Abortion, Sin and the State in Thailand

Andrea Whittaker

• Publisher: Routledge
• Year: 2004
• eBook ISBN: 9781134327560
• Edition: 1
• Topic: Politics & International Relations
• Subtopic: Politics
• Index: Politics & International Relations

This book discusses abortion in a non-Western, non-Christian context - in Thailand, where over 300, 000 illegal abortions are performed each year by a variety of methods. The book, based on extensive original research in the field, examines a wide range of issues, including stories of the real-life dilemmas facing women, popular representations of abortion in the media, the history of the debate in Thailand and its links to politics. Overall, the work highlights the voices of women and their subjective experiences and perceptions of abortion, and places these 'women's stories' in an analysis of broader socio-political gender and power relations that structure sexuality and women's reproductive health decisions.

1 Introduction

Bearing politics

Patient 1. 40 yrs old. Pregnant 8 weeks. Presented with bleeding per vagina, fever, dizziness, complains of weakness and tiredness …

Patient 2. 19 years old. Came by herself. Pregnant approximately 20 weeks. Stated that at 6.45 am she went to have an abortion at the Thawee clinic, presented to hospital 3.45 pm. Today had symptom of extreme abdominal pain, heavy blood loss. Upon presentation, temperature 37 degrees centigrade. BP 80/50mm/hg …

Patient 3. 23 years old. Presented at 16.00 hours, patient came lying down. Pain in lower abdomen, had passed a large clot in last 30 minutes …

Patient 4. 27 years old. Presented at 21.00 hours. Lower abdominal pain, bleeding per vagina, patient groggy. Had been bleeding heavily for one day before presenting to hospital. LMP 20 December 2539, Pregnant approx 18 weeks. BP 90/60mm/hg Temperature 40.5 degrees centigrade … (2 days later patient had not improved, was referred to provincial hospital)

Patient 5. 30 years old. Went for abortion 2 days before presenting, cold, weak, Temperature 39 degrees centigrade BP 120/70, UTI …

(Selected medical records from one district hospital 1996/1997)

Every day, women like these present to hospital wards in Thailand with complications of illegal abortions. Despite restrictive abortion laws, it is estimated that between 80,000 and 300,000 abortions are performed each year, many using unsafe methods. Although many women experience no complications, others experience injury, infection, infertility and maternal death (Koetsawang et al. 1978, Narkavonnakit 1979, Chaturachinda et al. 1981, Narkavonnakit and Benett 1981, The Population Council 1981, Ladipo 1989). My interest in the issue began in 1991 when I first started fieldwork in Northeast Thailand, studying women’s reproductive health. Among the women I knew well in my field site of Ban Srisaket, abortion was a whispered subject that few women spoke of to me. The elderly woman whose house I shared claimed no knowledge of the practice of abortion in the community, yet I found out from her daughter that her Aunt had died from an abortion, after attempting to induce an abortion following the insertion of some twigs into her uterus. Other women I interviewed were more forthcoming about their experiences of abortion. Some spoke in a matter of fact manner about their past abortions, others spoke of the fear and pain they experienced and the subsequent guilt over the Buddhist sin they had incurred. I met midwives who spoke of how they had helped women abort in the past through massage techniques ‘but not any more’.

Whispered secrets among women stand in stark contrast to the very public horror stories of abortion paraded on the front pages of Thai daily newspapers. Raids of clinics and prosecutions of women procuring abortions and practitioners remain a regular feature of the Thai press complete with graphic photographs and sensational headlines. Along with this has been an ongoing debate about reform of the Thai legal codes regarding abortion. This book attempts to draw together the private and public face of abortion in Thailand. As an anthropologist, my work has always been concerned with drawing together the impact of the larger social and political context on the lives and bodies of women in local settings. In my earlier work Intimate Knowledge: Women and their health in North-East Thailand, I tried to combine the macro and micro view of women’s health; the political and the cultural economy, the ways in which state policies were played out on the ground and affected women’s access to health care, health practice and experiences of their bodies. My goal in this work is similar – to highlight the voices of women, their subjective experiences and perceptions of abortion, and to place these ‘women’s stories’ in a broader analysis of gender and the power relations that structure sexuality and women’s reproductive health decisions. As I argued in my previous work, while structural factors such as the distribution of economic, political and institutional resources, are fundamental to the degree of control women and men have over reproductive decision-making, cultural processes shape the contexts and meanings of their reproductive decisions, in particular gender ideologies, norms about morality and understandings of how women should behave (see also Browner and Sargent 1990). Similarly, this book looks not only at the political economy so crucial to women’s decisions about abortion, but also the wider social and cultural context, the political history, the popular representations and discourses about abortion, religious ideology and gender relations. But this book is not only about the issue of abortion; it simultaneously provides a new commentary on Thai society, gender relations and politics.

Women’s bodies as contested sites

Until relatively recently, the topic of abortion remained in the realm of demography, reduced to questions of its effects on fertility rates and maternal mortality, and the effectiveness of family planning programs. Recent work by anthropologists and feminists both within and outside of demography brought new perspectives to the study of all facets of reproduction, including abortion. In particular, they drew attention to the ‘political economy of fertility’ (Greenhalgh 1990), the ways in which the meanings, beliefs and practices surrounding reproduction are structured historically and culturally by local and global forces (Ginsburg and Rapp 1995, Greenhalgh 1995, Ram and Jolly 1998). They highlighted the nature of state interventions into the reproductive lives of citizens (Anthias and Yuval-Davis 1989, Jolly and Ram 2001) and the ways in which reproductive experiences are structured by macro and micro relations of power, class and gender politics (Handwerker 1990, Rapp 1993, Lock and Kaufert 1998). For example, Ginsburg and Rapp’s (1991) notion of the ‘politics of reproduction’ and book Conceiving the new world order (1995) links global reproductive policies and practices with local cultural understandings and social relationships. They describe ‘stratified reproduction’, the power relations acting selectively to encourage and empower certain groups of people to reproduce. They observe that although women’s bodies are central to reproductive regimes, this centrality is displaced by religions, development agencies, scientists and states.

During the same period the ferocious abortion debate raging in the United States inspired a number of studies. These analysed abortion as a practice and as a political and social construction subject to historical change, and embedded within the social and economic context, transformations in gender relations and changing sexual culture. Rosalind Petchesky (1990), whose work Abortion and woman’s choice: The State, sexuality and reproductive freedom was first published in 1984, provides a feminist analysis of abortion history, practice and politics within the United States. Her work, along with that of Kirsten Luker (1984) and Celeste Condit (1990) all begin with examinations of the history of the social and political configuration of abortion since the 1970s in the United States. They analyse how control over reproduction is a critical site of contest, reflecting broader economic, social and ideological concerns over women’s status and roles, and competing constructions of gender relations, sexuality and motherhood. Petchesky (1990: xi) writes: ‘Abortion is the fulcrum of a much broader ideological struggle in which the very meanings of the family, the state, motherhood, and young women’s sexuality are contested’.

Condit added to the perspectives of Petchesky and Luker by adding a further perspective, a systematic examination of the ‘public repertoire of meanings’ surrounding abortion. She argues that emphasis upon economic and social change alone gives an incomplete explanation of the functioning of public argument in the revision of widely shared meanings. Her book, Decoding abortion rhetoric explores the changes to the practice and meanings of abortion in the United States through a study of ‘the vast flows of public discourse that spread across America to shift the meanings of abortion and of related terms, practices and laws’ (Condit 1990: 1). She traces the various events and rhetorical turning points within the abortion debate in the United States, the legal and public vocabulary, as well as a new visual vocabulary that emerged in the public culture.

Anthropological work has also placed emphasis upon ‘women’s stories’ and their subjective experiences to balance the objectifying and generalised picture of abortion usually found in the demographic and epidemiological statistics. For example, Ginsburg’s (1998) work on the narratives of pro-life and pro-choice activists in North Dakota traces the reformulation and redefinition of gender oppositions articulated by proponents of both sides and their translations into a local community’s experience. Similarly, Luker’s (1984) study gave insight into the worldviews and social circumstances of activists on both sides of the abortion debate.

However, until very recently, studies of abortion have been dominated by works in Western countries. On the whole, there are few books which offer understandings of abortion within other religions (an exception is Keown’s (1999) volume on Abortion and Buddhism) and none which fully contextualise abortion in detail in a non-Western setting. Exceptions include studies on the mizuko kuyo rituals for aborted foetuses of Japan (LaFleur 1992, Hardacre 1997) and Taiwan (Moskowitz 2001), and a number of academic papers and edited volumes which offer smorgasbord essays from a variety of countries, cultures and disciplinary perspectives (see, e.g. edited volumes by Githens and McBride 1996, Rylko-Bauer 1996, Mundigo and Indriso 1999). Whether in countries with restrictive abortion laws or not, the studies in these collections reinforce the relationship between the economic situation of women and the quality of abortion care they receive, a theme that also emerges in the stories of Thai women in this study. The depressing stories of women’s desperate attempts at self-induced abortion in Mexico, the presentation of Brazilian women to public hospitals following their use of misprostol (cytotec) and Chinese women’s fears about the effects of abortion upon their long-term reproductive health, all find their parallels in this book. The studies also emphasise the lack of information that women had about actual abortion procedures, even in countries where abortion was legal and carried out in medical facilities. A picture emerges of women in many countries submitting themselves for medical procedures surrounded by fear, misunderstandings and uncertainties.

Overview of the book

This book comprises of eight chapters that juxtapose competing narratives about abortion in Thai society – from the history of the abortion debate in Thailand and public representations of abortion in the media to stories of the real-life decisions facing women. It moves from the rhetoric to the realities of women and men’s lives, from the historical to the present, from the abstract to the specificities of people’s lives and decisions. In this way it is inspired by all the works mentioned above, seeking to combine various different dimensions of the ongoing debate and experience of abortion in Thai society.

Writers are always faced with difficult decisions regarding the organisation of their material, and rarely will the solutions they find be adequate to represent lived experiences that are multivocal, dynamic, multidimensional and change across time. I am forced to impose a continuous narrative where one does not exist. Following this introduction, Chapter 2 comprises of an outline of the situation regarding illegal abortion in Thailand within the context of the widespread Thai family planning programme and reviews the current Thai studies of abortion. It describes Thai social attitudes towards abortion, including academic and Buddhist religious commentaries on abortion from both sides of the debate. It reinforces the fact that the issue of abortion remains crucial in terms of women’s health and women’s rights. In the following chapter, I begin my cultural analysis of the history of the abortion debate in Thailand and the struggle for abortion law reform in Thailand. I detail the history of the abortion debate and practice in Thailand, from a private act performed alone or with the assistance of a village midwife or healer to an illegal practice commanding high prices and the subject of heated public controversy. As Chapter 3 demonstrates, abortion has always been practised in Thailand, and is not simply a new practice that has grown with the sexual revolution and advent of Westernisation in Thailand. The increased visibility of abortion in the 1970s and 1980s is a consequence of complex changes in Thai society – transition to an industrialising economy from a subsistence agriculture-based economy, social changes wrought by greater exposure to Western cultural forms and ideas, the advent of family planning, and a decrease in the size of families and the desirability of children, greater mobility through migration of young people and especially young women to participate in the cash economy, greater access to education for the population. While the works of Petchesky and others have looked at the politics of abortion, in this Chapter 1 also use abortion as a means of talking about politics. I provide a new gendered perspective on Thai political history through the lens of this single issue.

The issue of abortion in Thailand yields a further example of the ways in which women’s bodies are used to represent and constitute the territory upon which the imagined communities of nation-states debate contesting visions of the nation and affirm cultural values. In Chapter 4, I draw upon material from the public media, parliamentary debates and popular texts to explore how abortion is employed within narratives of Buddhist morality, nation, democracy and culture in Thailand. As I note in Chapters 4 and 5, the rhetoric presented in this debate is less about the realities of women’s actions than the consolidation of the Thai state, the ideological creation of a sense of Thai-ness, and ongoing anxieties regarding rapid social change. As I note, in anti-reform rhetoric, women who abort are presented as unnatural mothers, un-Thai and un-Buddhist. It has become an issue readily linked in public discourse with debates about threats to Thai culture and gendered narratives of the nation.

Abortion draws attention to the politics of gender relations. In Chapter 5, I bring the discourses surrounding women, maternity and gender relations to the fore. The meaning of abortions will vary in different cultural systems where the social value of women depends upon their ability to bear children, or the number of children they bear or the sex of those children. The emphasis placed upon women as ‘good mothers’ in Thailand provides little recognition for women who do not fall into that category. Women are described through essentialist representations related to their reproductive roles as dutiful wives and mothers. Women who do not fit these roles, such as young pregnant unmarried students and prostitutes serve to highlight the dangers of deviation from these roles. I explore how three main tropes are used to depict ‘women who abort’ in Thailand – as corrupt girls, victims of men or desperate women. These tropes position ‘women’ and ‘men’ in certain ways and mandate how abortion is defined as a ‘social problem’ requiring management. Public depictions of gender relations in regard to the abortion issue tend to reinforce stereotypes of male sexual irresponsibility and female passivity and victim-hood.

These chapters give a sense of the powerful characterisations, ideographs and meanings evoked in discussions of abortion in Thailand, the uses of abortion as a metaphor for Thai political and social life, and point to some of the difficulties in substituting alternate views, a theme returned to in the concluding chapter.

In the final part of the book, the narratives of women who have had abortions take centre stage. Here I answer questions about how women and men negotiate their experience of unplanned pregnancies and make the decisions about having an abortion. In Chapter 6, women speak of their lived experiences, the decision-making process, the relationship with their partners, and their feelings about the consequences of their abortions. I describe ethnophysiological understandings of conception and pregnancy, and factors affecting the accessibility of abortion. Men’s stories tell us about their roles in sexual responsibility, contraceptive use and decision-making. Paternity in village Isan society is very much described in terms of ‘responsibility’ and economic support, in contrast to women describing their role as mothers as one of ‘care’ and nurturance. As women and men struggle to find an idiom in which to speak of their experience, they also reveal broader social pressures impinging upon their lives.

Chapter 7 looks at the decision-making process and the situational ethics of village women and men. Here I find that Petchesky’s (1990: 370–371) feminist humanist concept of ‘morality of praxis’ has its parallels in rural Thailand.
Villagers may subscribe to a Buddhist morality, but one that cannot be separated from the social conditions and real situations in which pregnancies occur and careful considerations of the will and intention behind an act. It allows us to understand the apparent inconsistencies between morality, ideology and practice, and how people express notions of reproductive rights cross-culturally.

The concluding chapter is less an end than a beginning of a comparative approach to some of the issues raised in the book. Although I am concerned with the speci-ficities of the Thai experience, in this Chapter 1 explore the global agendas influencing local abortion debates. In conclusion, I present some of the challenges facing abortion-reform advocates in Thailand.

Agency, choice and reproductive rights

A crucial theme underlying this book is that of tensions between agency and structure and the notion of choice. As Jacobson (2000: 26) has observed, it is too easy to ‘fail to give women their due as autonomous agents and turn them into dupes and victims by suggesting that their choices are but mindless capitulations of social pressures’. Petchesky (1990: 11) suggests that the critical issue for feminists is not so much the content of women’s choices, but the social and material conditions under which choices are made:

To paraphrase Marx, wo...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Series editor’s foreword
• Preface
• Acknowledgements
• Note on the transcription system
• 1: Introduction
• 2: Abortion, sin and the state
• 3: A history of the abortion debate
• 4: Conceiving the nation
• 5: Corrupt girls, victims of men, desperate women
• 6: ‘A small sin’
• 7: ‘The truth of our day-by-day lives’
• 8: Global debates, local dilemmas
• Appendix I
• Appendix II
• Glossary of Thai terms
• Notes
• Bibliography