Choices Network Thailand, along with a network of civil society organizations, went to the Department of Health (DOH) on 15 May to submit an open letter to the DOH Director-General calling for the DOH to ensure that women can access safe abortion services during the Covid-19 pandemic.

Representatives of the network submitting the open letter

The Tamtang Group and the 1663 counselling hotline found that there has been a significant increase in the number of women seeking abortion since the Thai government declared a state of emergency in March. Meanwhile, the spread of Covid-19 has made accessing abortion services more difficult, as some government hospitals stopped providing these services to shift their effort to caring for Covid-19 patients and other hospitals limited the number of cases or opening times and became stricter about referrals from areas affected by Covid-19.

Not only that, the lockdown also limits the ability to travel to health centres in other provinces as well as access to the most effective forms of contraception. The Tamtang Group and the 1663 counselling hotline also found that socio-economic factors such as higher rates of domestic violence and the impact of economic crisis may also contribute to the increased number of women seeking to terminate their pregnancy.

Safe and legal abortion services in Thailand are available through the Referral System for Safe Abortion (RSA), a volunteer network of medical personnel, social workers and mental health professionals run by the DOH’s Bureau of Reproductive Health and Choices Network. However, the petition explains that, due to stigma and resistance from some healthcare providers, not all public hospitals provide safe abortion services and often women have to be referred to a healthcare provider in another province, increasing expenses and unnecessarily delaying their access to the service.

The increased workload of healthcare professionals during the Covid-19 pandemic also means that reproductive health services are delayed. Before the outbreak of the virus, the RSA had in its network 142 hospitals in 42 provinces. The number has declined to 71 hospitals in 39 provinces, only 40 of which accept referrals from other provinces and only 4 perform abortions after 12 weeks.

“Limited access to safe abortion services during the spread of Covid-19 may drive more women to risk unsafe abortion,” says the petition. “If there are no preventive measures or solutions, the number of women with post-abortion severe complications and death may increase. Moreover, there will be more people experiencing a low quality of life as they are forced to cope with additional children they are not ready to care for.”

Choices Network and its partner organizations call for the implementation of immediate measures to give women better access to abortion services and for the DOH to take the following actions:

1. Coordinate with the Ministry of Interior and other authorities responsible for the lockdown so that women seeking abortion are allowed to travel to other provinces
2. Provide both short-acting and long-acting reversible contraceptives as measures preventing unintended pregnancy and make post-abortion contraception accessible, adequate, and widely available
3. Implement strategies to ensure there is no shortage of abortion medicine in the near future
4. Consider integrating tele-medicine for abortion into the health services system, as it can reduce the risk of both medical personnel and service recipients contracting Covid-19
5. Inform all healthcare providers under the Ministry of Public Health to provide ultrasound examination without forced antenatal care registration
6. Raise awareness among the public and all service providers about safe abortion services so that they may support women’s access to safe abortion.
7. Collect and analyse national data relating to barriers to access to safe abortion during the Covid-19 outbreak
8. Ensure that public hospitals are ready to care for women with post-abortion complications or any health impacts from clandestine abortions during the Covid-19 pandemic
9. Develop policies and long-term strategies to increase the number of public hospitals providing safe abortion services to at least one per province.

“We[…]hope that the Department of Health will strongly consider the significance of women’s sexual and reproductive health during the COVID-19 crisis, and thus initiate immediate measures to reduce the barriers to safe abortion services. This is to reduce post-abortion complications and death rate caused by unnecessary unsafe abortion and show your strong support to health care provider who provide safe abortion services to women despite the pandemic,” says the petition.

The petition is signed by 56 organizations both in Thailand and elsewhere, and now has over 599 signatures on Change.org.