Establishing a referral system for safe & legal abortion care: Evaluation of a pilot project on the Thailand/burma border

Introduction: In Thailand, abortion is legal when the pregnancy endangers the physical or mental health of the woman, in cases of rape or incest, or if the girl conceived at age 15 or younger. In practice, access is also restricted by providers' interpretations of the law and by the willingness of potential providers to perform abortions for any indication. Burmese refugees and migrants living in Thailand face additional obstacles in obtaining legal services. This pilot project connected Burmese women who were eligible for safe, legal abortion care with a local provider. Methods: In 2012, the project team helped establish a referral system between Mae Tao Clinic, a major healthcare provider for Burmese migrants, and Mae Sot Hospital, a local Thai hospital. Joint trainings that also included other community based organizations were held about Thai law, options counseling for unintended pregnancies, and the steps required for referral. We provide evaluation data from the first year of the project. Results: The pilot program resulted in nearly two dozen completed referrals for physical and mental health indications (8), rape and incest (13), and age (2). In reviewing and analyzing specific cases we reflect on the obstacles faced by both individuals and the overall referral system as well as successful and creative navigation strategies employed by stakeholders. Conclusion: The evaluation suggests implementation of a referral system for legal abortion care is feasible, even in protracted conflict and crisis settings. Expansion of the program to other areas of Thailand with large Burmese populations appears warranted.