The reality is that the government provides a 3000 baht subsidy for every patient supported by abortion service-providers, irrespective of where that patient might live. 

Patients may need to resort to seeking out private facilities, or have to travel to other provinces to try their luck at another hospital which can be costly both in terms of time and money. Bangkok is yet to have a single state-run abortion service provider. With places like Planned Parenthood quoting around 5,000 baht for medical abortions, many women in the capital and beyond are effectively priced out of options.

The implications on women’s rights 

In place of government support, civil society organizations like the unplanned pregnancy helpline 1663 and Facebook groups such as those run by Tamtang are providing Thais with advice and direction, but patients need to be prepared to advocate for themselves. 

K had thought that as the biggest RSA Thailand-listed hospital in her province, the quality of service she would receive at Sakon Nakhon Hospital would be high. An RSA Thailand representative said that the list published on their website includes affordable private or NGO abortion providers who are part of RSA’s information-sharing network, but this ultimately doesn’t guarantee an experience free from stigma. They noted that many state-run hospitals refuse to be listed or to advertise that they offer abortion services due to fears of backlash from their own staff as well as the public. There is currently no government-issued list of all safe abortion providers in Thailand.

Despite waiting all day, K was finally informed that the hospital had run out of the abortion medication. RSA Thailand says the pandemic has caused a shortage of the abortion drug Medabon, and that the approval of an alternative, Misomifi-Fem Combo, is being held up by government pro-lifers. In the end, 1663 recommended another doctor in K’s area who she contacted on Line. After providing a copy of her Thai ID card and ultrasound scan, the medication arrived in the mail two days later.

But for women who are dissuaded from aborting and who decide to raise the child themselves, their babies are often born into socio-economic difficulties. UNFPA warns that unintended pregnancies trap millions of people across the world in “a cycle of hardship and missed opportunity that ripples through generations.” 

Unless the Thai government takes greater ownership over the law amendment, organisations like Tamtang fear attitudes towards abortion will continue to affect not only the quality of gynecological services but wider progress on women’s rights too. Baotip is particularly concerned by the U.S. Supreme Court decision to overturn Roe v. Wade. “Thai people look to the U.S., so this ruling influences public perception,” she warns.

The doctor’s harsh words may have stayed with her to this day, but K stands firmly behind her decision. “We weren’t ready,” she says. “If we had had no choice but to go through with the pregnancy, what would that have meant for mine and my partner’s future, and therefore the future of our child?”
*source has requested anonymity

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