Everything you should know about abortion in Singapore

You might have heard by now about the recent big news from the US. On June 24, the US Supreme Court made the decision that abortion is no longer a constitutional right and left it as a decision for the individual states to make.

While it doesn't make abortion illegal in that country, it means that each state decides what to do within its jurisdiction and the more conservative ones are already veering towards outlawing the practice.

The Supreme Court decision overturned Roe v Wade, a landmark 1973 case which ruled that women had a constitutional right to an abortion and made it legal across the country. It is seen as a victory for the political and religious conservatives who are keen on getting abortion limited or banned.

The decision was condemned by various world leaders, with New Zealand Prime Minister Jacinda Ardern, saying it was a loss for women everywhere and Prime Minister Mette Frederiksen of Denmark calling it "a huge setback".

With the issue of abortion at the forefront of many people's minds even here in Singapore, it's a good time to be informed about what the procedure actually involves and what the legalities are in Singapore.

Is abortion legal in Singapore?

Yes, it is. Abortion has been legal here since 1970 and its laws are now encapsulated in the Termination of Pregnancy Act, enacted in 1974. This law provided for the safe termination of unwanted pregnancies by trained persons in appropriately-equipped facilities.

Between Jan 1, 2020 and Dec 31, 2020, 4,029 abortions were performed in Singapore.

Abortions are legal here up to 24 weeks (six months) of pregnancy. After that, it can only be performed if the mother's life is in danger.

The procedure can only be done by a doctor who is specialised in obstetrics and gynaecology. And it has to be done in a clinic or hospital that has been approved by the Ministry of Health to perform abortions.

Women who qualify for an abortion in Singapore are:

• A Singapore citizen or the wife of a Singapore citizen.
• Someone who holds or is the wife of someone who holds a work pass issued under the
• Employment of Foreign Manpower Act. Note that this only refers to those who have a work permit of an employment pass and not a temporary work permit.
• Foreigners who have been residing in Singapore for at least four months prior to the date of abortion.
• Women who are in exceptional circumstances, such as when an abortion is necessary to save their lives.

If a pregnant woman doesn't meet any of these requirements and gets an abortion in Singapore, she can be fined up to $3,000 and/or jailed for up to three years.

The medical professional who carried out the procedure could also face the same penalties. Also, pregnant women in Singapore cannot be forced to get an abortion. Anyone who coerces, intimidates or induces a woman to do so can face the same fine and sentence mentioned above.

There is no age limit on who can get an abortion. There is also no legal requirement for parental consent for minors ie. anyone under 16.

However, every woman who wants an abortion in Singapore has to go through mandatory counselling. The job of the counsellor is to advise women on the implications and risks of abortions, as well as make them aware of the alternatives available.

What is the process to get an abortion?

Once you consult your GP or gynaecologist about getting an abortion, they will refer you to the counselling service. Women below 16 have to be counselled at the Health Promotion Board Counselling Centre (rape victims are exempted from this).

Also, women who are mentally disabled need a psychiatrist to certify that continuing the pregnancy would be harmful to the mother, before an abortion is done.

There is also a compulsory cooling-off period. After receiving counselling, women need to wait at least 48 hours before consenting to an abortion, if she wishes to proceed. The procedure cannot be done less than 48 hours after counselling.

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Women who terminate their pregnancy are required to sign a declaration of marital status, educational level and number of living children. A register is kept by the Ministry of Health with their name, date of procedure and method of termination.

Medical professionals and institutions are legally obliged to keep details of the abortion procedure confidential to protect the privacy of these patients. They may only disclose the details of the abortion procedure if she expressly consents to such disclosure.

Anyone who breaches this confidentiality requirement can be fined up to $2,000 and/or jailed up to 12 months. However, there is no confidentiality requirement for girls below 14 as it is considered as a case of statutory rape.

Patients need to undergo post-abortion counselling too. This takes place on the day of the procedure, usually after the abortion is done.

Some patients may be asked to return for a check-up a week after the procedure. And some doctors may advise women not to have sex for up to two weeks after the abortion.

What does the procedure itself involve?

There are two types of abortion procedures — medical and surgical.

Medical abortion

This can be an option for early-stage pregnancies, usually less than eight weeks, and no surgery or anaesthetic is needed. Your doctor gives you an abortion pill (Misoprostol) to induce abortion. It opens up the neck of the womb to contract the uterus and expel the pregnancy tissue through bleeding from the womb.

It feels similar to a heavy menstrual period and the whole process lasts a few days, or even weeks in some cases. Common side effects include abdominal cramps, fever, chills, diarrhoea and nausea.

It's crucial to attend follow-up appointments with your doctor so they can check via ultrasounds that all the pregnancy tissue has been expelled.

Surgical abortion

Vacuum aspiration — medication is used to dilate the cervix and a cannula (thin tube) is passed through it, into the uterus.

A vacuum suction is then used to extract the pregnancy tissue. Dilation and Curettage (D&C) — an instrument is used to manually dilate the cervix, and the pregnancy tissue is scraped away from the uterus lining using a curette.

Abortions are day-surgery procedures so you'll be able to able to go home after a short period of observation. Follow-up appointments are required too. When done in the first trimester by a qualified medical professional, surgical abortions are very safe procedures.

If you have a second-trimester abortion, they are more complicated and you'll be required to stay in the hospital for a day or two. The further along in a pregnancy an abortion is performed, the higher the risk of complications.

Where can I get an abortion?

There are three public hospitals that perform abortions:

• KK Women's and Children's Hospital (KKH)
• Singapore General Hospital (SGH)
• National University Hospital (NUH)

Many private clinics perform abortions too. They generally cost more but the waiting times are usually shorter.

Abortions in Singapore cost between $800 and $5,000. You can withdraw between $1,500 to $1,650 as part of the MediSave Maternity Package, depending on the complexity of your procedure.

This article was first published in Her World Online.