Abstract
Thai Drug System and Women Health: A Case Study of Contraceptives This study is aimed to be integrative research. Its objectives are to study on Thaicontraceptives policy and their situation under the drug system framework namely selection, procurement, distribution, and use. In doing this the project looks at thestructure and process of drugs system by analyzing roles and collaborations of relevantsectors to gather critical information for women health development. The result is thusproposed in order to protect health of Thai women using contraceptives. Methods include multi-disciplinary techniques such as documentary study, interview, simulated case survey, observation, and questionnaires. Data collections are conducted at various levels from policy maker, professionals, practitioners, and consumers. Various studies show that Thai health status has changed dramatically, with longer lifespan (life expectancy = 75 years) but still face complex health problems. These came from multipart social phenomena and over utilization of technology. Sources of illness and death are changed from complicated delivery and infectious diseases to accident, committed suicide, killed, and cancers of breast and vagina. Sexually transmitted diseases (STD), AIDS, rapes as well as unwanted pregnancy and abortion are the rising problems. These situations occur in younger girls as low as 14 years old. However, numbers of abortion practices in married women are also prevalent from failed contraception together with social norms and economic constraints. Thailand is recognized as success in population control shown by the decline in growth rate as being less than one. Nonetheless, women have the most responsibility in this job (more than 90% of all contraception used). Oral contraceptives are gradually less preferred than injectables. The potent and the longer hormones used the more harmful women received. But there is less policy to motivate men involvement for family planning program showing by very few and decreased rate of men sterilization and condoms used. Thai policy on family planning focused merely on birth control hence ignored safety of hormone use for women. Lots of irrational contraceptives with unclear evidence were approved while the post marketing surveillance, re-evaluation, and improvement of package insert were worked at slow pace. Data were gathered from 14 public health facilities – one university hospital, one public provincial hospital near Bangkok, 10 health centres from Bangkok MetropolitanAdministration (BMA), and 2 health centres from Ministry of Public Health (MoPH) byinterviewing health providers and their clients together with the observation. It was foundthat services of these facilities are delivered to response more on birth control policy than on women health needs, reproductive rights, and women integrity. This reflexes by the simple services that are convenient to personnel such as contraceptives both orally and injectably. However the quality of services is questionable on the understanding, and knowledge of providers result in various forms of practices. Thai women of poverty are thus face less choice and have to accept the circumstances. Simulated cases in 23 pharmacies in Bangkok and vicinity are intended to study family planning provision, standard of practices, and dispensing behaviours. Interestingly, there was no difference between practices of pharmacist and non-pharmacist in this setting. Not enough information was given to clients asking for contraceptives in 3 various scenarios. The only useful information is probably derived from labelling and package insert. By comparing this information with legal requirement, WHO criteria, and recent academic information, we found that information from labelling and package insert were not conformed to the law and not enough for safety consumption. There was no information mentioning that contraceptives can not about STD and AIDS. The most important thing it unclear whether the package insert is intended for health professionals or consumer and lead to inadequate utilization. Post-coital contraception is currently popular among adolescent. The study done in one public university in Bangkok showed that they know this product quite well and sometimes introduces to their friends. The result from this study provides some policy implications toward reproductive health in Thailand. First, the MoPH needs to adjust their direction on reproductive health by acknowledging women rights and providing enough information for women to decide, as we as recruiting women in the policy process.
