Urogynaecology & Pelvic Reconstructive Surgery,
Minimally Invasive & Robotic Laparoscopic Gynae Surgery

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The Abortion Journey

The journey begins with the unwelcomed awareness of an unplanned pregnancy. Many tested positive in their urine after two to four weeks of period delay. A few continue to live in denial of the absent period until four to six months. The undesired pregnancy happen because of (1) early sexual activity without understanding of its consequences, (2) reckless and risk taking behaviour, and (3) inadequate information on the use of different types of contraception.

The initial days are distressing, and sufficient emotional support from close friends is helpful to keep the nerves. Amongst the teens, there is an urgency to deal with the unwanted pregnancy, usually the fear of the pregnancy being discovered constricts their considerations. When contemplating an abortion, she will choose between going to the government subsidized service or private clinics to seek help. The private clinics offer promptness and efficient care, whereas the institutions cost less. The initial consultation is to confirm the pregnancy inside the uterus and to estimate the gestational age. The mandatory pre-abortion counseling will explore the many facets of the woman arriving at her decision. The ramifications of keeping and stopping the pregnancy will be discussed. The decision should not be impulsive and the "cooling off" period is essential for the woman's emotions to gravitate.

If you are certain of the abortion, then keep well on the days prior to the surgery. On the day itself, a short fast (of food and drink) of four to six hours duraiton is required. This reduces the risk of food content in the stomach from regurgitating into the lung passages. Do arrange to come with a friend, who will accompany you home. Please do not wear nail polish or any jewellery. Wear something light and convenient, and avoid tight garments.

After the procedure, you will be recovered till you feel well enough to walk around. Pain killers and anti-nausea medication may be necessary. When you are ready, your friend will see you home. You are advised not to take a full meal immediately. You should stay away from crowded places immediately after the procedure. Quiet rest is best.

You will need to return for a review appointment one week later. Contraceptive issues will be discussed again so as to prevent further unplanned pregnancy. Most of you will have your next period in four to six weeks’ time. If your period is delayed beyond eight weeks, it is important to call in. For two to three week after the procedure, you may want to avoid sexual intercourse in order to minimize the chance of pelvic infection. We will advise you on when it is safe to resume sexual activity when we review you a week later. Emotionally, most of you will feel relieved after the TOP, as the unplanned pregnancy would have kept you worried for a while. Nevertheless, some of you will be overcome by other emotions, such as anger, regret and guilt, which may persist for some time. We strongly encourage you to discuss your reactions with us at anytime. We understand your dilemma and are available to support you through your physical and emotional recovery.

Abortion Laws In Singapore

In Singapore, the procedure to terminate a pregnancy is regulated by the Termination of Pregnancy Act (1967) and Guidelines on Termination of Pregnancy (updated 2004). Salient information is represented below: Termination of Pregnancy may be carried out only by authorized medical practitioner in an approved institution. Woman who wishes to have Termination of Pregnancy must meet the following criteria:

that she is a citizen of Singapore or the wife of a citizen of Singapore

that she is a holder or the wife of a holder of a work permit pass or employment pass. Holding a temporary work permit by either the woman or husband is not sufficient;

that she has been a resident in Singapore for at least four months.

It is not legal to terminate a pregnancy of more than 24 completed weeks, unless the treatment is immediately necessary to save the life or to prevent grave permanent injury to the physical or mental health of the pregnant woman. Since the legalizing of abortion in 1970, the Abortion Act has been liberalized on several occasions. The local community has accommodated induced abortion as a necessary evil.

Being a pragmatic multi-cultural and multi-religious society, the local laws are constructed to balance the diversities of beliefs & opinions. Strong sentiment for or against abortion is discouraged, as long as the abortion is done legally. Both the pro-life and pro-choice propositions are weaved into the majority view – which is, that the societal integrity be maintained in the promotion of individual rights.

The goverment's approach to abortion regulation is to “ensure that all children born in Singapore are wanted children, who will be properly cared for” (“Singapore sees abortions rise amid recession”, 1 May 2009). The Singapore’s live birth rate has declined from the peak of 63500 (in 1958) to about 40000 per year (in the 2000s). When the Abortion Act was first enacted in 1970, about 2000 abortions were performed. The annual number of pregnancy termination reached the maximum of 23000 in 1985 before falling to an average of 12000 a year in the first decade of this millennium. In 1986, the abortion rate was 33%, and in the last few years, it hovers around 23%. This rate is similar to many societies where legalized abortion is practiced. It has been studied that the abortion rate does not fluctuate significantly between societies (whether induced abortions is allowed or not); that which differ are the complications and death that arise from “back-street” or illegal abortions. Termination of pregnancy is not without its risk, and it is the duty of the medical practitioners and the government of the land to make it safe for the woman who has to resort to it. The official grounds for performing induced abortion in Singapore are (1) to save the life of the woman, (2) to preserve physical health of the woman, (3) to preserve mental health of the woman, (4) when the woman was involuntarily impregnated as in an event of rape or incest, (5) when the fetus is discovered to have major defect or impairment, (6) when the woman is incapacitated with economic or social issues and (7) upon request of the woman. Studies have found that majority of induced abortions are for social or economic reasons.

Abortion Service For Foreigners

A woman who is not a Singaporean cannot have her pregnancy terminated in Singapore if she has arrived on a two-week Social or Tourist Pass (except for emergency). However, a non-Singaporean may request for abortion if she has been residing in Singapore for more than 4 months; and the following documents will be needed:

Passport with the date of the entry into Singapore;

Employment pass

Work permit

Dependant’s pass

A non-Singaporean/foreigner who arrived in Singapore on a two week social or tourist pass and is found to be suffering from a miscarriage and required the clearance of the pregnancy content from her womb may request for such a surgical procedure. This is not termination of a viable pregnancy and does not come under the purview of the Termination of Pregnancy Act. Complication from the miscarriage may occur if left untreated, and therefore delaying the treatment until her return to the home country may not be advisable.

Why Is There A Need For
Pre-abortion Counseling?
Is Pre-abortion Counseling Beneficial?

Many women's initial reaction after finding out of their unplanned pregnancy is to "stop the pregnancy" as soon as possible. The immediate awareness stunned them into a knee jerk response. Naturally, the cooling off period of 48 hours, further increases their anxiety. Pre-abortion counseling helps to organize the woman's thoughts surrounding the pregnancy and the abortion. It focuses on her decision making process. It clarifies the physical aspects of terminating the pregnancy. It emphasizes on the path of psychological healing that some find difficulty with. All in all, the pre-abortion counseling hold the woman in reality to appreciate the ramifications in dealing with a difficult life-event.

Pre-Abortion Counseling

The abortion must be requested by the pregnant woman and perform with her consent. Pre-abortion counseling is mandatory.

Reporting Of Abortion

Parental consent is not legally required.

>16yrs old	Mandatory counseling by MOH trained counselor. Complete confidentiality. No parental consent needed. Partner does not need to know.
14-16yrs old	Mandatory interview by the Health Promotion Board Counseling Centre (HPB CC). A certificate of attendance will be issued before TOP can proceed. Parents not informed unless foul play suspected, i.e. sexual assault or rape. Otherwise, parents, relatives or partner not involved.
<14yrs (married)	Mandatory interview at HPB-CC.
<14yrs (unmarried) or <13yrs (married)	Committed offence of statutory rape. No medical confidentiality. Will be reported to police and parent.

Will My Parents Be Informed?

If you are above the age of 14 years old, the law does not require your parents to be made aware of your pregnancy or abortion. Nevertheless there may be occasion when we will advised that you involve the parents for your own benefit; and this is entirely your decision. In the event that you are below 14 years of age, the law requires you to attend the pre-abortion counseling at the Health Promotion Board.