A choice, not a death warrant

A choice, not a death warrant

Many unaware safe abortion an option

Night spots in the Patpong area of Bangkok remain shut due to the Covid-19 pandemic. They are among businesses being allowed to conditionally reopen on July 1. (Photo by Nutthawat Wicheanbut)
Night spots in the Patpong area of Bangkok remain shut due to the Covid-19 pandemic. They are among businesses being allowed to conditionally reopen on July 1. (Photo by Nutthawat Wicheanbut)

Noi thought her world had tumbled down when she discovered she was pregnant at the age of 50.

But it has dawned on Noi, a teacher, that an unwanted pregnancy could happen to any woman, young or old. What compounds the already dire situation for many women is that they feel their only choice is to have an illegal abortion.

Noi, and many women in similar circumstances, thought they had no one to turn to for advice on pregnant women's rights and their options which include a safe termination.

The answer to the pressing issue came from the rights group called the RSA (Referral System for Safe Abortion).

The coalition network comprises doctors, nurses, care workers, pharmacists, psychologists and welfare providers from the government and private sector.

A coalition of saviours

The network of volunteers imparts advice to women with unwanted pregnancies and refers them to facilities where safe procedures are performed via methods prescribed by the Royal Thai College of the Obstetricians and Gynaecologists.

The methods involve the administration of drugs or employment of a vacuum aspiration machine which gently removes tissue from the uterus. The methods comply with the law and ethical practices mandated by the Medical Council of Thailand.

The network said it works to reduce unsafe and illegal abortions and resulting fatalities of mothers. The referral system, a collaboration of state and non-state organisations, provides an uninterrupted chain of services delivered by medical professionals.

It drives its safe abortion campaign by holding various forums on the subject. An event which galvanised the RSA has been the arrest of a doctor in the network and trained assistants who carried out an abortion in Prachuap Khiri Khan two years ago. Police suspected the procedure was illegal.

The incident rallied activists behind a push for a constitutional interpretation of Section 305 of the Criminal Code. The section exempts licensed doctors from prosecution if they performed an abortion for legitimate medical or other sound reasons -- for example, pregnancies which pose physical or mental health threats to the mother, or victims of sexual assault who are younger than 15, or where the foetuses show severe or fatal abnormalities.

The petitioner insisted the section is out of date because it protects only physicians who perform the abortions, but not other medical personnel who are part of the procedure. The Constitutional Court has ruled that Section 305 does not violate the charter, although the section was open to being rewritten.

The Choices Network Thailand (CNT) and its allies are moving to have the Criminal Code amended to give women with unwanted pregnancies wider rights to legal abortion and protect medical personnel performing the procedures from facing legal action.

The law of obstacles

CNT coordinator Krittaya Atchawanitchakun said Section 301 of the code stipulates that women can face imprisonment for up to three years or be fined up to 60,000 baht for going through with an abortion or having someone else perform the procedure.

The groups want this section scrapped, saying women are being unfairly blamed for getting pregnant.

The CNT has hammered home the level of urgency to remove the legal quagmire as the number of women with unwanted pregnancies runs into tens of thousands a year, as estimated by the National Health Security Office.

Last year, 23,259 women had legally performed abortions. Of them, about 3,000 were aged 20 or younger. The law allows abortions to be conducted if mothers suffer physical or mental health issues or have been raped.

However, the CNT and other rights groups want more issues to be recognised by law as grounds for abortion, saying women should be able to end pregnancies caused by failed contraception or if they experience economic hardship and are unable to provide sufficient care to the child. Women should also be legally allowed to abort pregnancies if foetuses display a physical disability or develop genetic disorders, they say.

Somwong Uraiwattana, deputy director of the Aids and Unwanted Pregnancies Access Foundation, said the laws were often written by people with little knowledge of the problems on the ground.

Women on the verge

The foundation has launched emergency hotlines and most callers were "confused, afraid and desperate". They needed advice on how to cope with unplanned and unwanted pregnancies.

"Some said they were waiting for delivery of abortion pills they ordered online. They wanted to know what side effects of the pill will be," he said.

Mr Somwong said many callers refused to have an abortion at the hospital fearing they would be marked on official records which would ruin their education and their job prospects. But the worst fear of all is the stigma and being shamed.

"We must stop hurtful talk like 'what kept you from using protection in the first place?' '' he said.

"It's too late for that," Mr Somwong said, adding the focus was to give these women a lift in their hour of need.

He said most callers who sought the foundation's advice were 12 weeks or less into their pregnancies, a period medically determined to be safer for having an abortion.

Mr Somwong said the foundation "is not bent on encouraging callers to end their pregnancies". In fact, it lets the women know they are not deprived of options, which include keeping the baby. The foundation offers its advice after it has listened to the women and gathered enough information about them.

Some women might need to be placed in emergency homes while their problem is being sorted out. The young women are also educated about their rights to continue their education during their pregnancies.

After consultations over the phone, 84% decided to go through with the abortion while 6% keep the baby. The rest remain undecided.

The deputy director said that while the law allows for abortions on specified grounds, some women were turned away by hospitals which also refused to refer them to other medical institutions.

"This pushed the women to illegal abortion clinics. It's like a death warrant," he said.

No age barrier

Mr Somwong said an unwanted pregnancy can also be a nightmare for women in their advanced years.

Noi said she had rarely been intimate with her husband who had been sickly for 10 years. As her menstrual cycles were few and far between, Noi thought she was not likely to conceive.

But after a night of unprotected sex with her husband, she became pregnant. She was worried her husband, a senior educational administrator, who was old and suffering from chronic illnesses, would not be around much longer to help her raise the child.

"I'm depressed," Noi, who ended up terminating her pregnancy, said."I never understood why some women wanted to get an abortion. Now I do."

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