Abortion in the Lao People’s Democratic Republic

Abstract

Ministerial Approvals in 2021 clearly articulated for the first time the wide range of circumstances under which abortion in Lao People’s Democratic Republic (PDR) is legal. These approvals likely reflect norms around abortion existent since the establishment of the Lao PDR in 1975: unregulated abortion is and remains illegal, but abortion that meets certain criteria is and has always been legal in Lao PDR. The legal status of abortion was fuzzy in practice until 2021, likely due to cultural factors. Buddhist conceptions of life and morality contribute to a widespread sense that abortion is fundamentally wrong and ought to be illegal. Laos’ political culture strongly values solidarity, meaning prolonged public discussion of potentially divisive topics is rare. As a result, abortion is often misunderstood in international research. For instance, Laos regularly appears on lists of the few countries where abortion is completely banned. Abortion is also not a politically charged topic in Lao PDR. Women’s experiences of accessing abortion are not rooted in a rights-based discourse. Instead, abortion is a possible (and legal) path in Laos, but one that entails considerable anguish and concern about its moral and ethical consequences.

Keywords:

• Lao PDR
• abortion
• political culture
• socialism

Introduction

On the 8th of July 2021, the Lao People’s Democratic Republic (Lao PDR) quietly introduced a new set of approvals stipulating the wide range of circumstances under which abortion is legal. Notably, this occurred as abortion rights were rolled back in the USA and had already been strictly curtailed in post-socialist Poland. However, little reliable information about abortion in the Lao PDR has been published, and even less is available in English. In this article, we attempt to address this lacuna by offering an informed reading of the legal and cultural status of abortion in Lao PDR. We draw on an extensive survey of Lao-language newspapers, other Lao language documents, Lao literary works, anthropological fieldwork and interviews. We untangle some of the misunderstandings that have developed regarding the status of abortion in the Lao PDR, likely due to the language barrier: Lao legal documents have been quoted to indicate—erroneously—that abortion is completely banned in the Lao PDR. Other misunderstandings are generated by Laos’ political context.

As one of only five remaining one-Party state-socialist governments (along with China, North Korea, Cuba and Vietnam), Laos has navigated the fraught issue of abortion legislation through a distinct political culture that values unity and avoids acrimonious public discussion. Laos has some of the world’s most generous provisions to support women who choose to abort, but this is not widely publicised, as abortion is also widely perceived as evil. Our article is the first we know of to assemble and assess the scarce available material on abortion in Lao PDR. It grows out of an anthropological study of pregnancy, birth and parenting in Lao PDR that mobilised literature reviews (especially reviews of Lao language sources and multimedia), fieldwork and interviews. We find that while Buddhism and socialism do influence abortion in Laos, in practice both allow for a diversity of perspectives and experiences.

Goat sacrifice

Goat Sacrifice is the name of a poem by the Lao poet Napaktaen (2019) that describes an abortion in a remote mountainous village of Laos in the 1960s. It begins:

Table

When I was little	just 8 years old
I had a problem	in my life
My mother thought	to kill my little sibling.
She had so many children	and not enough to feed them.
Birth control	was not yet available.

The poem goes on to describe how the mother, at two months pregnant, was too ill with morning sickness to adequately breastfeed her baby. The narrator, eight-year-old Ay, notes how her infant sibling cried constantly. Ay tried to help, holding the baby on one hip while taking the toddler by the hand. One day, dark blotches appear on the mother’s skin, and she falls unconscious. Ay hears her father running through the village calling, ‘my wife has taken medicine.’ A healer diagnoses opium overdose and uses banana tree sap to revive her. Ay is there when the villagers ask the revived woman why she overdosed. Ay’s mother responds that she had not intended to kill herself, but to abort the pregnancy so she could have milk enough for her baby. The father defensively asserts how hard he works in the fields and forest to feed his family. He reprimands his wife for her murderous wish.

‘Perhaps my mother received karma from that (aborted) child,’ the narrator wonders, as she tells how her mother bled without cease for a month. An elder in the village arranges a ritual cure: a goat sacrifice. The child-narrator describes the dripping blood falling from the goat’s slit throat: on her mother’s head, over her shirt, her whole body. Ay wants to cry out but is told it is taboo to make any sound. Gathered villagers watch in silence. The final line of the poem curtly notes that her mother was unwell for another year but then, everything went back to normal.

On the one hand, this poem could be read as condemning abortion. The karma brings illness and discord. The father does not sympathise with the mother’s plight. The narrator describes the foetus as ‘little sibling’ and ‘child’ throughout. On the other hand, the narrator lists very good reasons behind the abortion. The child-narrator sides with her mother, literally sharing her burdens. In this sense, the poem can also be read as a critique of the difficult situation of women in pre-revolutionary Laos. Finally, it can also be read as a portrait of illegal and unsafe abortion and a call to extend access to birth control and safe abortion even to remote, mountainous villages. The poem tells the tale of one abortion, but shows that even in a single case, there are multiple perspectives and experiences. The poem does not resolve these into one final viewpoint.

Napaktaen is clear that her poems are intended to be realistic. She states: ‘I take observations from many aspects of life that I have seen in society and present them in the form of poetry’ (2019, 9). Born in 1960 she joined the revolution at fifteen, in the year that the Lao People’s Revolutionary Party (LPRP) took power. She taught Lao language and culture at the National University of Laos until her retirement in 2021. Napaktaen is a revolutionary, and her poems can be read as examples of contemporary Lao socialist creative expression. The LPRP condemned unhelpful ‘backwards superstitions’ and women’s heavy workloads and urged husbands to sympathise with their wives and participate equally in the care of children: all themes evident in Goat Sacrifice.

The poem also weaves in elements of the mystical and spiritual: sacrifice and karma are as significant as material conditions and gender roles in shaping the family’s plight. In this sense, Goat Sacrifice is exemplary of a Lao socialist Gothic realist tendency to depict modernist desires as haunted by the past.

Laos, an exception among socialist peers?

After peacefully taking power in December 1975, the Lao People’s Revolutionary Party (LPRP) was at first pre-occupied with ‘healing the wounds of the war.’ Attaining sufficient food was hampered by punitive trade sanctions and a devastating flood in 1976. Even basic medicines were scarce. Laos did not release its first constitution until 1991. Many sectors, including reproductive health, remained legally ambiguous for years after the revolution. After an early pro-natalist ban on contraceptives, since 1988 contraceptive use has been encouraged. The LPRP has promoted ‘birth spacing’ to limit the size of families. The 1989 Penal Code introduced specific laws to punish illegal abortions, however conditions under which abortions might be legal remained a grey area.

In our extensive survey of Lao language newspapers and online material, conducted as part of a larger study on pregnancy, birth and parenting in Lao PDR, we found only one news article touching on abortion. January 2021 Vientiane Mai (2021) ran a broad social commentary decrying the rise of individualism, the diminution of parental authority, and the loss of traditional culture among some young people. Previously, it said, rituals and taboos had prevented men and women from sleeping together before marriage. Now, young people have the right to ‘live like husband and wife’ and ‘no one can stop them.’ However, if the two are not ready to have ‘evidence of their love’ (i.e. a child) then this can create ‘a problem.’ The article speculated that in such a case, the couple may look for ways to abort ‘such as: taking medicine, going to an illegal clinic, or letting another person get it out,’ but stated categorically ‘These are wrong-doings and against the law.’ Penalties specified in the penal code for illegal abortion were quoted in detail. Perhaps because of reporting like this, Laos has often been understood as one of the few countries that enforces a complete ban on abortion.

The political scientist Achim Hildebrandt (2015) found that abortion on request is now allowed in 29 out of 31 countries that are or had been under socialist governments. The only exceptions Hildebrandt identified were the Lao PDR and Poland. In post-socialist Poland, Hildebrandt links recent restrictions on abortion to the influence of Catholicism. Not having any special knowledge about Laos, he refers to its low socio-economic status: as the least developed among the countries with a communist tradition (according to the Human Development Index), and a strongly rural nation, Laos would understandably be swayed by ‘traditional values,’ or so he assumes (Hildebrandt 2015, 423). This conclusion echoes those of many other scholarly contributions that have attempted to explain abortion in Laos and tend to link a purported ban on abortion to some kind of lingering cultural or traditional inclination.

Comparing kith and kin

This apparently strict stance on abortion puts Laos seemingly at odds with other examples of state socialism, such as the Soviet Union, China, Vietnam and Cuba. The Soviet Union was the first country in the world to legalise abortion in the 1920s (Ghodsee and Mead 2018). Laos’ neighbour, Vietnam, legalised abortion in 1945 with access increasing in the 1960s and 1970s as a part of the state’s vision of creating a ‘modern socialist society, free from the entrenched gender inequalities… [of] the presocialist era’ (Gammeltoft 2014, 45).

In their 2018 article ‘What has socialism ever done for women?’ cultural analyst Kristen R. Ghodsee and historian Julia Mead propose a re-assessment of the often-underrated achievements of state socialisms (Ghodsee and Mead 2018). They suggest that the influence of communism on women’s experiences be gauged not simply by comparing socialist countries with one another, but by comparison with a neighbour that most clearly shares similarities of language, religion and culture, yet diverges in its historical engagement with socialism.

For gauging of the impact of Lao socialism on women, the best comparison is Thailand. The two countries share a long riverine border (the Mekong), a dominant religion (Buddhism), and a similar language. More ethnically Lao people live in Thailand than in Laos. In an iconic and rhapsodic nationalistic poem, Maha Sila Viravong (1952) famously claimed that the Mekong ran through the centre of Lao territory. Historians Mayoury and Pheuiphanh Ngaosavathn (1994) describe the relationship between Laos and Thailand as one between ‘kith and kin.’

However, while Laos was going through its long revolutionary struggle, socialist movements in Thailand were brutally crushed. Thailand was host and ally to the USA in its attempt to curtail the Indochinese communist revolutions and received a mixture of economic and political patronage from the Western bloc. In one of the most intense air wars ever seen, B-52 bombers were launched from US air bases in Udon Thani and Ubon Ratchathani to bombard Laos, Vietnam and Cambodia (High, Curran, and Robinson 2014). Thailand has experienced significant political instability since the establishment of a multi-party constitutional monarchy in 1932, with twelve successful coups and many more unsuccessful ones since the abolition of absolute monarchy in 1932, and twenty charters or constitutions.

In terms of women’s status, Thailand currently outshines Laos in maternal mortality, education and literacy rates, which is understandable given the chronic underfunding of Laos’ postwar health and education sectors. That said, Laos outstrips Thailand in the consistency and proportion of female representation in parliament, and Lao families report a much more equitable divide of household chores. Lao women complete 1.4 times more unpaid work than Lao men: rates that are some of the most equitable in the world, comparable to Norway and Sweden. Meanwhile Thai women completed 3.2 times more unpaid domestic work than Thai men, roughly similar to Hong Kong and the People’s Republic of China (The World Bank 2023).

One of the greatest contrasts between the two countries is how abortion is discussed. The anthropologist Andrea Whittaker (2004) reports that in her fieldwork in Thailand from the 1990s onwards, abortion was always a ‘whispered subject that few women spoke of to me’ (2004, 1) in rural villages. At the same time, sensationalist and ‘very public horror stories’ haunted Thai newspapers: raids on illegal clinics, prosecutions, and even photographs of the women charged (2004, 2). Abortion was outlawed in Thailand in 1957 yet illegal abortion increased from the 1970s onwards, leading to calls for reform from domestic NGOs, academics, health professionals and lawyers (2004, 29). Eventually a court ruling in 2020 found that abortion bans violated women’s rights, and in 2021 medically approved abortion was legalised.

Public debate, and even grisly scandal, drove this change. One turning point was the discovery of thousands of illegally aborted foetuses awaiting cremation at a Buddhist temple (Mei 2023). National and international press reports often included graphic images of bagged foetuses. The debate has been so public that Whittaker even ventures to assert that it positioned women ‘at the centre of an ongoing debate about the nature of Thai society, culture and democracy’ (Whittaker 2001, 424).

Better to die now

In Holly High’s fieldwork in rural Laos since 2002, the situation is almost the inverse: abortion is frankly discussed at the village level, but barely mentioned in media or political debate. In 2018, an ethnic Kantu woman explained that she had given birth nine times and miscarried twice. When she was pregnant after the second miscarriage, she decided to abort: ‘better to die now than live and suffer and then also die,’ she said. In the same village, a much younger woman ruminated about her unplanned pregnancy. A mother of two and still recovering from the stillbirth of twins two years earlier, she felt too weak to sustain it. She said, ‘I am risking my own life.’ She considered abortion, but a fortune teller told her it would be terrible karma. Her dreams suggested the foetus was a reincarnation of her husband’s mother. She decided to carry on with the pregnancy. In the same village, a young, unwed couple aborted, and the man paid compensation to the woman’s family rather than marry her. The compensation was decided through mediation by the village committee and consultation among the affected parties. Such frank conversations were typical, so much so that at first High experienced a kind of confusion: on the one hand, the English language literature available at that time indicated that, legally, abortion was completely banned. On the other hand, High knew people in Laos who seemingly accessed abortion easily.

All these examples took place in 2018, a few years before the release of the 2021 Ministerial Approvals that clarified—for the first time in the Lao PDR—the circumstances under which abortion is legal. Rather than indicating a radical shift of legalisation (which is, in any case, not possible at a ministerial level), we contend that these approvals merely clarified and stated what had been de facto practice for some time. The 1989 Penal Code stipulated punishments for illegal abortion, and the 2005 Curative Treatment Law outlawed abortions ‘without permission.’ Clause 201 of the 2017 Penal Code identified ‘abortions that are against the law’ as an offence (President’s Office 2017, 62). But this legal framework left open the definition of what constituted a legal and permitted abortion. It is likely that, even after the 1989 Penal Code, abortions continued to be considered legal if they were ‘correct,’ for instance, by obtaining village level or medical approval. The 2021 Ministerial Approvals thus offered for the first time clear definitions of legal abortion.

People don’t want to talk about it

In 1987 a young student of medicine and pharmaceuticals at the National University of Medicine was completing a placement in gynaecology at Mahasot Hospital, Vientiane.¹ Abortion was not part of the curriculum, but she and her classmates learned about relevant medicines in their studies, and some students even self-medicated to terminate their pregnancies. On rotation, the young student assisted a woman in her second or third trimester who arrived at the ward, alone and bleeding heavily. She came from a village around 30 kilometres from the city, leaving her children with their father. She had a worn face: the student thought she must be in her thirties at least. Her hands were calloused from heavy agricultural labour. Explaining the bleeding, the woman said she believed she was losing her pregnancy, probably due to carrying heavy rice sacks. Notably, the words used in Laos for miscarriage are the same as those used for abortion (ລຸລູກ) when the woman said she was losing her pregnancy, then, it was not clear if it she had intended to terminate it or not. And no one at the hospital asked. The woman was given intravenous pain killers, the cervix dilated and the uterus curettaged. After staying at the hospital for a couple of nights, she said she had to go back to her children. The staff called a pedicab to take her home. The gynaecologist—a Lao man trained in France—scolded her gently for working too hard and implored her not to keep carrying such heavy loads.

Reflecting on these events in 2023, this former medical student found this was typical of how she learned about abortion: everyone knew that, of course, abortion happens, but it was not openly discussed. It was managed in a practical way. Women with complications after a bungled abortion were given the same care as women having a miscarriage, without drawing any real distinction.

One retired general practitioner who worked in a hospital and a private clinic in Vientiane until the early 2020s—speaking to us anonymously in 2021—commented that even today,

‘People do not want to talk about it. It happens. Everyone in the gynaecology department does it, of course. But they won’t talk about it. Not because it is illegal, but because it is just not a topic people talk about.’

When we probed her on what exactly the procedures were for obtaining a legal abortion at the time, she was surprisingly vague:

‘I’ve heard the story if people have too many children or are poor, they can go to the hospital and ask for an abortion, but they need a letter from the village authorities, because the village level would know and understand their situation. The village chief signs off and writes a letter of explanation to take to the hospital. The woman might ask the doctor to sterilise her at the same time.’

This retired doctor had not heard of the 2021 Ministerial Approvals, indicating that these were not trumpeted as a major policy shift or a rights-based breakthrough but instead as—at most—a clarification of an administrative modus operandi already in place. It appears that until recently, medical trainees learned about abortion obliquely: on the job, through corridor talk, and by observing how teachers handled actual cases. The norm was to treat cases in a matter-of-fact way, dispensing the care women needed or asked for without much or any overt discussion.

This oblique treatment of abortion contrasts with medical discourses in other socialist countries, for instance Vietnam, where abortion is widely and openly discussed in the context of prenatal screening. Physicians in Gammeltoft’s (2014) study in Hanoi saw it as their duty to give pregnant women clear guidance on whether to keep a child or not. These physicians emphasised ‘moral values of empathy, affiliation, care and responsibility’ as motivators for directive counselling on a possible abortion (Gammeltoft 2014, 132).

Counselling around abortion may also be changing in Laos. The Ministry of Health (2022) released updated standards for midwifery care, clarifying that counselling women through legal abortions is part of midwives’ daily work. Again, the tone taken was not politicising, or appealing to moral values, but practical with the aim to improve women’s reproductive health.

The consensus from the Lao medical professionals we consulted was that what distinguished a legal from an illegal abortion was, first, the reason, and second, the practitioner. Although abortion on demand is not legal, recognised reasons for a legal abortion are very broad, including rape, failed contraceptives, having more than four children, poverty, and young age (MoH 2021).²

In terms of providers, only official medical providers (hospitals, health centres) are permitted to carry out legal abortions. This contrasts with the informal medical sector in Laos, including private clinics and pharmacy shops which may be staffed by people with partial or no qualifications. Misoprostol and mifepristone are available over the counter (Durham et al. 2016), often going by the name ya chin (the Chinese drug). Perhaps this reflects the socially marginalised people willing to sell these drugs with few questions asked, or with illegal Chinese abortion clinics reported to exist in some towns (Radio Free Asia 2019). Likely it was these illegal avenues that were targeted by the strict penalties still listed in the penal code against ‘illegal abortion.’ However, in our investigations we did not find any reports of women, clinics or practitioners ever charged with illegal abortions in Lao PDR. Abortionists have not appeared among those whose criminal acts and trials are publicised (unlike, for instance, social media celebrities who in recent years have been filmed in court or making official apologies, see for example: The Star 2021).

Buddhist evil deeds and rituals of repair

In a TikTok video that attracted thousands of views, a Lao guru offers a ‘method to repair bad karma from an abortion’ (annyxaiylath789789 2022a). She addresses the camera dressed in white, her hair pulled into a high bun and seated in front of Lao astrological and Buddhist paraphernalia. She acknowledges that abortion is not a topic people want to think about, but still a woman who has aborted ought to make an offering at a Buddhist temple at least once a year, including money, drinks and children’s clothing (annyxaiylath789789 2022a). Another video by the same contributor showed yellow-robed monks chanting over an example of such an offering (annyxaiylath789789 2022b). The original video attracted hundreds of comments, a large majority thanking and praising the contributor, some asking for more information, and some seeking to connect with this holy woman for further assistance.

This video, and other religious acts like it, reaffirms the Buddhist position that abortion is an evil, but also that—like any other misstep—it can be countered by good deeds. Unlike the Christian concept of sin, karma cannot be extinguished or absolved, but it can be outweighed: both by other considerations and by meritorious acts. In an analysis of Buddhist abortion ethics, Florida (2000) notes that the first Buddhist precept is to abstain from taking life, and in Buddhism life is usually understood to begin with conception. Furthermore, parenting, and particularly mothering, is a tremendous opportunity to show loving-kindness, compassion, and selfless nurturing: all important meritorious acts. However, Florida notes that the few Buddhist thinkers and scholars who engage with abortion ethics are overwhelmingly Western-based lay people. Florida connects this Asian Buddhist relative silence on abortion to treatments of morality: the moral path requires attentiveness to circumstances, not adherence to unquestioned rules (Florida 2000, 137–8).

In her autobiographical account of experiencing an unplanned pregnancy as an unwed mother, Lao author Dokkhoun Xiengkhuang (2019) writes of how—upon learning of her pregnancy—she immediately felt a sense of maternal care and responsibility for ‘this new life for which I am responsible, a life born from a wrong’ (21). Her boyfriend also immediately took responsibility and they planned to marry as soon as possible. She acknowledges that many readers might think she has an ‘easy heart’ to consent to sex before marriage, and agrees it was a poor decision. But is she shy to admit of breaching traditions in this way? No, she replies: the child was born of the love between its mother and father. What does make her shy, and which she thinks really is a sin, is ‘cutting off the opportunity for this child to come out and open its eyes on the world’ (2019, 27). She points out that abortion comes with emotional and physical costs for the parents, especially the mother, but more importantly it represents the destruction of ‘an innocent child who has done nothing wrong’ (2019, 28). Her partner agrees that while their sex out of marriage was a mistake, abortion is a paab (the Buddhist concept of evil).

She writes that as soon as she knew she was pregnant she felt herself to be a mother and knew in that moment the enormous virtue of parents: ‘just as one does not know the virtue of a cat until a mouse gnaws on your weaving, you don’t know the virtue of your own parents until you yourself have a child on your hip’ (2019, 22). However, when the couple broke the news to her parents, they pleaded with her to abort, marry, and then conceive again (2019, 29). Otherwise, they feared her lover would abandon her. Her older sister concurred, emphasising the sacrifice the parents made to support this younger daughter when she was little and now to study and work. Dokkhoun is persuaded, thinking: ‘they worked hard to raise me: how will I repay them (if I become a mother now)?’ (2019, 32). Dokkhoun accepts that her parents insisted on an abortion out of compassion for her. Her friends, too, concurred that she ought to abort as soon as possible. Although her maternal feelings conflict with her desire to comply to her parent’s wishes (2019, 32-33) she visits a local pharmacist to buy the medicine. The pharmacist replies that she can’t sell that pill on a Buddhist holy day, but to return the next day (they make an appointment). When Dokkhoun returns (tearfully) at the appointed time, the pharmacist replies that she has run out. Dokkhoun visits several other pharmacists, but they have all sold out or are closed. She acknowledges that readers will probably not believe this story, but protests that it was true. She called her parents that night to report that, though she tried very hard to abort in accordance with their wishes, it was not possible. After that, she could not be persuaded to consider abortion again.

This story reflects an important element of Buddhist influences on abortion in Laos. While people in Laos—when surveyed—generally agree that abortion is an evil, there is also a recognition that there are many circumstances where abortion is nonetheless the preferable option, and indeed the most compassionate course (which is another important Buddhist consideration). The 2021 Ministerial Approvals dwell intently on the reasons for a legal abortion: they can be read as a list of situations where loving-kindness, compassion, and selflessness would indeed suggest that abortion was the kindest path. Dokkhoun’s story also illustrates important inter-generational dimensions of abortion in Laos: children are thought to be indebted by the virtues of their own parents. For many, this debt is best repaid by living a respectable and happy life. Young people with an unplanned pregnancy may fear disappointing their parents more than they fear the unknowns of an illegal abortion.

As Gammeltoft (2014) found during her fieldwork in Vietnam, people’s decisions for or against an abortion are situated within claims of social attachments and strivings of belonging at the level of family, village or nation, which appear far more relevant than notions of freedom or self-determination in driving people’s decisions. Yet belonging, Gammeltoft stresses, is always ‘a fragile, contingent, and temporary achievement’ which becomes particularly evident at times of reproductive crisis, requiring people to re-consider and re-enact their connections and obligations towards others (2014, 226).

For some, this can lead to devastating outcomes. In a YouTube video, one young man—a contributor of spoken word videos with tens of thousands of followers—addresses his audience while seated before green foliage suggestive of a remnant forest (ArYoun Ssl 2022a). He recalled it happened when he and his girlfriend were both in their final year of high school. They did not use contraception. She was the only daughter of a pair of civil servants. When she discovered she was pregnant, they were too embarrassed to approach her parents to explain the situation. The pregnancy had progressed to three or four months when the young couple decided to abort. They purchased over-the-counter medicine. She was soon in significant pain and he rushed to buy Pepsi and M50 (an energy drink), thinking this would progress the abortion. But still it did not come out. Eventually they decided to tell her parents. The parents took her to a clinic in Pakse to finish the termination.

Visibly shaken, the man pleads with his viewers to learn from his mistakes: ‘Younger siblings, listen to and remember this.’ After the abortion, she was not the same, suffering from weakened health, persistent problems and strange dreams. He concluded that men should educate themselves about sexual health and use condoms. His advocacy of men’s involvement with contraception is at odds with most family planning services and reproductive rights campaigns supported by international donors in Lao PDR, which remain directed at women. His advocacy for condoms is also at odds with current practices amongst most adolescents in Laos (Keobounphanh and Toole 2008; Lorkuangming, Beban, and Stewart-Withers 2021). He also warns his listeners that medicine used in abortion can endanger a woman’s life, apparently attempting to counter a widespread perception that abortion is a viable method of contraception (Morineau et al. 2011). Finally, he warns that abortion is bad karma which will follow you in this life and future ones.

This confirms a widespread understanding that abortion is equivalent to ending your own child’s life. One Buddhist website even attempted to quantify how evil that is, saying one abortion is worth one thousand evil deeds (Phan Lao Khom (blog)) 2010). Notably, though, in Laos and Thailand Buddhist conceptions, aborted foetuses are not necessarily disgusting. Scholar of Buddhism, Justin McDaniel (2011), detailed how Kuman Thong (golden boys) are produced by some highly esteemed monks who mummify the remains of stillborn or aborted foetuses, or even children that have died in their first few years. These charms are thought to give incredibly good fortune. In practices like these, there is a distinctly Gothic overtone: an abortion, once committed, is not an end (to the pregnancy, the situation, or the experience). Instead, it persists in the form of karma, the need for ritual repair, illnesses, or even lucky charms.

Socialist, yes, but Lao socialist

The 2021 Ministerial Approvals clarifying the legal grounds for abortion in Laos emerged around the same time as the relaxation of abortion laws in Thailand, but the pathways by which legal change was achieved could hardly be more different. In Thailand, the process involved an active civil society, sensationalist news reporting, scandals, and eventually a court ruling that forced a legal change. In Laos, the 2021 Approvals were framed as a clarification. They came about without fanfare, publicity or any claim to radical change. Abortion never became a focal point for activism in Laos or a catalyst for feminist action. People know of abortion mostly from private conversations and personal experiences, or perhaps social media, but not from the newspapers, civil society agitation or political debates.

Even so, Laos now has some of the most liberal abortion laws in the world, at least on paper. Not only is abortion legal in a wide range of circumstances, there is also material support for women who choose this path. For instance, Instructions in Implementing Employee-Civil Servant Law, Clause 18 on ‘Personal and Official Leave,’ states that women employees who carry a pregnancy for two to six months but then either lose or terminate it are entitled to three months leave (Interior Ministry 2016). If the pregnancy is lost or terminated after six months gestation, the leave entitlement is five months, the same as a regular birth (2016, 11–12). During leave, these women are also entitled to financial support under The Social Security Law. First implemented in 2014 and updated in 2018, this law covers employees of private business and industry as well as government employees, such as in the bureaucracy, military and police force (and employees’ wives). This Law stipulates in Clause 12 that women are eligible for financial support if they have an abortion, just as they are when they have a live birth, a stillborn or adopt a newborn. However, Clause 24 specifies that women who have an illegal abortion are not eligible for that financial support (although they presumably still qualify for the leave) (National Assembly 2018, 5, 8). This is in stark contrast to liberal countries: in Australia, for instance, women expect some paid parental leave on the birth or adoption of a child, but the suggestion that those who abort are entitled to any leave, let alone paid leave, is not even on the agenda.

That said, there is often a gap between policy and practice in Laos, including in respect to many health interventions (for example Sychareun et al. 2010, 2012). Hence, it is wise not to assume at this stage that the very progressive legal provisions stipulating support for employees who have abortions are enacted consistently. Our study did not identify any cases where a woman had taken paid leave as a result of an abortion, but that may be due to the cultural reluctance to discuss abortion.

Laos’ approach to regulating abortion reflects an evolving approach to democratic centralism. Democratic centralism is the hallmark principle of Marxist-Leninist parties. Soviet-scholar Michael Waller’s Waller (1981) definitive study notes that democratic centralism is a contested concept, with Marxist-Leninist thinkers proposing a range of interpretations, and any given party adapting these in different ways at different times (1981, 6). Still, appeals to democratic centralism ‘run like a central thread through the history of the movement since 1905’ (1981, 5). The original formulation of democratic centralism—as proposed by Lenin—emphasised free elections, accountability and recall of elected representatives, and the free circulation of ideas. Under Stalin, democratic centralism was reinterpreted to insist on unity in the party and to ban fractionalism. A ‘two term relationship’ was imagined, between ‘the masses’ and the party leadership. While the leadership was empowered to make decisions that were binding on the masses, it was also required to be responsive to the masses, reflecting majority will. This version of democratic centralism was a condition of entry into The Communist International and thus exported to other socialist movements.

In Laos, democratic centralism has played out in a distinctive way. The LPRP is known for its remarkable unity: if there are significant disputes within the party, these are not widely known about. The leadership has also discouraged disunity in society. One reason one does not encounter the lurid and graphic reporting of abortion present in Thailand is that there is no free media in Laos. State-run media reports on current issues but not in a way that facilitates divisiveness or sensationalism. Likewise, one does not find vocal domestic NGOs radicalising debate on abortion since civil society is also closely regulated, with issues that may be divisive or cause social discord treated very carefully. It appears that abortion is considered one of those issues. The 2021 Ministry Approvals which clarify the conditions under which abortion is legal have not been widely publicised. For instance, these Ministry-level approvals were not to be found online during our investigations, although there was one English-language newspaper article reporting on their contents (Thanabouasy 2021). The Lao legal scholar who provided High with a copy of the original Ministerial Approvals was exasperated, ruminating, ‘Why does Laos make all these laws but then not make them widely available?’

This approach has its shortcomings—especially in the possibility of lack of access to safe abortion for some younger women who may be less savvy with how things work in Laos and less assertive in seeking quality care. However, there are also benefits. There is a kind of freedom when the issue is not radicalised. It leaves people free to acknowledge that range of positions on the issue are legitimate. In the poem, Goat Sacrifice, the author does not present one view or one conclusion on abortion, but instead paints a range of experiences. She leaves open the question of what the Party should offer by way of leadership in such a complex, personal and ambiguous situation among ‘the masses.’ Dokkhoun, too, was able to understand how her parent’s compassion for her led them to suggest abortion, even if she herself viewed abortion as evil. Her autobiographical account suggests that there is a range of perspectives on any one experience of unplanned pregnancy and does not insist that any particular one is right. The response from the LPRP so far has been to avoid any loud discussion of abortion that might cause social division, or risk setting one camp against another, while also quietly allowing and even supporting abortion in a wide range of circumstances.

By contrast, health care legalisation under liberal democracies has tended to frame abortion as a matter of women realising liberal ideals of ‘autonomy’ and ‘self-determination,’ and employ a language of ‘choice’ that tends to ‘grossly misrepresent […] the human predicaments at issue’ (Gammeltoft 2014, 27). Those supporting access to abortion often resort to describing it dispassionately as a right and technical solution to unwanted pregnancy. This may risk leaving little room for recognising and dealing with possibilities of what we in the Anglophone world tend to call ‘trauma,’ which seems to be a current way of talking about haunting. The Lao approach, by contrast, weds a socialist matter-of-factness about the medical side of abortion, and some of the world’s most progressive material support for women who do choose that path, to a kind of Buddhist-Gothic openness to the range of hauntings such an experience may engender in any given personal experience. Studying abortion then also requires us to consider what Gammeltoft (2014) calls ‘subdued universes of unrealized human being and relating’, and ‘lives that could have unfolded but did not’ (299).

The man who posted the YouTube video about his own experience with abortion later published a video where he recounted a ghost story (ArYoun Ssl 2022b). In Thailand, in ‘ancient times’ before safe abortion was available, a woman aged 16 or so was sent away for schooling. She fell pregnant and, abandoned by her lover, returned to her rural home. Her parents at first concealed her pregnancy and then, at four or five months gestation, arranged an abortion. A witchdoctor concocted a semi-magical potion, warning that when the child emerged, the woman must not see its face. With the dreadful inevitability of a horror film, when the moment came, she took a glimpse, wanting ‘to know her child.’ The corpse was buried not far away. That night, a great gusting wind shook the house, carrying the sounds of a crying baby. Soon, the apparition of a blood-covered infant found its way into the recovering woman’s bedroom, asking, ‘Why did you kill me?’ Every night it visited. The story concludes with the image of the villagers talking about the young woman years later: she still lived in the village, but appeared haunted, as it was her habit to walk as if she carried a child on her hip, playing with and calling to a baby that no one else could see.

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No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by the Australian Research Council, grant number FT200100346 and facilitated by a collaboration with the University of Health Sciences (Ethics approval number 555).

Notes

1 Speaking anonymously with us in 2023.

2 The 2021 Ministerial Approvals list the following medical reasons: On the part of the mother: cardiovascular disease, Thalassemia, thrombocytopenic purpura, nervous disease (mental health problems), neurological disease, cancer, kidney or liver disease, Type 1 diabetes (from birth), severe pre-eclampsia, Rubella, Toxoplasmosis, CMV, Haemophilia, Tay-Sachs disease. On the part of the child: Downs syndrome, Fragile X, Hydrocephalic, heart conditions, exposure to harmful medicines, radiation therapy over 15 rads, Molar pregnancy; Blighted ovum – pregnancy without a foetus, or if the foetus is dead. Social reasons include rape, failed contraceptives, more than four children already, poverty, and underage.