Abstract
Between 2011 and 2020, Thailand experienced a notable increase in abortion rates,
which influenced by economic, social, and maternal health factors. In response, the Thai
government introduced measures to ensure the provision of safe abortion services, including
legal amendments permitting abortions over 12 weeks but within 20 weeks of gestation.
Financial support for these services is also available through all public health insurance
schemes such as the social security scheme, civil service medical benefit scheme, and
universal health coverage scheme. Nevertheless, challenges persist in accessing healthcare
facilities due to the discretion exercised by medical personnel and facilities.
The 1663 Call Center for unplanned pregnancies, operated by AIDS Access Foundation,
offers counseling and referral services for unplanned pregnancies, ensuring safe abortion based
on individual suitability. However, budget constraints compelled the hotline to reduce service
lines from 10 to 5 lines, resulting in insufficient service capacity to meet service demand.
Consequently, there has been an increase in missed calls recorded each year. To establish
sustainable operations and enhance the efficiency of the service, a research study titled
"Assessment of the Feasibility and Cost-Effectiveness in Health Promotion and Prevention
through the 1663 Call Center for Unplanned Pregnancies under the Universal Health Coverage
Scheme" was conducted.
The study aimed to 1) examine the effectiveness of the 1663 Call Center for Unplanned
Pregnancies counseling service, 2) study the cost per unit of the 1663 Call Center for
Unplanned Pregnancies service, 3) assess the cost-effectiveness of the 1663 Call Center for
Unplanned Pregnancies service, and 4) evaluate the suitability of the current service delivery
model and the potential for expanding the 1663 Call Center for Unplanned Pregnancies
counseling services. This mixed-methods study utilized quantitative and qualitative methods,
drawing insights from the service utilization database of the 1663 Call Center for Unplanned
Pregnancies between 2016 and 2022, as well as the hotline's annual budget reports. The
research methodology included studying the cost per unit for each consultation service, costbenefit analysis (CBA) to comparing costs and benefits, and in-depth interviews with medical
and public health personnel regarding the 1663 Call Center for Unplanned Pregnancies service
provision.
Key findings include: 1) A significant increase in the amount of counseling services from
12,144 people in 2015 to 43,997 people in 2022, despite a reduction in service lines from 7
to 5 lines; 2) an average cost of 153 Thai Baht per consultation, totaling 50.8 million Thai Baht
over next four years; 3) The 1663 Call Center is cost-effective as it contribute to reduced
mortality and complications from unsafe abortions; and 4) the current service model being
deemed appropriate, allowing counseling and proper referral regarding safe abortion to
network hospitals nationwide. Limitations of the study include the absence of a tracking
system for service recipients referred for abortion between the hotline and network hospitals.
Therefore, the effectiveness of the service primarily focuses on the outcomes of referrals for
safe abortion.
Policy recommendations for the 1663 Call Center for Unplanned Pregnancies include
enhancing operational systems for efficiency and safety, integrating with network hospitals for
outcome monitoring and evaluating, and increasing financial support for sustainability.
Policymakers, particularly the National Health Security Office (NHSO), are recommended to
consider financial support by allocating a budget of 10. 5 million Thai Baht per year with the
condition that the hotline need to provide at least 70,000 services per fiscal year, and ensuring
follow-up evaluations within 5 years.
