Safe abortion is a basic healthcare service and an important enabling factor for Thailand to achieve the UN Sustainable Development Goals (SDGs). Under Target 3.1 of Goal 3 (ensure healthy lives and promote well-being for all at all ages), a two-thirds reduction in maternal mortality -- in which unsafe abortion is a leading cause -- is called for by 2030. And this is directly under the mandate of the Ministry of Public Health (MOPH) to deliver.
While Thailand has legalised abortions up to the 20th week of pregnancy in 2021, women still face an information deficit, social stigma, and lack of access to safe abortion services. In recognition of the International Safe Abortion Day last week, I would like to speak out as a woman and a member of parliament.
From the consultation with TamTang, a safe abortion advocacy group, I was advised that most people do not know that the National Health Security Office (NHSO) has provided an abortion subsidy for every Thai citizen since 2016, or that abortion is now legal. Those who are informed reportedly encounter acute stigmatisation, shaming, and discrimination for being pregnant, often alluding to promiscuity. This often occurs in public healthcare facilities, which, at times, leads to women being rejected from receiving abortion services or being transferred to facilities that are willing to provide the services.
Such discrimination is attributable to the fact that some public health professionals, from top to bottom, in deciding whether to provide abortion services, subjectively base their judgement on religious belief and personal bias rather than professional ethics and scientific facts.
Second, there is an inadequacy of public health institutions that provide safe abortion services. From 2021 to 2023, there has been a meagre, almost negligible, increase in facilities that supply the service. In some provinces, most are private clinics or hospitals that are not part of the NHSO, hence ruling out access to the abortion subsidy. In Bangkok, for example, there are no healthcare facilities registered under the NHSO that provide abortion services. Zero. None. This is a tragedy because, per the MOPH's 1663 hotline statistics, Bangkok has the highest demand in the country requesting access to abortion services.
These factors have negative impacts on women's reproductive health. The more time they have to spend on finding information or healthcare facilities to receive the services, the more advanced the stage of their pregnancy, which may increase medical complications. On top of this, additional costs may apply as some may have to travel to different provinces far from their workplace or hometown to access abortion services.
Below are possible actions that the current administration can take to alleviate the situation.
Institutionalise safe abortion services in the country's public health system through the Royal College of Obstetricians and Gynecologists, which can set up professional thresholds per international standards on providing the services. Note that those who perform the services need not be limited to gynaecologists. Nurses and general practitioners should be allowed to step in and perform the task so as to lessen the workload.
Issue circular notices through public health institutions that are under the supervision of the MOPH. This is to enforce the latest amendments to the Penal Code, which legalise abortion and inform health professionals that refusal to provide safe abortion based on personal judgment outside professional standards may be considered a dereliction of duty.
Last but not least, promote safe abortion through the use of telemedicine for up to the 12th week of pregnancy. This is to save costs and reduce the time women have to travel in order to access the services, as they can receive the medications through the postal service or at the sub-district healthcare facilities.
Ensuring women's access to safe and legal abortion will not merely improve their reproductive health. It is also an enhancement of gender equality -- women's autonomy and capacity to make independent and informed decisions over their sexuality and reproduction.
MD Kalyapat Rachitroj is a member of parliament of the Move Forward Party (MFP).