Termination of Pregnancy: Understanding Abortion in Singapore

Termination of pregnancy, commonly known as abortion, involves ending a pregnancy. It's a sensitive and important topic, involving legal, medical, and emotional considerations.

In Singapore, abortion is regulated under the Termination of Pregnancy Act, ensuring procedures are safe and ethical.

Legal framework for termination of pregnancy in Singapore

In Singapore, abortion is legally permitted under specific conditions outlined by the Termination of Pregnancy Act. Here are the key points: 

1. Eligibility 

• Termination of pregnancy is accessible to Singapore citizens, wife of a Singaporean citizen, permanent residents, holders of a work pass or dependent's pass, or those who have lived in Singapore for a minimum of four months.

2. Consent 

• Women under 16 are required to receive pre-abortion counselling and bring a parent or guardian for consent.

3. Gestational limits 

• Abortion is allowed up to 24 weeks of gestation. Beyond this period, it is only permitted if the pregnancy endangers the mother's life or if the foetus has severe abnormalities.

4. Mandatory counseling 

• Women seeking an abortion must undergo mandatory counselling to ensure they are fully informed about the procedure and its implications. Additionally, there is a mandatory 48-hour waiting period after counselling before the procedure can be performed.

5. Privacy 

• The law protects the privacy of women undergoing abortions, keeping all related information confidential. 

Medical procedures for termination of pregnancy

The method of abortion depends on the stage of pregnancy and the individual’s health. There are two main types of abortion procedures in Singapore:

Medical abortion

This procedure involves using medication to terminate the pregnancy and is typically performed up to 9 weeks of gestation. The process uses two medications—mifepristone and misoprostol—to induce a miscarriage.

• Mifepristone: 

  • This medication blocks progesterone, a hormone essential for maintaining pregnancy. Mifepristone alone can induce abortion in some patients (1%). You must take another dose if you vomit within one hour of taking mifepristone.

• Misoprostol: 

  • Taken 24 to 48 hours after mifepristone, misoprostol causes the uterus to contract and relax the cervix to expel the pregnancy tissue.

You will be given additional medications, including:

• Antibiotics: 

  • They reduce your risk of an infection after MTOP. You should complete the course of antibiotics prescribed for you.

• Painkillers: 

  • It relieves abdominal cramps. You may take this medication 30 minutes before misoprostol and as required.

• Anti-D (Rhogam®): 

  • If you have a Rhesus negative blood group, you may be given a prescription. You should get the injection within 72 hours of the expulsion of the pregnancy tissues. This prevents you from forming antibodies that can affect the foetus in your future pregnancies.

• Feticide: 

  • It should be performed in advanced pregnancies after 21+6 weeks of gestation (except for lethal foetal abnormalities) before the commencement of MTOP to ensure no risk of live birth.

• Lactation suppression (oral cabergoline 1 mg tablet, one dose): 

  • It should be given to women carrying pregnancies after 20+0 weeks of gestation and discussed from the 16+0 week.

If any complications occur, further treatment such as blood transfusion, laparoscopy, laparatomy or hysterectomy may be required. Your doctor should also provide you with information on follow-up plans, contraception, sexually transmitted infection (STI) screening, cervical cancer screening, and emotional and social support, where appropriate. 

Surgical abortion

Surgical abortions will involve a minor surgical procedure and have a high success rate. It may be necessary when there are contraindications to medical abortion. These procedures are performed in a clinical setting by trained medical professionals and include:

• Vacuum aspiration: 

  • Used up to 12-14 weeks. It involves gently suctioning out pregnancy tissue from the uterus, typically under local anaesthesia.

  • On average, the entire surgical procedure will take around 2 to 3 hours.

  • The majority of the patients experience a quick and painless recovery. However, periods may only start again after 5–6 weeks of the procedure.

• Dilation and evacuation (D&E): 

  • For pregnancies beyond 14 weeks. It involves dilating the cervix and removing pregnancy tissue using surgical instruments, usually under general anaesthesia.

  • This will require you to be in the hospital for around 1 to 2 days.

  • Due to the legal limit of an abortion being 24 weeks and the added complexity of D&E, the preferred option is vacuum aspiration, as it is more straightforward. 

Regardless of the type of surgical abortion, it is recommended to go for follow-up appointments with the doctor after the procedure to ensure that it was successful and recovery is taking place as planned, and receive advice on future family planning and contraception.

Reasons for termination of pregnancy

Women may choose abortion for various reasons, including:

1. Personal choice 

• The individual may opt to terminate the pregnancy for personal, social, or financial reasons.

2. Health risks 

• For situations such as an ectopic pregnancy where continuing the pregnancy poses a risk to the mother's physical or mental health.

3. Fetal abnormalities 

• If the foetus has severe abnormalities or conditions that are incompatible with life.

4. Pregnancy resulting from rape or incest 

• Situations where the pregnancy is a consequence of rape or incest.

5. Other circumstances 

• Other personal or familial circumstances that make carrying the pregnancy to term untenable.

Risks of termination of pregnancy

Although pregnancy termination is generally safe, it does carry certain risks, including:

1. Infection

• There is a small risk of infection following the procedure, which can be managed with antibiotics. Remember to avoid sexual intercourse to avoid the risk of infections.

2. Heavy bleeding

• Some women may experience heavy bleeding, particularly with surgical procedures. Bleeding can range from light to heavy and is usually heavier than a normal period. It should decrease after the pregnancy has been expelled. It lasts an average of 8 to 10 days. Remember to use a sanitary pad and not tampons.

3. Incomplete abortion 

• In some cases, the abortion may not completely remove all pregnancy tissue, requiring a follow-up procedure.

4. Injury to the uterus or other organs 

• Surgical procedures carry the risk of injury to the uterus, cervix, or other organs.

5. Emotional and psychological impact

• Women may experience a range of emotions, including sadness, relief, or guilt. Access to counselling and support is important.

Emotional and psychological considerations

Undergoing a pregnancy termination can be an emotionally challenging experience. It is important for individuals to have access to support and counselling services to help them cope with any emotional distress. 

Support from family and friends, as well as professional counselling, can be beneficial during this time.

Termination of pregnancy is a legal and safe medical procedure in Singapore, provided it is conducted under the regulated conditions set by the Termination of Pregnancy Act.

Understanding the legal, medical, and emotional aspects of the process can help individuals make informed decisions. If you are considering a termination of pregnancy, it is important to seek medical advice and support to ensure your well-being throughout the process.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a gynaecologist at Thomson's Women Clinic.

FAQ

Is termination of pregnancy safe?

Yes, when performed by trained medical professionals in a regulated medical setting, abortion is a safe procedure. Although complications are rare, it is important to follow medical advice and attend follow-up appointments to ensure proper recovery.

What are the costs associated with termination of pregnancy?

The cost of an abortion varies depending on the method used and the healthcare provider, typically ranging from several hundred to a few thousand Singapore dollars. Financial assistance may be available for those in need.

Can I get an abortion without my parents knowing?

If you are under 16, parental consent and counselling are required. If you are 16 or older, you can decide independently. All information will be kept confidential.

Will having an abortion affect my fertility in the future?

Most women do not experience long-term fertility issues following a safe, legal abortion. However, it is crucial to follow post-procedure care instructions and attend follow-up appointments to ensure optimal recovery.

What support is available after an abortion?

Support services, including counselling and support groups, are available for individuals who need emotional or psychological assistance following an abortion.

How long can I return to normal activities after an abortion?

Recovery times may vary, but many women can return to normal activities within a few days. It is crucial to follow your doctor's advice and avoid strenuous activities until you are fully healed.

Is it necessary to have a follow-up appointment after an abortion?

Yes, a follow-up appointment is important to ensure that the abortion is complete and to check for any complications.

Are there any risks associated with abortion?

Like any medical procedure, abortion carries some risks, including infection, heavy bleeding, and injury to the uterus or other organs. However, these risks are low when the procedure is performed by a qualified healthcare professional.

What are the alternatives to abortion?

Alternatives to abortion include carrying the pregnancy to term and either parenting the child or placing the child for adoption. Counselling can help explore all options and support decision-making.

How can I prevent an unplanned pregnancy in the future?

Using effective contraception methods and practicing safe sex can significantly reduce the risk of unplanned pregnancy. Consult with your healthcare provider to determine the most suitable contraception method for you.

The information provided is intended for general guidance only and should not be considered medical advice. For personalised recommendations and tailored advice, please consult a specialist by requesting an appointment with Thomson Medical today.