Analysis
Abortion is now decriminalized in Thailand thanks to a landmark court case, but access to the service continues to be denied to many women, due to resistance from many medical professionals.
For years, Ms Supeecha Baotip and her group of activists fought for rights to abortion to be recognized by the law. They got their wish fulfilled in 2020, when Thailand’s highest court struck down the ban on abortion, and again in September 2022, when the country officially decriminalized it once and for all.
But the legal victory they fought for only led to a new hurdle: many doctors are simply refusing to perform abortions, in spite of the unequivocal wording of the law.
“The obstacle we’re now facing is the attitude of medical service providers,” Supeecha said in an interview. “It’s so far away from what the law has aimed to achieve.”
The legal amendments in 2022 – which permits the termination of pregnancy up to 20 weeks in most cases – granted Thailand one of the most progressive abortion laws in the region. But interviews with health experts show a very different reality on the ground: convenient and affordable access to abortion remains elusive for many women, largely due to objections from none other than those in the medical profession.
“There are a number of doctors who refuse to provide the service. They’re still attached to their values or religious beliefs that see abortion as immoral,” said Ms Nanthakan Sungsuman Woodham, Executive Director of Planned Parenthood Association of Thailand.
She added, “The law says the rights to abortion up to 20 weeks are protected. But some medical doctors or health care providers may not agree due to their perception and belief toward the abortion care.”
A relatively liberal abortion law in Southeast Asia
Following a legal challenge, the Constitutional Court in February 2020 declared that the Criminal Code’s statutes banning abortion to be unconstitutional, as they violated women’s rights and agencies over their own bodies.
The verdict paved way for a series of decriminalization, culminating in the amendments to the Criminal Code in 2022 that permit abortion up to 20 weeks if the woman’s physical or mental well-being is threatened, if the pregnancy is a result of sexual assault or incest, or if the fetus has serious deformities. For the termination of pregnancy up to 12 weeks, no condition is required.
The changes, at least on paper, set Thailand ahead from many of its neighbors in Southeast Asia where abortion is often restricted to narrow circumstances, such as Laos, Myanmar, Brunei and Indonesia, and somewhat on par with Malaysia and Cambodia.
Only Vietnam and Singapore are generally considered to have a more liberal approach to abortion than Thailand in the region, while the Philippines does not allow abortion at all.
Abortion in the Thai kingdom is also available to foreigners, including migrant workers from neighboring countries, said Nanthakan, whose organization has a program dedicated to helping migrant workers who need an abortion.
“We have volunteers that pick them up from their home all the way to our clinic, so that they won’t be victims of any intimidation or scams. We want them to have access to safe procedures,” she said.
Refusing in the face of a permitting law
In spite of some improvements in the laws however, women seeking abortion continue to be turned away by medical professionals who object to the operation based on their personal values – a rationale that alarmed reproductive health advocates like Supeecha.
“The law doesn’t say anywhere that doctors have to feel comfortable when they treat someone,” said Supeecha, whose group TamTang has been campaigning for safe and legal access to abortion since 2010.
“If doctors think suicide is a sin, for example, can they refuse treatment to people who attempted suicide? Or if the patients are from Red Shirt or Yellow Shirt camps [Thailand’s rival political factions], can doctors refuse to treat them just because they’re uncomfortable?”
At least 111 hospitals, both public and privately owned, are known to have refused requests to perform abortion and declined to refer the women to medical facilities that provide the operation in the past year, according to a database collected by AIDS Access Foundation, which runs a hotline for people seeking help about HIV/AIDS and unplanned pregnancies.
Their refusal appears to be in violation of a guideline issued by the Medical Council of Thailand, which advises doctors to either perform abortion as requested by the women, or refer them to other medical professionals “without delay.”
Foundation director Mr Somwong Uraiwattana said his team has logged at least 8 cases where doctors refused to perform abortion even when the women’s lives were at risk.
“This is not about the law. This is about attitude,” Somwong said in an interview from the foundation’s office, adding that the majority of calls received by his helpline involve pregnancy of less than 12 weeks – well within the legal boundary for termination.
“In order for an abortion service to be available at a hospital, three groups of people need to consent to it: the executives, the doctors, and the nurses. If just one of the three refuse to go through with it, the service isn’t possible.”
He cited several cases where abortion used to be available at a medical facility, but was later discontinued after the leadership passed on to a new director who objected to it, or hospitals where the management was open to abortion but its doctors are not.
Medical opinions – and strong judgements
Supeecha from the TamTang group, whose name means ‘paving a way’ in Thai, said she’s been hearing disturbing accounts from many women who reported having been refused abortion in recent months, even after the law was amended.
In one anecdote shared by Supeecha, a college student seeking abortion at a hospital run by the university’s medical faculty was not only denied, but a staffer also threatened to report her to her professor for “infraction”.
According to another report, a medical worker berated a young couple for seeking abortion on the grounds of unplanned pregnancy, and questioned the man why he still insisted on dating a woman who’s proven to be “evil enough to kill her own child”.
“In many cases they don’t only reject the requests for abortion, they also condemn those who need it,” Supeecha said. “This is too much.”
“If it’s kidney disease we’re talking about here – like doctors refusing to treat someone because it’s kidney disease – wouldn’t that be strange?”
Nanthakan, the Planned Parenthood Association of Thailand director, also acknowledged that access to abortion is far from ideal, due to the inconsistency in services and availability.
“When it comes to access to information [abortion], I give our country 9 out of 10 in scores. But when it comes to availability, it’s certainly not a perfect score, because abortion service is still not available in every province,” she said. “The quality of service also relies on each individual facility.”
Nanthakan added, “We train our staff to be mindful about the patients… but we can’t guarantee what other places have been doing.”
Opening conversations to open social views
All three experts interviewed for the story agree that the best approach to overcome the resistance from physicians is discussions – not coercion.
“I understand that they feel genuinely uncomfortable about this whole thing. I don’t want to take legal action, like filing lawsuits at the Administrative Court. I don’t believe that’s the way,” Supeecha said. She also said the Ministry of Public Health should take the lead by encouraging doctors to be more cooperative and do their job as mandated by the law.
Nanthakan has a very simple message for medical professionals who object to abortion: “No woman wants an abortion on their own volition. They come to us because of necessity.”
“We have to keep pushing for society to accept this and fix the viewpoints that equate abortion as sinful conduct,” she said.
“Medical providers should see [safe abortions] as a way to help reduce maternal deaths, and treat women who sought the service with sympathy, instead of stigmatizing them. It’s a long process, but if we don’t begin it today, we won’t ever be able to fix it.”
Somwong, whose organization runs the unplanned pregnancy helpline, also hosts training for medical students in the hope of starting conversation with them and raising awareness about safe, convenient access to abortion as human rights.
“The laws only help doctors who’re already willing to perform abortion, so that they’ll know their action is backed by the law,” he said. “But it doesn’t increase the numbers of doctors who are willing to be part of abortion services. The law alone does not accomplish that.”
But Somwong is still looking forward: “That’s why we have to help nurture the idea in the younger doctors. I personally don’t have any hope left in the older ones.”
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Teeranai Charuvastra is Journalist, feature writer at Prachatai English and Vice President of the Thai Journalists Association (TJA).
The views expressed in this article are not necessarily those of Heinrich Böll Stiftung.
