“Without this program, women can lose their lives”: migrant women’s experiences with the Safe Abortion Referral Programme in Chiang Mai, Thailand

Abstract

For displaced and migrant women in northern Thailand, access to health care is often limited, unwanted pregnancy is common, and unsafe abortion is a major contributor to maternal death and disability. Based on a pilot project and situational analysis research, in 2015 a multinational team introduced the Safe Abortion Referral Programme (SARP) in Chiang Mai, Thailand, to reduce the socio-linguistic, economic, documentation, and transportation barriers women from Burma face in accessing safe and legal abortion care in Thailand. Our qualitative study documented the experiences of women with unwanted pregnancies who accessed the SARP in order to inform programme improvement and expansion. We conducted 22 in-depth, in-person interviews and analysed them for content and themes using deductive and inductive techniques. Women were overwhelmingly positive about their experiences using the SARP. They reported lack of costs, friendly programme staff, accompaniment to and interpretation at the providing facility, and safety of services as key features. Financial and legal circumstances shaped access to the programme and women learned about the SARP through word-of-mouth and community workshops. After accessing the SARP and receiving support, women became community advocates for reproductive health. Efforts to expand the programme and raise awareness in migrant communities appear warranted. Our findings suggest that referral programmes for safe and legal abortion can be successful in settings with large displaced and migrant populations. Identifying ways to work within legal constraints to expand access to safe services has the potential to reduce harm from unsafe abortion even in humanitarian settings.

Disclosure to social network members among abortion-seeking women in low- and middle-income countries with restrictive access: a systematic review

“…Not all of these women can access legal services on their own and some go to informal providers on either side of the border with or without the help of friends [ 88 ]. Burmese migrants also need their friends to navigate the complex and unfamiliar Thai system of legal abortion [ 89 , 90 ]. Similarly, in a study of 17 Mexican women who crossed the border to use legal abortion services in California, the women reported learning about the clinic from family members, friends, or the Internet.…”

“…Gipson [87] Cambodia Petitet [21] Burma/Thaïland Arnott [88], Tousaw [89], Tousaw [90] Middle East Iran Zamanian [36] Saudi Arabia Alsibiani [49] Palestinian OT Shahawy [98] through the abortion process alone (only one mentions having told her parents) [26].…”

Maternal Health in Crisis: A Scoping Review of Barriers and Facilitators to Safe Abortion Care in Humanitarian Crises

“…Most articles referred to legal restrictions as one of the main barriers to access ToP, and the main reason why humanitarian organisations may opt not to offer ToP under any circumstances in humanitarian contexts (5,23,24,(27)(28)(29)(30)(31)(32)(33)(34)(35). Among other reasons, restrictive abortion laws (23,24,29,30,34,35), i.e.…”

Delivery of sexual and reproductive health interventions in conflict settings: a systematic review

“…44 Culture/context appropriate Interventions that were specific to the context and the culture were seen to be more beneficial and as effective even for interventions that were are legally restricted such as abortions. 45 A study by Wayte et al 46 also found it was necessary to modify guidelines to the local context. Meeting with religious and community leaders were important for building trust and for getting permission to initiate certain interventions that may be innovations, such as CHWs delivering injectable contraceptives, 15 or introducing programming for adolescent girls.…”