A young mother sits on a low wooden stool above burning embers from a piece of bark placed in a small earthenware pot. A bright purple and white cloth covers her legs and keeps the smoke from escaping.
This is part of a lower-body treatment process for mothers who have given birth as teenagers. She will soon lie down on a mat on the floor and receive a soothing and warming massage as her six-year-old son draws with crayons right next to her.
Aorn is now 21 years old, but looks a lot younger. She’s one of an estimated 47,400 teenagers between the ages of 15 and 19 who give birth each year in Thailand and one of many who have faced discrimination and stigmatization.
She was just 14 years old when she became pregnant after she and her boyfriend failed to use any contraception. The boy’s parents were supportive and both families met to decide how to manage the pregnancy.
Although Aorn felt positive about giving birth, her mother felt that she would be stigmatized for being a young parent and that she was likely to drop out of school.
Her mother persuaded her to take a herbal drink that would abort the foetus, which ultimately did not work. Despite this failed attempt to terminate the pregnancy, her son, One, was born fit and healthy.
“I was so relieved when he was born healthy, and I have no regrets,” Aorn told UN News. “I’m so happy to have him in my life.”
While his mother receives care, energetic and inquisitive One patiently makes crayon drawings.
Aorn’s mother was right in her prediction that her daughter would stop going to school, as is the case among many young mothers from disadvantaged backgrounds.
Eventually, she was put in touch with a small non-governmental organization (NGO) Khon Wai Sai in her hometown just outside the regional capital of Chiang Mai in the north of Thailand. Supported by the UN Population Fund (UNFPA), the organisation provides services, guidance, and small financial grants for small start-up businesses to teen mothers. It was one of those grants that helped Aorn to realize her dream of opening a coffee shop.
She now provides advice, as a peer educator at regular meetings at Khon Wai Sai, to other young women who could benefit from her experience.
“I tell young women, especially those from the countryside who do not have access to information about their options for example birth control,” she said.
“Many don’t have that information. I knew about birth control, but decided not to use it, so what I needed most from Khon Wai Sai was financial support to start a small business,” she explained.
The woman who is massaging Aorn is herself a teenage mother. Nan gave birth at age 16, and now, her daughter is now almost four years old.
She too came to Khon Wai Sai for advice and support and ultimately was promoted as a staff member.
“At my school, they didn’t talk about sexual activity,” she said. “Teachers told us that we were too young to know about reproductive health. And when I went to the health centre to get a condom, they said the same. People just wanted to gossip about me.”
Nan is now involved in small income-generating activities. She makes compost from food scraps and is an expert at raising earthworms. She also makes traditional snacks at the Khon Wai Sai centre called Dok Jok, a deep-fried bread product in the shape of a flower “which is mainly popular with older people”, she said.
Despite the challenges faced by these two women in accessing good advice, Thailand has worked hard to ensure all Thais, including young people, have the right and access to sexual and reproductive health services.
The universal health coverage system, which is available to all citizens, provides family planning services and access to a range of birth control options, including contraceptive pills, long-acting contraception implants, and up to 10 free condoms a week to every young Thai person.
Legislation introduced in 2016 to ensure the right to appropriate services and to ultimately reduce adolescent pregnancy has also proved successful. Five years after the law’s implementation, the pregnancy rate of 15 to 19-year-olds was halved from a record high in 2011 of 53.4 births per 1,000 to 24.4 births. The aim is now to go beyond the original target to less than 15 births per 1,000 women.
While the progressive legal framework and commitment to provide care makes Thailand a leader in the region for sexual and reproductive health, the letter of the law is not always adhered to by healthcare providers, and many teen mothers are still struggling to access the care they need, according to Aemmy, the Khon Wai Sai coordinator.
The legislation is relatively new, so many healthcare providers, especially in government facilities, “still have a negative perspective or attitude towards teenage parents despite the law stipulating that denying their rights is illegal,” she said.
Speaking ahead of International Youth Day, marked annually on 12 August she said more work needs to be done to ensure that young women are not denied services.
“It is the responsibility of the government to enforce the law and also to make sure health providers are properly trained.”
Discrimination and the resulting stigmatization of pregnant teens remains one of the key social barriers to them accessing care, but according to Asa Torkelsson, the UNFPA Country Director for Thailand, there are other factors.
Among them are gender inequality, poverty, sexual violence and coercion, social pressures, exclusion from educational and job opportunities, and negative attitudes about girls, she said.
Working with the Government, UNFPA has developed new partnerships, including with the corporate sector, to promote what Ms. Torkelsson calls “a more holistic approach to support girls’ rights and to empower them to avoid adolescent pregnancy”.
That approach includes age-appropriate comprehensive sexuality education for all young people, the building of “gender-equitable societies by empowering girls and engaging men and boys,”, and “measures to ensure adolescents’ access to sexual and reproductive health information as well as services that welcome them and facilitate their choices”, she explained.
Back at the Khon Wai Sai centre, One has finished his drawing and is ready to eat lunch with his mother, while Nan fries up a new batch of Dok Jok.
Both young women have ultimately accessed the services they needed and are committed to ensuring that those who follow behind them can do so as well.
*some names have been changed to protect identities