Nongluk Boonthai, Bureau of Reproductive Health, Department of Health, Ministry of Public Health, Thailand - Co-author: Kamheang Chaturachinda, Women’s Health and Reproductive Rights Foundation
With the largest population of any region of the world, Asia has the largest absolute number of abortion
around 26 million per year Nearly half of the world’s unsafe abortion take place in Asia and almost one third in South Asia alone. Unsafe abortion accounts for 12% of maternal death in Asia worldwide there is a declining trend in abortion between 1995 to 2003. Asia is no exception the rate of abortion declined from 33 to 29/1000 women of reproductive age. At the same time contraceptive use (CPR) in Asia, as estimated by UN, climbed from an estimate of 65.6 percent in 2000 to an estimate of 68.2 in 2010 and a further estimated climb to 70 percent in 2020.This climb in CPR is hand in hand with the reduction in UN estimate of Asia’s total fertility rate( TFR )from 2.6 in 2000 to 2.4 in 2010 and to 2.2 in 2020.
Since 1997, 17 countries around the world liberalized their abortion laws, 4 countries in Asia are among them (Bhutan, Nepal, Cambodia, Thailand ). With the population of just over 63 millions, abortion law in Thailand promulgated in 1956 permits abortion if it is done by a physician with the consent of the patient. Grounds for abortion include maternal health as well as pregnancy arising from sexual crimes , pregnan-cy in the young, ages under 15 years old. There is no hard national data on unsafe abortion. It is not officially collected. Moreover, abortion is socially controversial, stigmatized and condemned. Poor women lacked access to the safe service and therefore suffered most from unsafe abortion and its complications including sequelae of secondary infertility.
The number of unsafe abortion is estimated to be somewhere between 300,000-400,000 cases annually, mostly done “underground”, while there are approximately 800,000 births occurring each year. The cost, economically, physically and psychologically to women and to the nation is unacceptable. In spite of legal freedom to safe abortion access to safe abortion is still limited due to negative attitude of the health care provider. Only a hand full of providers in the govern-ment sector and a few private organizations provide out let for safe abortion in large cities, using Vacuum Aspiration. Almost all other Thai providers still use exclusively dilatation and curettage (D&C).
Lack of service providers is another problem. There are only 2,000 OB-GYN. and not all are willing to provide abortion. The myth that abortion is illegal plus negative personal and religious beliefs and their unwillingness to provide the service, resulted in poor access to safe abortion. Abortion seekers went to see quacks instead.
Over the past 50 years many attempts were made to amend the law; all were unsuccessful. The Thai Medical Council and the Royal Thai College of Obstetricians and Gynaecologists (RTCOG) decided to widen the criteria for termination of pregnancy by defining health to include mental aspect. The new regulation was approved in December 2005.
More works still need to be done. The negative attitude of the physicians toward abortion has to be changed. The use of D&C has to be replaced by vacuum aspiration. Therefore, to increase access, trainings on safe abortion using vacuum aspiration are being conducted. The Women’s Health and Reproductive Rights Foundation of Thailand (WHRRF) a non-profit, non-governmental organization. It is established to eliminate unsafe abortion and promoting safe abortion in Thailand through advocacy research, education and training by using the most up to date abortion technology. It has been collaborating with the Department of Health and the RTCOG, have carried out training workshop on prevention of unsafe abortion and use of MVA (Manual Vacuum Aspiration) through our established training centers in the 4 regions of the country. The 3 day- training include conceptual training, socio-economic, legal impacts of unsafe abortion , value clarification manual skill in using MVA on simulated first trimester pregnant uteri model using HAWAIIAN PAPAYA fruit. During the last years we have trained physicians and nurses from provincial and regional hospitals in all regions over Thailand. We have also organized the First International Congress on Women’s Health and Unsafe Abortion in January 2010 (IWAC 2010). There were over 600 attendees from over 62 countries worldwide attended. The second congress is planned for January 2012.