35-year-old Hom Kham (pseudonym) works as a cleaner. She is hired as a daily wage labourer by a cleaning company in Chiang Mai, earning 357 baht per day. Late last year, she got pregnant but miscarried at three months, requiring uterine curettage to remove remaining tissue. Her doctor speculated that she miscarried because she did not get enough rest.

The company Hom Kham works for has a contract with a large hospital in Chiang Mai. She is one of three cleaners working on the same floor, each responsible for a different area on the floor. Although doctors often advise patients to avoid doing heavy labour for up to a month after a uterine curettage, she still had to work and could not avoid lifting heavy objects. She experienced continuous stomach pain and bleeding and eventually had to have the procedure redone. Although she didn’t have to pay for the second round, the first cost her 3,800 baht and, combined with a cervical cancer screening, she spent almost 5000 baht.

Hom Kham is from Laihka in the south of the Shan State. When she was 15, she came to Thailand and started working as a nanny in Mae Hong Son, where she lived with her employer and was paid 2,500 baht per month. A year later, she moved to Pai with her parents and worked in construction for 6 years. She was paid 60 baht per day, while her parents were each paid 80 baht.  Fortunately, she did not have to spend as much on her work permit then as she does today.

When she was 21, Hom Kham moved to Chiang Mai. For 2 years, she worked in a grilled pork restaurant, where she was paid 4,500 baht per month. She then started working as a cleaner along with her parents.

At 23, Hom Kham went back to Myanmar and got married. Her husband later moved back to Thailand with her. She has had two daughters: the oldest is 15 years old; the youngest died at 4 after a motorcycle she was riding fell into a well. Her third pregnancy at the age of 35 was unplanned. She said she and her husband did not want another child and that she was taking birth control pills. She said she never considered getting an abortion, however, even though she knew she could lose her job if she became pregnant.

“I was working much harder than this when pregnant with my first child. I was still at the grilled pork place.  Maybe I miscarried this time because I worked all the time,” she said. On days when she had to work overtime, she wouldn’t get home until midnight and had to start working again at 6.00 the next morning. Her actual working hours were 7.00 – 16.00, but the company wanted cleaners to be done before hospital personnel arrived, so she had to go early.

The work of a hospital cleaner involves collecting trash, cleaning bathrooms, and cleaning examination rooms on the ward. On days when they have to work overtime, cleaners had to clean the bathrooms on three floors, as well as cleaning rooms after patients had been released.

Hom Kham knows that her pay is lower than the legal minimum wage in Chiang Mai. The company told her that they won the bid for the hospital contract at a low price and that this was all they could afford, but she said that cleaners in other areas who mostly clean private rooms were being paid 380 baht per day. She does not know why their pay was different from hers.

Hom Kham said that the company allows pregnant workers to stay on the job, but will not be held liable if something happens to them during working hours. She also said that cleaners would not be placed at the same location if they wanted to come back to work after giving birth. The company sent them elsewhere as women would have to leave the job when they were eight months pregnant and their position would already have been filled when they reapplied later. Hom Kham herself got a job because the previous worker resigned to have a baby.

The same goes for one of Hom Kham’s friends, who resigned when she was eight month pregnant to give birth. She was not paid severance. Daily wage workers like Hom Kham are not entitled to a maternity leave and women have no choice but to leave their jobs. The company will take them back if they reapply later but according to Hom Kham, most cleaners try not to get pregnant unless they are planning to have a child and prepared to be unemployed.

Other cleaners told Hom Kham that companies in Chiang Mai have similar practices. In some places, workers are given 3 month severance packages and made to resign in their sixth month of pregnancy.

Right-wing groups in Thailand often perpetuate the idea that migrant workers want to have children in Thailand to get Thai citizenship. Hom Kham says she never thought of doing this as she would be unable to work while pregnant and it is expensive to raise a child here.

“I didn’t want to get pregnant; I did even though I was taking birth control pills. If I had had a baby, I wouldn’t be able to work. It would just be my husband working and we wouldn’t have enough money to live or cover rent. I already have a child, so I need to pay her tuition. I would need to save some money beforehand. It is expensive to have a child in Thailand.”

When asked if she had to choose between a baby and her job, Hom Kham said she would choose her job. “If I have a baby and I don’t have a job, it would be hard for both of us,” she said.

But even if a pregnant migrant worker wants to get an abortion, it is not easy. Abortion is legal in Thailand up to the 12^th week of pregnancy, and can be obtained up to the 20^th week after a required counselling and examination process, but access remains limited due to the lack of facilities and lingering social stigma.

Dr Chutinart Chinudomporn works at the Tarntawan Clinic, a clinic runs by the abortion rights group Tamtang Foundation which offers unplanned pregnancy counselling and safe abortion care. She said that 30% of the clinic’s patients are migrant workers and stateless people who do not have Thai ID cards. Many come to the clinic for economic reasons, like not having enough money to get an abortion or not wanting to be pregnant out of fear that they would lose their jobs.

Although the clinic is located in Bangkok, workers from other provinces including Chiang Mai and Chonburi have reached out for advice.  Each time, the clinic’s counsellors start by making sure that patient contact is voluntary.

“We usually just asked if … it was their own decision and they were being forced into it. We provide services to people either way. Many patients say the same thing, that they can’t afford it. Some don’t have any money. Some are unemployed. Many say that if they get pregnant they will be fired from their jobs.”

Dr Chutinart said that some patients even send pictures to prove that they are unable to give their existing children good lives. Concerned about their child’s citizenship, some stateless mothers want an abortion because they do not want a child to suffer the same fate and want to get their own citizenship paperwork first.

“90% of the workers who come to our clinic use birth control - pills, condoms, IUDs - but no method is 100% effective. And there is no point in asking them why they didn’t use birth control.  Many have tried and by the time they are pregnant, it is too late.  For those seeking an abortion, we should be openminded and help them rather than judge them for what has passed.”

A language barrier is the first problem a migrant worker who goes to a hospital or clinic to get an abortion faces, said Dr Chutinart. Not every worker speaks Thai, and while Tarntawan Clinic provides Burmese or Cambodian interpreters, workers would have a hard time communicating at many facilities. Good employers may help contact a facility, but this makes it harder to prove that workers made their own decision to get an abortion. Workers are also concerned that they will be charged a higher “foreign” rate if they go to a hospital.  Undocumented workers are concerned about being deported.

Thai citizens or not, patients can still be turned away by hospitals that refuse to perform abortions. According to Dr Chutinart, one patient, who was only 30 years old and hoped to have children in the future, was even told that she would have to agree to be sterilised or the hospital would not help her. She came to Tarntawan Clinic after refusing her consent.

Dr Chutinart said that it is not uncommon to hear medical professionals say that migrant workers who have had several abortions should be sterilised. She thinks the problem could be better addressed by improving access to birth control.

Even first time abortion seekers might still be turned away.  Not every hospital performs abortions, in part because of the biases held by medical professionals.

Things are even more difficult for undocumented migrants. Not only do they face a language barrier, but being undocumented means they have a harder time finding a medical facility that will accept them. Many resort to buying illegal drugs or taking herbal “women’s tonics” often used to regulate menstrual cycles but is ineffective as an abortifacient. Some buy medication from online sources because it is cheaper than going to a hospital. A number find that they have been given fake medication.

Technically, migrant workers who buy health insurance or are insured under the Social Security Scheme should have access to abortion, but Dr Chutinart said these rights are only on paper. If a worker goes to their Social Security hospital wanting to get an abortion and the hospital does not perform the procedure, they are not told where to go next. Meanwhile, a Thai person refused by their Social Security hospital can still go to other facilities and have their procedure covered by the National Health Security Office (NHSO)’s universal healthcare scheme, which covers abortion fees up to 3000 baht.

“Migrant workers under the Social Security Scheme do not have access to [the NHSO’s healthcare scheme], so it depends on their Social Security hospital to refer them. There are still problems with getting a referral,” Dr Chutinart said.

Dr Chutinart noted that migrant workers often have a hard time requesting leave.  Because most don’t want to be seen as troublemakers, they also don’t want to follow up with hospitals about referrals or ask questions about Thailand’s healthcare schemes when denied treatment. They come to private providers like Tarntawan Clinic, instead.

As to the choice between having children or a job, Dr Chutinart explained that the issue is quite complex, involving not only the question of nationality but also social and religious bias, economic status, and family dynamic.

“Women who get to this point are hurt no matter which choice they make. If they want to keep a pregnancy, there is a lot for them to lose. If they choose an abortion, there is a lot of hurt. It should not be this way. In terms of workers’ rights, having an unplanned pregnancy and being forced to get an abortion is a lot like forced labour … they have to choose between being a womb or a person.”

“It’s not just migrants. It happens to Thai workers too. [In some factories], they conduct a random urine pregnancy test every three months. Pregnant workers are fired … every pregnant person is very vulnerable. Sometimes factories owners are the first to learn that a worker is pregnant: the workers find out and lose their jobs at the same time. There is not even a choice for them to get abortions.”

And pregnancy tests can still come back positive after an abortion, Dr Chutinart said. Workers cannot tell their employer they have already terminated their pregnancy. They are judged beforehand.

“The government does not protect their right to choose.” To the contrary, biases against migrants who give birth to children in Thailand have become more pronounced, especially during the Thailand-Cambodia border conflict.

With many migrant patients, Dr Chutinart believes that most migrants workers do not want to have children here.  It is difficult for them to survive in Thailand. Many don’t earn enough to make a living and have to help family members back home. “The migrant workers that I’ve met, not only Burmese, Cambodian, Lao, Karen, and Shan but also Dutch and American, cannot get pregnant and give birth in this country because their employment status is uncertain. It happens to everyone regardless of nationality,” she said.

“They don’t have enough to take care of themselves and they also have to take care of people back at home. They cannot imagine the future. They choose abortions because they can’t see the future of an unborn child, don’t believe that they could give the child a good future. The idea that people want to come to Thailand and have lots of children is a myth. Even those who decide to give birth have moments when they contemplate aborting. Many don’t have access to birth control. Some don’t have money for prenatal care. They only get medical attention when they give birth.”

Abortions are also very expensive for low-paid migrant workers.  Often exploited by their Thai employers, many can’t afford the option. Others have been sexually assaulted by their employers and are forced to get an abortion after becoming pregnant.  According to Dr Chutinart, assuming that migrants come to Thailand to have children amounts to a further oppression of people who have already been marginalised.