Abortion access remains difficult two years after legalization

Two years after Thailand passed an amendment to the Criminal Code legalising abortion up to the 12th week of pregnancy, access to services remains difficult due to lack of information and facility and prejudice from medical personnel, while the Ministry of Public Health has refused to cover abortion fees for people not covered by the “Gold Card” universal healthcare scheme.

Activists gathering at the Ministry of Public Health on 7 February holding placards calling for access to safe abortion performed by medical professionals

In 2021, the Thai parliament passed an amendment to Sections 301 – 305 of the Criminal Code to allow abortion up to the 12th week of pregnancy as long as the pregnant person wishes to terminate the pregnancy.

Abortion is also allowed under certain circumstances, such as for the sake of the pregnant person’s health, if the foetus is at risk of severe disability once born, or if the pregnancy is a result of sexual assault. Anyone seeking an abortion after the 12th week but before the 20th week of pregnancy are also required to go through an examination and counselling process before they can terminate the pregnancy.

However, the new law does not completely decriminalize abortion, as abortion after the 12th week of pregnancy and outside of the outlined circumstances still carries a prison sentence of up to 6 months or a fine of up to 10,000 baht, or both, despite demands from civil society for the repeal of Section 301 in order for abortion to no longer be a criminal offense.  

Activists gathering at the Ministry of Public Health on 7 February perform a Buddhist merit-making ceremony in memory of those who died from unsafe abortions.

On 7 February, the 2nd anniversary of the new law’s implementation, abortion right activists and civil society workers, including members of the Tamtang Group and Choices Network Thailand, gathered at the Ministry of Public Health to demand that the authorities ensure access to safe abortion.

They also performed a Buddhist merit-making ceremony in memory of those who died from unsafe abortions, and another symbolic ceremony in which water is poured on the ground to cut ties with Public Health Minister Anutin Charnvirakul and condemn him to never having a successful political career after he signed an order preventing the National Health Security Office (NHSO) from covering abortion fees for people not under the NHSO’s Universal Healthcare Scheme, or “Gold Card,” such as those covered by the Social Security Scheme or by government employee benefits.

Sulaiporn Chonvilai, a Tamtang Group researcher, said that it has been two years since the Criminal Code was amended to allow abortion up to the 12th week of pregnancy, but many people still don’t know that abortion is now legal or where to go if they need one.

Sulaiporn said that the Ministry of Public Health has yet to release a list of medical facilities providing safe and legal abortion, especially public hospitals. Meanwhile, the number of abortion facilities remains the same, even though there should be more so that people can access services without needing to travel.

“The law has actually been amended. It looks like there is progress, but in practice, that is not the case,” Sulaiporn said.

Sulaiporn Chonvilai

Sulaiporn said that abortion can now be done safely and no one should die from an unsafe abortion, but because the service remains largely inaccessible even after the law has been amended, many resort to buying illegal abortion pills, leading to injuries and death.

When asked if there is information on how many people have died from botched abortions, Sulaiporn said that there are no statistics on how many people have had an abortion in Thailand and how many have died from seeking illegal abortions. She said that only one survey has ever been conducted on the number of abortions in the country and that was done in 1999. The authorities now collect information from one hospital per each health provider region, which does not cover all cases.

Sulaiporn also noted that it is difficult to collect information on deaths from illegal abortions, as families tend not to want to disclose that their relative died from a botched abortion, while the authorities are not collecting the information. However, she said that abortion can now be done so safely that the number of deaths should be decreasing, and that according to information from the NHSO, the number of people who died from an abortion is in the single digits.

Sulaiporn noted that, since the NHSO began covering abortion fees in registered medical facilities, of which there are around a hundred in the country, the number of deaths has continuously decreased, and in the three years before the law was changed, no deaths were recorded at all.

The NHSO has been covering these fees using part of its Health Promotion and Disease Prevention budget, which has also been used to provide birth control and HIV prevention regardless of one’s healthcare scheme. However, a recent order signed by the Public Health Minister means that the NHSO can no longer use this part of its budget to provide services to people covered under other healthcare schemes, such as the Social Security Scheme or those covered by government employee benefits.

As a symbol of cutting ties with Public Health Minister Anutin Charnvirakul, activists poured water on the ground and turned over the bowls in a traditional ritual symbolising breaking off a relationship.

Tamtang Group coordinator Supeecha Baotip explained that, in the past, anyone seeking abortion at a public medical facility would not have to pay regardless of their healthcare scheme, since the NHSO would cover it. However, questions have been raised about whether the NHSO’s budget can be used for people not under the Gold Card scheme, which is the NHSO’s responsibility. Government employees and those covered by the Social Security Scheme will be excluded, which Supeecha said will affect full-time workers, most of whom are covered by the Social Security Scheme.

“Right now, hospitals that provide these services are trying to keep going, but after this, if the problem is not solved, they may have to stop, and this will mean that people will have to go back to private facilities or the government will have to start charging people,” said Supeecha, who explained that an abortion at a private facility before the 12th week of pregnancy can cost at least 5000 baht. The fee will also go up if the pregnancy is more advanced.

Supeecha Baotip (right) handing the open letter to an officer from the Office of the Permanent Secretary of the Ministry of Public Health

During the gathering, the activists also read out an open letter addressed to the Public Health Minister, which they submitted to the Office of the Permanent Secretary of the Ministry of Public Health.

The letter states that the Tamtang Group, Choices Network Thailand, and their partner organizations call on the Ministry of Public Health to act on the new abortion law, since they found that safe abortion remains mostly inaccessible.

The letter says that the public and government personnel are still unaware that abortion is now legal in Thailand before the 12th week of pregnancy and after the 12th week in some circumstances, and so while people are becoming more aware that they have the right to these services, medical personnel are still not aware that they need to provide legal termination of pregnancy.

Meanwhile, the Ministry of Public Health has not made available a list of abortion or consultation facilities., This has led to many people going to hospitals seeking an abortion to be refused and stigmatized as the medical facility did not want to provide such services.

The letter noted that, even though the law does not require facilities to provide abortion services if they are not willing, regulations about abortion issued by the Ministry of Public Health and the Medical Council of Thailand require facilities to refer patients to other facilities without delay.

However, many medical personnel are not following these regulations due to lack of up-to-date information and negative attitudes towards abortion. Not only are they refusing to provide abortion services, they are also not referring patients to other facilities and are not training their personnel in counselling methods.

As most medical facilities do not want to perform abortions, there are few legal abortion facilities, and only 37 – 38 provinces out of 77 have one. The letter says that, because of this, people have to travel to other provinces to seek an abortion, and so have to cover the cost of the trip, which is unnecessary. The number of facilities is also not increasing even though the Ministry has said that, within 5 years, there will be a legal abortion facility in every province.

Information from civil society organizations providing consultation for unplanned pregnancies like the Tamtang Group and the 1663 unplanned pregnancy hotline found that most of those seeking consultation and safe abortion are from Bangkok, but Bangkok does not have any registered abortion facility that is supported by the NHSO.

A sign carried by an activist during the protest tells the story of a woman found dead from a botched abortion attempt in an apartment in Chiang Mai. According to the landlord, she initially moved in to live with a friend, who subsequently moved out. The landlord found her dead after smelling an odour from her room and deciding to open the door to check on her.

The Tamtang Group, Choices Network Thailand, and their partner organizations call on the Ministry of Public Health to release a list of medical facilities providing safe abortion services and unplanned pregnancy consultation, and to ensure that there is at least one facility in each province. The Ministry must also increase the number of abortion facilities by 5 – 10 each year.

The Ministry must also require public medical facilities that do not want to perform abortions to refer patients to other facilities and must provide clear guidelines on how to do so, including counselling, referral, evaluation, and providing medical care in cases of complications to ensure the safety of the person seeking abortion.

The Ministry must also educate medical personnel on safe abortion as a basic medical service that will reduce the number of injuries and deaths from unsafe abortions, and to ensure its personnel understand that access to abortion is a human right.

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