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Three years in, Thailand's abortion access goals fall short

Thailand’s plan to expand public abortion access to all provinces by 2026 is underway, but activists criticise the slow progress and the persistent stigma faced by women seeking these services.

Ratchanee Jumratpoom/Tumtang

BANGKOK – Three years since the legalisation of abortion, Thai pro-choice activists have appealed to parliament for a progress update on making abortion services accessible nationwide.

The advocacy group TamTang, along with its allies MovED and the Institute of HIV Research and Innovation (IHRI), presented a letter to the Committee on Public Health at the parliament on 7 February, coinciding with the anniversary of abortion’s legalisation three years prior.

Despite the legalisation allowing abortions within the first 20 weeks of pregnancy, the reality of accessing these services is hindered by a limited number of facilities and prevailing medical stigmas.

 

One province, one abortion facility 

In 2021, Thailand set a goal to ensure at least one abortion facility per province in public hospitals by 2026. However, progress has been slow, with only a few areas seeing expansion, and many service providers are private clinics.

TamTang reports that since legalisation, only 28 new facilities have been added, expanding coverage to six more provinces. As of 2023, there are 180 abortion facilities registered with the Department of Health, covering 57 provinces, leaving 20 provinces without service.

The letter highlights the legal and financial barriers still faced by those seeking abortions, despite healthcare coverage for Thai citizens. Many facilities are private clinics outside the universal healthcare system, making the service financially inaccessible for the majority of women.

“Despite the legalisation of abortion and healthcare coverage for the expenses for Thai citizens, the reality is that people still face difficulties accessing safe abortion services, as if it were still illegal,” TamTang stated in the public letter addressed to policymakers.

Universal healthcare covers up to 3,000 baht (approximately $84) for the service for Thai citizens. The cost of an abortion at private clinics ranges from 3,000 to 4,000 baht ($84 to $111) for pregnancies up to 12 weeks, and can reach up to 20,000 baht ($557) for pregnancies up to 20 weeks.

Even Bangkok lacks a public abortion provider, forcing women to travel significant distances for services. This scarcity of facilities leads to longer waits and the risk of late-term abortions, compromising health and safety.

“Based on our experience advising abortion seekers, 70 percent cannot afford the service in private clinics,” the activist network stated in their letter. They urged the Ministry of Public Health to establish annual performance indicators to expand facilities nationwide and meet the 2026 goal.

Abortions in high demand

Data from TamTang shows that from 2018-2022, over 94,610 women received abortions in facilities registered with the National Health Security Office (NHSO). However, activists believe the actual number, including those who visit unregistered clinics, is much higher.

The data underscores the high demand and the critical need for more facilities, highlighted by the increase in abortion cases. Following the legalisation in 2021, the NHSO recorded over 13,693 cases, a number that rose to 20,500 the next year. This upward trend aligns with the consulting hotline 1663’s data, which advised 36,467 women in 2022 – twice the figure from 2018.

“Today, we still don’t know the actual number of abortion cases in the country,” the activist group emphasised, advocating for comprehensive research in their demands. “The Ministry of Public Health and related agencies should study the demand nationwide to understand the real situation and consider the magnitude of the issue.”

 

Overcoming the stigma 

During their letter submission, activists presented sanitising sprays to parliament members as a symbolic gesture to “sanitise the stigma” surrounding abortion.

In 2023, to combat stigma and commemorate the second anniversary of legalisation, TamTang and its network organised a Buddhist ceremony outside the Ministry of Public Health.

The stigma among medical personnel, often rooted in Buddhist beliefs, remains a significant barrier to abortion services, as a report by HaRDStories has shown. Despite legal protections, many healthcare providers refuse to perform abortions or refer patients elsewhere.

“Abortion is a safe medical procedure. But the obstacles to make the practice accessible in Thailand remain for the fact that there are few service providers,” said Dr. Krit Leetong-in, a consultant of the National Health Security Office in the opening remark of the Abortion and Reproductive Justice Conference 2024 (ARJC) in Bangkok on 15 February. 

“Many medical personnel still disagree to perform the procedure, leading women to perform their own unsafe abortions, which can lead to death, especially among low-income and marginalised communities,” he added.

Even Though abortion has been legalised, unsafe abortions are still prevalent. The Department of Health reported four deaths related to abortion in 2022.

Hosted for the first time in Thailand to represent the asia region, the ARJC conference gathered 315 abortion advocates from 60 countries, ranging from medical personnels, academia to activists, and was hosted under the theme “Unfinished revolution” – to address the realities in many countries that the legal triumphs are not the ending for the mission to provide safe abortion for all.

The event was run by Asia Safe Abortion Partnership in collaboration with local partners – Mahidol university, Ministry of Public Health’s reproductive health office and the volunteer-driven network Referral System for Safe Abortion.