July 25, 2000
The chance to choose Women experiencing an unplanned pregnancy need information and choices, not simply abortions. But prejudice, double standards and a lack of empathy prevent them from getting help Stories By SANITSUDA EKACHAI Woman experiencing an unplanned pregnancy suffer silently because of the social stigma and gender double standards. --Picture by Somkid Chaijitvanit It's a chilling question for most parents: What to do if your teenaged daughter becomes pregnant. Get her an abortion right away? But where to get one safely without entailing a legal risk since abortion is illegal? And how to deal with that nagging guilt that might remain for a lifetime? Keep the baby and put it up for adoption? But wouldn't letting her continue her pregnancy disrupt her schooling and damage her future? Wouldn't leaving school in mid-term make her friends suspicious and start gossip which could make her an outcast? And where on earth to get information about adoption services? What would people think if you began to ask around? How do you receive advice while ensuring privacy and confidentiality? Even if you want to raise the baby yourself, the question remains: How do you deal with that man who destroyed your girl's future? Have the police arrest him and risk a public scandal? Separate them? Force them to tie the knot? Abortion is an emotionally-charged, divisive issue, but there is one sure way to get beyond the moral high ground: to imagine our daughters, or even ourselves, in the distressed woman's shoes. When unplanned pregnancy becomes "our" problem, we immediately enter an emotionally turbulent domain where abortion ceases to be a black-and-white moral or legal issue, and rather a difficult, private choice. "Only then do we understand the silent suffering of women who are struggling with unplanned pregnancies, and how they want society to look at abortion with openness and honesty, with empathy, and to provide more choices," said Assoc Prof Dr Krittaya Artvanichkul, a prominent advocate of women's reproductive rights. Dr Krittaya was talking to a 600-strong audience, the biggest conference on abortion in Thailand since the pro-choice campaign's failure to amend the rigid Abortion Bill 20 years ago.The issue has been on the back burner ever since. A legal amendment was not the main thrust of the advocacy groups' latest effort to put abortion back on the public agenda, however. As they see it, pushing for legislative change is a futile effort when most politicians avoid this explosive issue like the plague. Besides, legislative success by no means guarantees effective legal enforcement. For example, rape victims and mothers whose pregnancies endanger their health can have legal abortions. But even when the rape victim has gone through the difficult legal procedures to get the necessary documents for a legal abortion, many doctors still refuse, or wait too long until it is not possible to have the abortion. Many advocacy groups believe that pushing for legal change will lead nowhere when public understanding is still governed by gender prejudice and high-minded morality. Legal debates tend to narrow a women's choices to either having an abortion or not, thus preventing society from exploring choices other than terminating the pregnancy. "One of the ways in which to demystify abortion is to present an overall picture of an unplanned pregnancy from the woman's point of view," said Dr Krittaya. Such an approach, she added, helps identify the diverse problems women are facing, many of which could be addressed without having to first amend the Abortion Bill. Aside from legal rigidity, problems which women face include religious beliefs, the irresponsibility of the male partner, social stigma, lack of access to health services, poverty, gender prejudice, sexual inequality, sexist regulations, and simply a lack of information. Their problems are a combination of various factors, said Dr Krittaya. "That makes one unplanned pregnancy different from another because each woman's situation is not the same. "We need, then, information from the woman's perspective so we can design services that meet the different needs of women in pregnancy distress. Unfortunately, this information does not exist in Thailand," she said. Most research on abortion in Thailand is conducted from the point of view of professionals as to how the situation should be handled, but none from the distressed woman's point of view as to what she needs and desires. The Population Council, a women's reproductive rights advocacy group, wants to fill the gap. The council conducted in-depth interviews with 77 women experiencing unplanned pregnancies, capturing the often moving testimonies of women struggling to decide what to do. Activists hope these testimonies will open hearts and help debunk the myth that the problem stems from careless sex among young, single women. In line with previous abortion findings, nearly half the women interviewed were married or lived with their partner. Teenagers comprised only 19 percent of the group. "Why are they pregnant? Why didn't they take precautions when there are so many birth control methods available? These are the standard questions used to put the blame on women," said Natthaya Boonpakdee, a researcher for the Population Council. The accounts show that among wives, failed sterilisations were a significant factor in unplanned pregnancies. Another was the serious side effects women may suffer from contraceptive pills and injections, which force women to resort to riskier, natural birth control methods because husbands refuse to use condoms or undergo sterilisation. "Unequal gender relations in our culture is an important factor," Natthaya said. For single women, the gender socialisation that says good girls must be sexually ignorant lends itself to sexual exploitation. Many pregnancies result from a single woman's first, unprotected sexual experience. Fear of being found out by families often prevents a young woman from using pills. Fear of being seen as sexually assertive also prevents her from insisting her partner use protection. For many women, pregnancy is the result of rape. All want abortions, but not all can have them. Whatever the cause, it can be deeply troubling and worrisome when a woman realises she is pregnant. Some women become suicidal. Fear of disgrace, the partner's irresponsibility, financial hardship, an unreadiness for mothering and poor health are among the more pressing concerns. But the women's testimonies also show that moral support can greatly reduce the stress of an unplanned pregnancy and influence the ultimate decision. Contrary to myth, apart from rape cases, not all women want to end their pregnancies. But all want early counselling, understanding, the assurance of confidentiality, and information on the services available before it is too late. "Thai society is against abortion on moral grounds but it does not provide enough services to prevent it," said Kanokwan Tharawan of the Population Council. "Some women need temporary foster care for their babies. Others want to put their babies up for adoption, but they don't know how to go about doing it."The women's accounts, said Natthaya, have important policy implications. They underscore the need, for example, to set up hotlines, and to offer counselling and services for women in distress, as well as the need to expand foster care and adoption services at the community level. "They want information, the pros and cons about each choice. They want sensitivity from professionals, and respect for their right to make their own choice," she said. The women who choose to end their pregnancies want the services to be safe and affordable. They also want a physical check-up afterward and psychological counselling as part of the healing process. Those who do not want an abortion say they desire better state assistance for struggling single mothers, including nursery and work-related aid, as well as more widespread adoption and foster care services. At present, these are available only in Bangkok and a few of the larger cities. They also want birth control services to be more easily accessible, particularly for singles and teenagers. Advocacy groups are also urging schools and universities to abolish regulations that allow only single girls to study. Many young girls choose abortion because they fear the social stigma of being "unchaste" and the public embarrassment of being discharged from their schools. "It's barbarian to discriminate on marital status," said Mechai Viravaidya, world-renowned family planning expert. Other bureaucratic and welfare regulations that indirectly force women with unplanned pregnancies to seek abortion must also change, say reproductive rights groups. For example, the social welfare scheme allows married mothers to receive childbirth benefits for two children, but unwed mothers may not be able to receive these benefits. The bureaucracy also frowns on unwed pregnancies, forcing unwed mothers to seek abortions. But as much as reproductive rights activists want to avoid the legal aspects of the problem, the need to amend the Abortion Bill keeps cropping up in their assessment of the situation. To start with, both women who seek abortions and the doctors who provide them are considered criminals by law. They are subject to a three-year imprisonment and/or a 20,000-baht fine. It is estimated that upwards of 300,000 women each year seek an abortion. Though no one can be sure of the accuracy of this figure, it still demonstrates the great demand. But the illegality of the services has effectively discouraged many doctors while jacking up prices. "Women with unplanned pregnancies suffer greatly. They need help. They are not criminals. The law must be amended accordingly," Mechai said. The conditions for a legal abortion must also be expanded to cover pregnancies that result from birth control failure and those in which the health of the foetus is at risk, advocacy groups say. Change must also address HIV-positive mothers, numbering about 20,000 a year, to have a legal choice should they opt for abortion. Strictly speaking, abortion for an HIV-positive mother is unlawful. In practice, everyone looked the other way when health care policy-makers first encouraged abortion in these cases. They no longer do so. Now, should HIV-positive mothers seek an abortion, they face both health and legal risks. "The choices for women with unplanned pregnancies are almost always determined by others. They are robbed of the right to make independent and well-informed decisions themselves," Kanokwan of the Population Council said. Health professionals, she urged, must get training to have more respect for their patients and to rid themselves of cultural prejudice against women experiencing unplanned pregnancies. Should pro-choice activists change their mind to pursue legal amendments, they should look at what other countries have done, Mechai said. Around the world, 193 countries allow abortion when it is necessary to save a mother's life; 189 to protect a mother's physical health; 120 to protect a woman's psychological health; 83 when pregnancy results from rape or incest; 67 when the foetus is deformed; 63 for economic or social reasons; and 32 when a mother requests it-but only during the early stages of the pregnancy. "We need to look into the framework of the abortion law and give women more choices," Mechai said. Together with precautionary measures to reduce unplanned pregnancies, society must look into the gender double standard that burdens women with social stigma should they veer from the "good girl" mould. More often than not, abortion is a painful decision, said Mechai. "Our society must learn to be more sympathetic with women experiencing an unplanned pregnancy. It is not for us to pass judgement. Change might come more easily when we consider that it might be our own daughter who needs help.		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