Establishing an Abortion Referral System

Location:

Introduction:

For displaced and migrant women in northern Thailand, access to healthcare is often limited, unintended pregnancy is common, and unsafe abortion is a major contributor to maternal death and disability. Although abortion is legally permissible in Thailand for a number of indications, women from Burma have difficulty accessing services even when they meet the eligibility requirements. Based on a pilot project and situational analysis research, in 2015 a multi-national team introduced the Safe Abortion Referral Program (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.

Project Description:

The Adolescent Reproductive Health Zone (ARHZ), a network of five community-based organizations serving refugee and migrant women from Burma, launched the SARPSafe Abortion Referral Program in April 2015. Prior to the launch, ARHZAdolescent Reproductive Health Zone counselors participated in a three-day training focused on the legal and medical frameworks around abortion in Thailand and Burma, pregnancy options counseling skill-building exercises, and the logistics of the SARPSafe Abortion Referral Program. The training also provided an opportunity for the ARHZAdolescent Reproductive Health Zone counselors to meet colleagues who were involved in the pilot project in Mae Sot, Thailand, Thai abortion providers, and North American researchers who provided technical assistance and monitoring and evaluation support. In addition to providing women with referrals for care, the SARPSafe Abortion Referral Program offers women financial support, including coverage of both the procedure and travel costs, interpreting services, and accompaniment, as needed and desired.

Results:

Over the first 2 years of the program, 81 women from Burmese communities in northern Thailand accessed the SARPSafe Abortion Referral Program; 52 women (64%) were successfully referred for care and received safe and legal abortions in either a Thai public hospital or a Thai private clinic. Both providers and women were overwhelmingly positive about their experiences with the SARPSafe Abortion Referral Program. Women reported lack of costs, friendly program staff, accompaniment to and interpretation at the providing facility, and safety of services as key features. After accessing the SARPSafe Abortion Referral Program and receiving support, women became community advocates for reproductive health.

Lessons Learned:

This experience suggests that referral programs for safe and legal abortion can be successful in settings with large displaced, migrant, and refugee populations. Identifying ways to work within legal constraints to expand access to safe services has the potential to reduce harm from unsafe abortion in humanitarian settings and facilitate women’s access to high quality abortion care.