Access denied: Understanding the experiences of Burmese women who are unable to obtain a legal abortion in Thailand
Awarded 2015
Large Research Grants
Angel Foster, MD, DPhil, AM
Cambridge Reproductive Health Consultants

Background: The decades-long conflict, human rights violations, and lack of development in Eastern Burma have led to mass displacement of women from Burma into Thailand. These women face significant challenges accessing safe abortion care. Objectives: We evaluated two programs designed to reduce harm from unsafe abortion: a referral program in Northern Thailand and a misoprostol community-based distribution program (CBDP). We aimed to assess outcomes of the programs and understand women’s experiences. Methods: We conducted in-depth interviews with 36 women who sought referrals for safe and legal abortion care in Mae Sot (n=14) and Chiang Mai (n=22). We purposely recruited women who successfully obtained referrals (n=23) as well as those who were denied referrals or safe and legal abortion care (n=13). We analyzed the pregnancy outcomes of the 918 women who used misoprostol-alone through the CBDP and conducted in-depth interviews with 16 women who accessed the initiative. Results: Women’s experiences accessing legal abortion care were positive and facilitated by appropriate options counseling, logistical support, interpreting, and financial coverage. More than half of the women who were denied a referral or a safe and legal abortion employed unsafe practices. The CBDP was highly successful – more than 96% of women were not pregnant at follow-up – and women found the program acceptable and culturally resonant. Conclusions: Our findings suggest that both referral programs and community-level provision of misoprostol have the potential to dramatically expand access to safe abortion care and reduce harm from unsafe abortion in legally restricted, low-resource, conflict affected settings.