For displaced and migrant women in northern Thailand, access to health care is often limited, unwanted pregnancy is common, and unsafe abortion is a major contributor to maternal death and disability. Based on a pilot project and situational analysis research, in 2015 a multinational team introduced the Safe Abortion Referral Programme (SARP) in Chiang Mai, Thailand, to reduce the socio-linguistic, economic, documentation, and transportation barriers women from Burma face in accessing safe and legal abortion care in Thailand. Our qualitative study documented the experiences of women with unwanted pregnancies who accessed the SARP in order to inform programme improvement and expansion. We conducted 22 in-depth, in-person interviews and analysed them for content and themes using deductive and inductive techniques. Women were overwhelmingly positive about their experiences using the SARP. They reported lack of costs, friendly programme staff, accompaniment to and interpretation at the providing facility, and safety of services as key features. Financial and legal circumstances shaped access to the programme and women learned about the SARP through word-of-mouth and community workshops. After accessing the SARP and receiving support, women became community advocates for reproductive health. Efforts to expand the programme and raise awareness in migrant communities appear warranted. Our findings suggest that referral programmes for safe and legal abortion can be successful in settings with large displaced and migrant populations. Identifying ways to work within legal constraints to expand access to safe services has the potential to reduce harm from unsafe abortion even in humanitarian settings.

译文

对于泰国北部的流离失所妇女和移民妇女来说,获得保健的机会往往有限,意外怀孕很普遍,不安全的堕胎是孕产妇死亡和残疾的主要原因。根据试点项目和情况分析研究,2015年一个跨国团队在泰国清迈推出了安全堕胎转诊方案,以减少缅甸妇女在泰国获得安全和合法堕胎护理时面临的社会语言、经济、文件和交通障碍。我们的定性研究记录了因意外怀孕而进入SARP的妇女的经历,以便为计划的改进和扩展提供信息。我们进行了22次深入的面对面访谈,并使用演绎和归纳技术对内容和主题进行了分析。女性对使用SARP的经历非常乐观。他们报告说,缺乏费用、友好的方案工作人员、提供设施的陪同和解释以及服务安全是主要特征。财务和法律环境影响了人们对该方案的了解,妇女通过口碑和社区讲习班了解了SARP。在获得SARP并获得支持后,妇女成为生殖健康的社区倡导者。似乎有必要努力扩大该方案并提高移民社区的认识。我们的发现表明,在流离失所者和移民人口众多的情况下,安全和合法堕胎的转诊计划可以成功。确定在法律约束下开展工作以扩大获得安全服务的方法,即使在人道主义环境中,也有可能减少不安全堕胎造成的伤害。

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