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A Review of Sexuality and Reproductive Health and Rights in Thailand

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A Review of Sexuality and Reproductive Health and Rights in Thailand A Review of Sexuality and Reproductive Health and Rights in Thailand Prepared for the Ford Foundation Office for Vietnam and Thailand Hanoi, Vietnam May – August 2006 Siriporn Yongpanichkul, consultant based in Bangkok, Thailand, wrote this report for the Sexuality and Reproductive Health program of the Ford Foundation office for Vietnam and Thailand, in Hanoi Vietnam. The report was written May - August 2006 and finalized in May 2007. Martha Ann Overland, journalist and editor, based in Hanoi, Vietnam, edited the report. Susan Y. Wood, Program Officer for Sexuality and Reproductive Health, the Ford Foundation, Hanoi, provided oversight and editorial support. Any part of this report may be copied or adapted provided that the author and source is identified. The Ford Foundation Office for Vietnam and Thailand Pacific Place 83B Ly Thuong Kiet Street, 14th floor Hanoi, Vietnam Tel.: (844) 946-1428 or 946-1418 Fax: (844) 946-1417 Email: [email protected] 2 Table of Contents Abbreviations 4 I. Executive Summary and Introduction 5 II. Success and Shortcomings of Sexual and Reproductive Health 8 Overview 8 Reproductive health service programs 9 HIV/AIDS and STIs 10 - The rights of people living with HIV 11 Adolescent sexual and reproductive health 12 Safe induced abortion 13 Gender-based violence 15 Reproductive health of women in vulnerable groups 17 III. Challenges and Opportunities for SRH Program Implementation 19 Opportunities 19 Challenges 20 Funding for SRH 21 IV. Looking forward 23 Recommended issues to be addressed 23 Strategies and approaches to be considered 26 Sexual and Reproductive Health Data 28 Bibliography 29 Attachment 1 Study background 33 3 Abbreviations ARROW Asian-Pacific Resource & Research Centre for Women ART Antiretroviral therapy ARV Antiretroviral CEDAW Convention on the Elimination of All Forms of Discrimination Against Women CBOs Community-based organizations CUP 100 % Condom Use Program GBV Gender-based violence HIV/AIDS Human immunodeficiency virus/acquired immunodeficiency syndrome ICPD International Conference on Population and Development INGOs International non-governmental organizations IDUs Injecting drug users MCH Maternal and child health MDG Millennium Development Goals MOPH Ministry of Public Health MSF Medecins San Frontieres (Doctors without Borders) MSM Men who have sex with men NGOs Non-governmental organizations OSCC One-Stop Crisis Center PHAMIT Prevention of HIV/AIDS Among Migrant Workers in Thailand PLWHA People living with HIV/AIDS PMTCT Prevention of mother-to-child transmission PPAT Planned Parenthood Association of Thailand PPFA-I Planned Parenthood Federation of America - International RH Reproductive health SRH Sexuality and reproductive health STIs Sexually transmitted infections TNCA Thai NGOs Coalition on AIDS TNP+ Thai Network of People Living with HIV/AIDS TWAT Thai Women against AIDS Taskforce UNAIDS Joint United Nations Programme on HIV/AIDS UNESCO United Nations Educational, Scientific and Cultural Organization UNIFEM United Nations Development Fund for Women UNFPA United Nations Population Fund VCT Voluntary counseling and testing WHAF Women’s Health Advocacy Foundation WHO SEARO World Health Organization, South East Asia Regional Office 4 I. Executive Summary and Introduction Background The Ford Foundation office for Vietnam and Thailand has been making grants in the fields of sexual and reproductive health (SRH) and rights in Thailand for over 40 years. The Foundation was one of the first non-governmental organizations (NGOs) to work on these issues in Southeast Asia and its commitment remains strong. In the ten years from 1998 through 2007, the Foundation committed at total of some $3.8 million in grants for sexual and reproductive health and rights in Thailand, plus additional funding for travel and study. In order to maximize the strategic effectiveness of limited funding, the Foundation commissioned an assessment of the current state of sexuality and reproductive health in the country. This report is the product of that assessment. It reviews the current status of the principal issues addressed by the Ford Foundation Sexuality and Reproductive Health program and identifies realistic opportunities for the Foundation and other funders to maximize their future commitments in order to improve the lives of vulnerable and underserved groups in Thailand. This report is not intended to be a statement of Ford Foundation priorities or grantmaking commitments, but rather used as a background document for those who would like to contribute to improving sexual and reproductive health and rights in Thailand. Successes and Shortcomings of Sexual and Reproductive Health and Rights Programs in Thailand In the past few decades, Thailand has made remarkable progress in improving its reproductive health service programs. Under the “30-Baht Scheme,” Thai people can access healthcare, including reproductive health services and obstetrical care, for about US $0.80 per visit.1 Yet the quality of reproductive and sexual health care offered in hospitals is often poor and young or unmarried people face barriers to accessing services and information. Successful pilot programs in many areas of SRH have served as powerful arguments for expansion. But such models have not yet been replicated nationwide because of budget constraints, problems with resource allocation, management issues, a lack of understanding on the part of health personnel and, in particular, a lack of commitment at the policy-making level. In addition, the segmented distribution of authority and responsibility that occurs within government agencies often makes it difficult to implement SRH programs. A diversity of women’s health advocacy groups, NGOs and academics, however, have improved reproductive health rights and services, as well as helped shape national 1 The 30-Baht program was started by the Thaksin government in 2001. After the coup in September 2006, the program was no longer officially in force, but universal access to subsidized healthcare has continued. 5 policy. For the first time in the country’s history, Thailand had begun development of a reproductive health law to protect sexual and reproductive rights, but progress on the law was halted due to the political stalemate throughout 2006. At the same time, HIV/AIDS transmission has increased due to unprotected sexual intercourse, largely through commercial sex and casual sex with regular partners. Thailand is widely praised for its HIV/AIDS prevention campaign. Yet problems in AIDS prevention, treatment and care persist, and laws to protect the rights of the HIV- infected persons need to be strengthened. Thai adolescents are now more aware of the risks of unsafe sex but many are not ready to adopt a safe sex life. Reproductive health education has been introduced and encouraged in Thailand for the past 10 years. Thai adolescents, however, still appear to be shy about the subject and prefer to receive the information in private. Abortion is currently legally-restricted in Thailand. Providing or self-inducing an abortion is prohibited unless it is carried out in consideration of a woman’s health or the woman has been raped or is a victim of incest. Illegal and medically unregulated abortions pose risks to women’s health. Hence, the government’s Department of Health has worked very closely with the Thai Medical Council and other key organizations to improve services to women who would qualify under the law and to offer guidelines to physicians to define what would be a negative effect on health. The problem of gender-based violence (GBV) persists. The majority of women in Thailand who suffer injuries from their spouses do not seek medical assistance or help from social services. Consequently, the Ministry of Public Health (MOPH) commenced a pilot program for One-Stop Crisis Centers (OSCCs), funded by the Ford Foundation, to assist victims of domestic violence. The program was carried out in several provinces following the success of the pilot project. The government has also tried to incorporate sexual and reproductive rights into the law, and make women feel more comfortable approaching police officers to report abuses. While expansion of the OSCC has been impressive, quality has suffered in many sites. Undocumented immigrant workers and women who are members of the minority hill tribes in Thailand are not protected by the laws, nor do they have good access to healthcare schemes. Moreover, in Southern Thailand, many medical centers have reduced their operating hours due to the fear of violence, thereby limiting women’s access to services, especially for Muslim women who may be more hesitant to use government services even when available. Challenges and Opportunities Despite progress in the areas of sexuality and reproductive health, there is still much to do. Unsustainable capacity development and a lack of funding for SRH programs is a major concern. There continues to be a gap between sexual and reproductive rights in policy and those in practice. Government agencies often lack a sense of commitment to SRH programs and the failure to integrate them remains a problem. It is also evident that many target groups remain uninvolved. And accurate and unbiased reports by the media are few and far between. 6 Fortunately, plenty of opportunities to improve the current situation do exist. Strong networks of NGOs and women’s health advocacy groups have laid the groundwork for change. A powerful movement to stop the transmission of HIV/AIDS is already in place.
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