Abortion is a decision that should not be taken lightly and should be an informed decision after careful consideration of all the facts.
Singapore has well-defined and strict regulations about how abortion should be conducted. The purpose of this article is to provide you with the facts about abortion in Singapore.
Today the Termination of Pregnancy Act Singapore is still in effect in the country. Since 1970, abortion on request has been legal in the country.
The Termination of Pregnancy Act Singapore 1985 is a minor expansion on the Abortion Act 1974.
Based on 2017 statistics, there were 6,815 reported abortions in the country. This was the lowest yearly abortion figure since 1973, a drop of half in just a decade.
The latest data from 2020 shows that there were 4,029 recorded abortions. This works out to a rounded-up average of 336 abortions per month.
The act applies to a wide range of women.
In addition, women who are married to a citizen or permanent resident of Singapore or a holder of a work permit pass, also qualify under the Termination of Pregnancy Act Singapore.
There is a special exemption for women that do not fit in any of these categories. If it can be medically justified that the pregnancy directly endangers a woman’s life, the termination can be carried out by a licensed health professional.
However, the limit for pregnancy termination in Singapore is 24 weeks. To calculate how long you have been pregnant, you should count the number of weeks beginning from the first day of the last menstrual period
Interestingly, there is also no legislation on the minimum age of eligibility for an abortion. In fact, patients who are under 16 years of age do not need parental consent but will require a special certificate after undergoing specialized counselling at the Health Promotion Board Counselling Centre.
If you need an abortion due to an unplanned pregnancy, the first step you have to take is to visit a licensed abortion clinic. The doctor will verify if you are eligible for an abortion.
If your first point of contact is with a doctor who is an objector on religious grounds, do ask for a referral to a non-objecting specialist. This applies to doctors in both public and private health institutions.
Since 2015, all women in Singapore applying for an abortion must attend counselling with a trained counsellor before they proceed with their decision. Studies show that most women that have had an abortion will feel less anxious following the session. A licensed abortion clinic should have staff and/or doctors who are qualified counsellors
In addition, the specialist gynecologist leading the consultation will verify that the patient does not suffer from any pre-existing health conditions that may complicate the abortion process.
The doctor will also ensure that the patients who are considering abortion are well informed about the procedure as well as about the alternatives to abortion.
The counselling is meant to be informative and non-judgmental and ultimately the final decision of the patient is upheld. If the medical professional is an objector on moral grounds, he is ethically bound to refer the patient to a non-objecting colleague for more objective counselling.
Throughout all this, patient confidentiality is held with paramount importance and protected by law.
There are also special measures for unmarried girls under the age of 16. They must attend abortion consultation at the Health Promotion Board Counselling Centre, from where they will receive a valid Certificate of Attendance (COA). The COA is mandatory for women in this age group who wish to have an abortion.
Once the pre-abortion consultation has been completed, the patient will need to wait a minimum of 48 hours before the procedure can be carried out.
This period is designated for the woman to be able to digest and process what was discussed during her prior consultation in order to empower her to make an informed decision.
In Singapore, abortion statistics are collected. However, the details of the data are confidential, and this confidentiality is protected by law.
A trimester is a term used to describe a period of 12 weeks. The type of abortion procedure, its complexity, and how long it will take will depend on how many weeks the patient has been pregnant.
First trimester Abortions can be performed via one of 2 methods – medical and surgical.
A medical termination is conducted entirely using medication with no surgery required. In Singapore, two medications are licensed for the process: mifepristone and misoprostol.
Mifepristone or RU486 is a medication that primes the cervix to enhance the effect of misoprostol which is administered subsequently.
Misoprostol induces menstrual cramps that will expel the fetus from the patient’s body.
Surgical abortion is a procedure that is carried out with local or general anaesthesia. This is generally carried out via vacuum aspiration and curettage procedure when a device is inserted into the uterus to suck out the pregnancy tissue.
Outpatient medical terminations can only be carried out reliably for pregnancies up to 9 weeks. Surgical intervention is usually required for more advanced gestations
The main benefit of medical abortion in Singapore is that no anaesthesia is required for this procedure to be conducted and it is perceived to be less invasive.
However, there are a host of disadvantages, including unpredictability regarding the timing of expulsion; longer duration and multiple follow up checks; significantly more pain and bleeding; as well as the unpleasant experience of disposing of the expelled tissue personally. Plus, the fact that there is a failure rate 5x higher than that of surgical termination requires a surgical intervention eventually anyway.
It is evident that the medical procedure will occupy much more of the patient’s time and is therefore unsuitable for busy individuals who have a busy schedule
Alternatively, the surgical option, if conducted in the right hands, is a planned process that has a 99% success rate, is significantly less painful and involves less blood loss; and has a predictable outcome with assured same-day resolution.
Most abortions will take place in the first trimester period before the 13th week.
On average, the entire surgical procedure will take between 2 and 3 hours. The reason for this is that you will have to wait for the sedative that you were given to wear off. This takes around an hour or maybe more. In reality, the entire abortion operation takes only around 20 to 30 minutes.
For first-trimester surgical abortions, the vast majority of patients experience a quick and comparatively painless recovery. You should expect non-serious symptoms such as cramps and mild bleeding. The patient should be fine to function by the very next day after a good night’s sleep and the anaesthetic has worn off, but the resumption of periods may take 5-6 weeks.
Once you pass 12 weeks, the abortion process becomes more complicated. The second-trimester surgical procedure will probably require you to be in hospital for one to two days. It usually involves 2 steps.
The first step involves medication inserted vaginally to induce contractions and to open the cervix.
After natural expulsion of the fetus, a second step may be required where an evacuation of the remnant material in the uterus may be carried out in the operating theatre under anesthesia, particularly if the placenta has been retained.
Due to the added complexity and expense of a second-trimester abortion in Singapore, the more straightforward first trimester procedure is by far the more preferred option. It is also important to be mindful of the fact that the legal limit is 24 weeks.
The cost of abortion in Singapore will depend on whether it is conducted by a government-run hospital or at a private clinic.
At a public hospital, the total cost of a first-trimester surgical termination will tend to range from $750 to $2000. While at a private healthcare provider you should expect to pay from $1000 to $4000.
For citizens and permanent residents, a Medisave deductible of S$900 can be used for surgical abortion.
Abortion is very safe as long as it is conducted by licensed health professionals. It is estimated that the chances of complications from abortion are less than 1% with death being a very rare occurrence.
In both medical and surgical abortion, there is a 1 in 1000 chance of womb damage, heavy bleeding, and infection.
With medical abortion conducted before 14 weeks, 70 in 1000 women need to return for another round of treatment to remove the remaining pregnancy tissue.
Damage to the cervix occurs on average in about every 10 in 1000 abortions.
The risk of infection is substantially lowered by the use of antibiotics, which is important as an ascending pelvic infection can affect future fertility as well as lead to chronic pelvic pain.
Many unjustified myths exist on the internet and the wider public sphere about the side effects of abortion.
There is no convincing evidence that having an abortion will increase your chances of having cancer, nor will it lead to the development of any permanent mental health issues.
The much exaggerated notions of pelvic infection leading to infertility are drawn mainly from data pertaining to unlicensed backstreet abortions and are in fact extremely rare in our current medical setup.
Overall, abortion can be considered as one of the safest medical gynecological interventions.
After an abortion, one should refrain from driving and any activity requiring mental alertness. Typically, an overnight sleep is required before all the effects of the anesthesia have worn off.
Painkillers are usually effective in dealing with post-procedural cramps. As the natural defences of the cervix need time to be reconstituted, vaginal intercourse and penetration should be avoided for a couple of weeks; during which time sanitary pads are preferred to tampon for management of the bleeding.
Medical attention should be sought if there are signs of infection including severe pain, unrelenting and profuse bleeding, fever and/or an abnormal greenish or yellowish discharge.
And of course, in the medium to long term, suitable effective contraception should be employed to avoid a repeat procedure, until such time that one is ready for pregnancy.
Abortion is widely available in Singapore, and only qualified medical practitioners are licensed to provide it.
In addition, Singapore’s abortion laws are liberal and progressive, with an emphasis on impartial information provision and empowerment of personal choice for the woman, with strict medical safeguards in place to protect her wellbeing and fertility.
We hope that this article has addressed the most pertinent questions about this understandably difficult and important decision.
We practice an open and non-judgmental approach at The OBGYN Centre. Should you have any questions or concerns at all, please contact us via our hotline or email address.
The OBGYN Centre
#11-07 Paragon Medical Suites
290 Orchard Road
T +65 6235 4188 / +65 9100 3874
E [email protected]
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