Termination of Pregnancy/Abortion in Singapore
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information on who to contact and how to proceed in the event of an unwanted pregnancy. Also information on the types of termination practised, the counselling available and general health promotion.
In Singapore, abortion is legal on socio-medical grounds. The legal time limit for abortion is 24 weeks into the pregnancy.
The Age of Legal Consent and Under 21s
In Singapore the Abortion Act law states that there is no defined age limit for the abortion procedure, nor is there a legal requirement for parental consent for minors under the age of 21.
In other words just about anyone may request the procedure for unwanted pregnancy, provided they are of sound mind and body and understand the risks and details of the procedure.
Note: In contrast, if a miscarriage happens, then parental consent is required for anyone below the age of 21.
The law applies to all patients, regardless of nationality.
Legal restrictions on foreigners
Foreigners are only eligible for pregnancy termination/abortion in Singapore if one of the following criteria are met:
They have been residing in Singapore for 4 months or more
They are married to a Singapore citizen or have PR status
If they have a work permit
These restrictions do not apply to foreigners who require evacuation for miscarriage, but the age of legal consent (21 and above) will apply in this scenario.
Before the Procedure
The Abortion Law act requires that the woman undergoes brief counselling by a qualified abortion counsellor at any accredited abortion clinic, and watch a video on the subject.
Girls under 16 years of age have to undergo mandatory counselling at the
Health Promotion Board Counselling Centre. They will be issued with a Certificate of Attendance (COA) without which they will not legally be allowed to have an abortion.
There is also a mandatory waiting period of 48 hours after the counselling before the procedure can be done.
Procedure for an Abortion
There are 2 main types of abortion procedure, depending on the gestation of the pregnancy
1, For early pregnancies 3 months (12 weeks) and below, the procedure is called vacuum aspiration. This usually involves being put to sleep for about 10 minutes, during which time a small tube is placed into the womb via the vagina. An attached vacuum will then remove all the pregnancy contents of the womb.
2. For pregnancies 3 to 6 months (13 to 24 weeks) , the procedure is known as Mid Trimester Pregnancy Termination (MTPT) which is a more complicated affair. Hospitalisation is usually required for a day or two, during which medicine is inserted into the vagina to induce natural expulsion of the pregnancy. After the foetus and placenta are aborted, the process of evacuation of the womb follows. This is basically the same procedure as used in vacuum aspiration; it ensures that the womb contents have been thoroughly evacuated.
The second method takes a little longer and is messier, so it is far preferable that an early decision for abortion be made, before 3 months if possible.
Abortion in a pregnancy beyond 24 weeks
Abortion is not allowed if a pregnancy has progressed beyond 24 weeks. The legal limit of termination of pregnancy in Singapore is 6 months, or 24 weeks, beyond which abortion of any pregnancy is illegal. Most doctors would not initiate abortion beyond 23 weeks as the abortion has to be completed by 24 weeks. The only exception to this rule would be a severe or lethal foetal abnormality but even then, special approval would have to be sought from the authorities before the procedure can be done.
Limit to how early in a pregnancy the abortion can be performed
A woman choosing to have the procedure, should make an appointment as soon as possible in order to date and to locate the pregnancy so that the timing of the procedure can be planned. This is important because is not advisable to have the procedure too early in the pregnancy, as the risks of retained products and a "missed" abortion is higher.
Expected downtime after the procedure
Though the evacuation procedure itself takes only about 10 to 20 minutes, it would probably be advisable to take the rest of the day off in view of the residual effects of the anaesthesia. Recovery should be complete by the next day.
Risks with the procedure
The risks of the procedure are rare, and consist of bleeding from the womb, infection and trauma to the cervix.
Another extremely rare complication is uterine perforation, which is when the probe goes through the wall of the womb, and which requires repair via keyhole surgery.
Long term effects (including emotional and psychological trauma)
The risks of infertility from abortion carried out in a modern setting, particularly in a sterile environment, are extremely low. As for psychosocial effects, these are far less common than some sensationalist media imply. In fact the only satisfactory studies conducted in this regard show that there is an improvement in the mental well-being when compared to someone who has to go through the entire process of an unwanted pregnancy.
Nonetheless many aspects of emotional and mental well being are subjective, and coloured by social, cultural and religious influences, making this a controversial issue. The impact of regret also varies from individual to individual. A qualified gynaecologist can provide in-depth discussion and unbiased counselling.
Cost of the procedure
The cost of the surgery itself in Singapore ranges from S$300 to S$2000. The large disparity is due to variations in the type of theatre employed, the depth of anaesthesia applied and in the package inclusions. For MTPT, the hospitalisation and medication charges must also be taken into account. An accredited abortion centre should be contacted for an in-depth discussion.
Patients are also usually entitled to a medisave claim, although this may not be relevant to foreigners.
Abortion through taking medication
The practice of medical termination via taking of prostaglandins has the advantage of avoiding surgery. However it is a more prolonged process, and may involve pain and bleeding which may last for weeks. There is also a slightly higher failure rate, which may still require one to undergo a formal evacuation if the medicine fails.
Traditional medicines
The procedure should only be undertaken under the supervision of a qualified non-objecting gynaecologist trained in abortion procedures. "Traditional" or "alternative" methods of abortion using pineapples, herbs and/or instrumentation in unsanitary conditions should be avoided as complications such as infection, bleeding and sometimes infertility can occur.
The Doctor's Rights, a Woman's Choice
A doctor may refuse to perform the procedure on personal grounds although the woman retains her choice in the matter of abortion. It is the duty of every responsible medical practitioner to offer the patient a second opinion even if they object to the procedure on religious grounds.
An accredited abortion centre is a good source of unbiased objective information. The final decision is made by the pregnant woman.
The most important aspect of abortion is the decision to have one. There are a myriad of conflicting social, religious and financial issues that have to be sorted out carefully so time should be taken to make an informed decision as this is something that should not be taken lightly.