Previous PageTable Of ContentsNext Page

Induced Abortion : Nationwide Survey in Thailand

(Funded by World Health Organization - WHO)

Boonthai Nongluk, M.Sc.PH. and Warakamin Suwanna, MD.

Address : Family Planning and Population Division, Department of Health, Ministry of Public Health, Nonthaburi, Thailand 11000.
Tel : 66-2-5904265, Fax : 66-2-5904163 E-mail : nonglukb@health.moph.go.th

Project Summary

The project “Induced Abortion : Nationwide Survey in Thailand”, has been conducted to collect a wide variety of information on abortion. This project was conducted by the Family Planning and Population Division (FP&PD) , Department of Health (DOH), Ministry of Public Health (MOPH), Thailand and supported by World Health Organization (WHO).Its objectives were to study the situation, type and character of abortion and other related factors. The results of this study will be presented in two forums to academic and administrators from related professions to consider recommendations for the development of protective policies and to alleviate the problems of unsafe abortion.

The data collection used cross-sectional study method to collect data over a 12 month period in 1999. The target organizations were 787 voluntary public hospitals in 76 provinces (including Bangkok) including public hospitals under the MOPH, the Ministry of Interior, the Ministry of Defense and the Ministry of University Affairs, which the FP&PD identified prior to the study.

A questionnaire developed by the FP&PD was conducted by appointed local staff. The target group of this survey was pregnant women entering hospitals with symptoms related to spontaneous or induced abortion and termination of pregnancy. Research was limited to those pregnancies where the gestation age was under 28 weeks regardless of whether the cause of the abortion was natural (i.e. spontaneous abortion) or induced abortion. Also included were pregnant women who had an induced abortion from a doctor due to legitimate medical reasons. All abortions were recorded in the study whether they occured before arrival at the target organizations or at the target organizations themselves. Incidents of threatened abortion which did not occur were excluded from the study.

Each questionnaire contains the hospital’s code, the date of the interview, the personal identification of the patient and the name of interviewer for verification purposes. The project investigator set up a randomized monitoring of data quality through telephone and mail. The completed questionnaires were collected to the FP&PD for analysis and data interpretation by experts in the field of research. The results will be presented in a forum of academic staff for discussion, brainstorming, and to make recommendations for the prevention of induced abortion and solutions to the complications caused by them.

Results and recommendations from the first forum will be presented to a forum of executives from concerned professions in order to revise and formulate policies and guidelines to both prevent and solve the problems of induced abortion.

Background

Induced abortion is one of the major health problems that affect the quality of life of women in reproductive age. This issue was addressed for special consideration in the 5th International Conference on Population and Development (ICPD) held in Cairo, Egypt from 5-13 September 1994. In many countries, including Thailand, induced abortion is illegal. As a result, determining statistics can only be done through estimation, which is sometimes an inaccurate measure of the true incidence rate. It was estimated that in 1987 there were 35-53 million induced abortions worldwide and 20-40 percent were unsafe. Regarding our neighbour countries there were 400,000 cases of induced abortion in the Philippines and 730,000 in Bangladesh. Frequent immediate and long term complications arising from unsafe abortion are, incomplete abortion, hemorrhage, uterus perforation, intestinal perforation, peritonitis, infection, shock, ectopic pregnancy, infertility and death. The world figure is estimated at 50,000-100,000 deaths cause by unsafe abortion each year.

In Thailand, induced abortion is illegal, but there are two exceptions to the law. Firstly, when the pregnancy is dangerous to the mother’s health. Secondly, when the pregnancy is the result of rape or incest. Overall estimation of induced abortion in Thailand is 200,000-300,000 cases in 1991 and the most recent figure is 56,369 cases of all types of abortions reported by the Bureau of Health Policy and Planning in 1996 through health reporting system.

To successfully prevent or decrease the number of unsafe abortions it is necessary to understand the scope of the problem and related factors as up-to-date and as close to reality as possible. So the FP&PD which is responsible for reproductive health conducted this survey to estimate the incidence rate of abortion in Thailand at present.

Due to abortion being illegal in Thailand, It is very difficult to collect abortion data from the private sector. The service providers were not willing to participate in the study and were reluctant to be identified as participants of the study. Therefore the study population was represented by clients of public (government) hospitals. The plan of this project thus started from surveying the readiness of such hospitals and it took 6 months to accumulate 787 voluntary hospitals out of 822 hospitals (95.7%) to enter the project.

Objectives

General

1. To study and evaluate the current situation of abortion in Thailand

2. To seek policy / guidelines for reproductive health and related issues

Specific

1.. To obtain abortion statistics and related factors in Thailand for 12 months (1999)

2..To obtain basic data for considering preventive and connective procedures regarding abortion

Outcome of the study

1. To get the most reliable figures regarding abortion in Thailand

2..To develop guidelines for effective prevention and corrective measures regarding abortion and its complication.

Utilization of Results

Beside developing knowledge of the numbers and factors related to abortion / induced abortion, the FP&PD expects that this study should result in a reconsideration of policies and preventive measure against abortion. Support for policies which have direct benefit for health of women of reproductive age and indirect benefit for related reproductive health issues (such as quality of family planning, maternal and child health, adolescent health, sex education and infertility) should result. Another outcome should be the decrease of economic cost related to health and the social problems surrounding abortions. The results should be used as strong evidence to support the revision of the abortion act in Thailand.

Methodology of the study

The FP&PD collected the data by two methods as follow ;

Monthly report of abortion cases from each of 787 hospitals (January – December 1999) .

Interview eligible abortion cases in the target group (expected sample size 4,000 cases) conducted by 134 hospitals with the highest number of cases, the duration of the interviews was 6 months (August 1999 – January 2000).

Major Activities Undertaken :

1. Identified appropriate target organizations. Altogether 787 hospitals volunteered to join the study. Some of them were from other Ministries.

2. Two brainstorm meetings were conducted to consider the study methodology and questionnaire design. The participants comprised of executives of the DOH, lecturers from various universities, researchers, representatives of NGOs, doctors from involved hospitals and technical staff of the FP&PD, DOH.

3. Developed, pre-tested and reproduced a report form.

4. Developed, pre-tested, updated and reproduced a questionnaire form.

5. Conducted three training workshops for interviewers who are doctors, nurses and personnel from 134 hospitals.

6. Monthly reports from 787 hospitals and interviews (134 hospitals) collected from the case population.

7. Data management / data analysis and completion of 1st draft report.

8. An executive meeting among stakeholders who play key roles in this area from various professions to present the 1st draft report and consider guidelines for correcting problems.

Activities to be implemented

1. A National Symposium to present the results of the study will be conducted in June 2001 in Bangkok, Thailand. The symposium will include participants from the public and private sector, who will be invited to contribute feedback on the study and provide input for policy development/ planning in prevention and corrective measures.

2. Final report : translation, publishing and disseminating.

Abstract

1. Introduction :

Induced abortion is one of the major health problems that affect the quality of life of women in reproductive age. In Thailand, induced abortion is illegal, with two exceptions, if the pregnancy is dangerous to the mother’s health or the pregnancy is the result of rape or incest. Annual statistics in MOPH public hospitals have reported recorded figures of abortion at 56,369 cases. To successfully prevent or decrease the number of unsafe abortions and the complications arising, it is necessary to understand the scope of the problem. One objective of this study is to estimate the current incidence of induced abortion in Thailand.

2. Methods :

A cross sectional study method to collect data for a 12 month period in 1999. The study population was clients of 787 voluntary public hospitals in 76 provinces of Thailand. The data collection was conducted by appointed local staff. The target group of the study was pregnant women (gestation <28 weeks) entering hospitals with symptoms related to spontaneous or induced abortion, also included were women who had legal medical reasons for induced abortion. Abortions were recorded if it occurred before arrival or while at the study site. The samples were interviewed by survey for qualitative information for the study, randomised monitoring of data quality was included for both arms of the study.

3. Results :

Data collection was carried out monthly by reporting the number of cases seeking treatment for complications of spontaneous and induced abortion. Of the total 45,990 cases, 28.5% were induced abortion (19.54 per 1,000 live-births). Among these cases, 30 % were under 20 years of age. The main reasons for inducing abortion were socio-economic problems (60.2%), medical indications such as fetal anomalies, dead fetus and health of the mother (39.8% total, 15.4%, 13.5% and 7.8% respectively). The remainder were HIV infected mothers, victims of rape and cases of German measles (2.2%, 0.6% and 0.3% respectively). The main serious complications were septicemia 28.8% with 14 deaths (0.11%).

By interviewing a sample of participants, it was found that of all 4,588 interviewed cases, 40.4% were induced abortion, 11.9% of the induced cases had tried to induce an abortion themselves. 29.9 % of the cases were teenage pregnancies. The three leading reasons for abortion were economic problems, social problems and improper family planning, e.g. pregancy at inappropriate age, short birth spacing or enough children. The methods used were insertion of substances or injection of liquid into the vaginal canal, vaginal suppository, oral tablets or application of tension to lower abdomen. Nearly half (40%) of the cases had serious complications such as severe hemorrhage, septicemia, peritonitis, tear or perforation of uterine and 5 cases died (0.3%).

4. Conclusions.

The Ministry of Public Health should play the major role in prevention of unwanted pregnancies and to minimize unsafe abortion through providing knowledge on sex education, life skills and family planning to adolescents. Also relief regulation in education system to help those adolescents with unwanted pregnancies which may lead to induced abortion is required. Revision of business or labor rules and regulations which are unfair to women and discriminatory ie. deterrence of pregnant during employment, no paid maternity leave is needed. Also there is a need for counseling services, accommodation and care for unwanted pregnant women, single mothers and their children. Most important is the revision of abortion law in Thailand. A decrease in restrictions for doctors to induce abortion and less stringent conditions than those at present to allow women access to induced abortion is needed. This will decrease risks from unsafe abortion especially those performed by “quacks” and those induced by women themselves.

Previous PageTop Of PageNext Page