Abortions have been legal in Cambodia since 1997, but social, cultural and religious stigmas are still preventing women from accessing them in safe settings.
As much as 40% of abortions are being performed by unlicensed practitioners, the Reproduction Health Association of Cambodia has said, even as around 1 in 14 Cambodian women are estimated to have had an abortion within a five-year period.
Abortions themselves are considered by some to be a sin, pushing the practice underground — but more than that, it is the stigma around premarital sex that is driving women into dangerous abortions.
Cambodia needs information and media campaigns that tackle the stigmas keeping women silent on these issues.
‘Bad Karma’
“Buddha taught us that we should not kill,” a monk told the Phnom Penh Post in 2002. “Unborn babies still love their lives so we should not kill them. If you kill them you will receive bad karma.”
Half of pressure against abortions comes against the practice of abortion itself, with critics often citing Buddhist principles.
But clinics say the majority of their clients are single women — and they face double the pressure due to judgment against premarital sex.
For example, a government report published in 2016 on the sexual health of adolescents in Cambodia could find only 1% of unmarried females 15-24 years reporting to have ever had sex. The report strongly qualifies this figure, saying this is “likely to be a gross underestimation and therefore does not provide an accurate picture of sexual activity among unmarried females 15-24 years.”
Unmarried women are hesitant to discuss the topic, even in an anonymous survey.
Sek Sokhom, youth health program manager at the Reproductive Health Association, sums up the widely held beliefs: “Social norms value virginity, so girls should not have sex before marriage, and those who do have sex before marriage will destroy their family’s reputation.”
It’s a factor that’s seen to be driving up the rates of teen pregnancies — as there is little discussion and poor knowledge around contraceptives — as well as the number of child marriages.
Heightened Risks
Chok Chanda, the manager of a Phnom Penh clinic, has told media that in her experience unmarried pregnant women tend to choose to travel long distances to terminate their pregnancy to avoid shame. But without proper knowledge about authorized abortion service providers, she adds, “They go to unsafe places, and afterwards they come to [the clinic] with complications.”
According to 2019 research on unintended pregnancies among adolescents, furthermore, unmarried young women commonly buy abortion medications from untrained shopkeepers at local pharmacies. “These young women try to manage their own pregnancy termination with dire results, requiring an urgent surgical intervention that causes additional economic cost and increased risk of mortality,” the research says.
The World Health Organization estimates that worldwide, 7 million women per year have been treated in hospital facilities for complications due to unsafe abortions, and says unsafe abortions are a leading cause of maternal deaths.
Widening the Research
More abortion-related campaigns and interventions are needed in Cambodia, and more accurate information on the actual lived experiences of these women — especially unmarried women — is key to tailor campaigns and interventions to the actual needs of this group.
The 2016 government report on adolescent sexual health, for instance, found that women were unlikely to answer honestly when an older person asked them questions about sex, “especially if the person is known to them, is from a higher social status, or is a local health or government worker.”
One option could be mobile phone surveys and other uses of technology to allow researchers to gather information in ways that do not require women to face a researcher in person.
Other considerations for research methods include expanding the types of questions asked and the demographics surveyed. Direct questions — such as “Have you ever had an abortion?” — can be supplemented with scenario-based questions, for example “If you had an unwanted pregnancy, what would you do?” and “Do you know where to get a safe abortion?”
These questions can help researchers understand the different levels of knowledge and perspectives depending on women’s experiences, and identify gaps in services and awareness.
Abortion research should also survey men. There is the question of whether and how much women discuss abortions with their partners. And if they do, they are part of the decision-making about whether, how and where to get abortions. They could be a source of an information for their partners, meaning that men’s knowledge and understanding of abortions is also important in helping women get safe abortions.
More Discussions
Many public information campaigns already exist when it comes to reproductive health, but they are mostly restricted to hospital environments, and the topic of safe abortions is not clearly emphasized.
Campaigns about safe abortions and the right to have an abortion should be organized in high schools or at youth events to reach those most affected by the issue: in this case, young and unmarried woman. But due to current social norms, actually conducting such campaigns could face resistance — due to potentially being seen as promoting premarital sex. To minimize adverse reactions, these campaigns could provide information about reproductive health as a whole, but with a strong emphasis on abortions.
Social media is another important channel for conducting information campaigns that can reach the target beneficiaries. Engaging influencers would be a powerful way to spread useful information related to abortions.
Without information campaigns to disseminate knowledge on safe abortions, and without public discourse about the importance of this knowledge, many Cambodian women are making life-threatening decisions in the face of judgments about whether their choices are bad, wrong or immoral.
Heng Molika is a junior research fellow at Future Forum
