Termination of Pregnancy in Singapore: Here’s What You Need to Know

A termination of pregnancy, commonly known as abortion, is a procedure to stop an ongoing pregnancy. It's a sensitive and important topic, involving legal, medical, and emotional considerations. In Singapore, abortion is a legal and safe medical procedure performed under the regulated conditions set out in the Termination of Pregnancy Act.

Understanding the legal, medical and emotional aspects of the process can help individuals make informed decisions and avoid unsafe abortion practices.

Legal framework for medical 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, wives of Singaporean citizens, permanent residents, holders of a work pass or dependant'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 is life-threatening for the mother or if the foetus has severe abnormalities.

4. Mandatory counseling

   • Women seeking to terminate the pregnancy 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, which include:

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 artificially induce a miscarriage.

• Mifepristone

  • This medicine blocks progesterone, a hormone essential for maintaining pregnancy. Mifepristone alone can cause miscarriage in 1% of patients. If you vomit within an hour of taking this medicine, an extra dose will be given.

• Misoprostol

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

Other than these two medications, you'll also be given additional medication to ensure your safety. These medications include:

• 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

  • This medication is performed in advanced pregnancies beyond 21+6 weeks of gestation (except for fatal foetal abnormalities) before the commencement of medical termination of pregnancy 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 the 20th week of gestation and discussed by the 16th week.

If any complications occur, further treatment, such as a blood transfusion, laparoscopy, laparotomy, 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 abortion involves a minor surgical procedure and has a high success rate. It may be necessary when a medical abortion may cause an adverse reaction and harm to the patient (contraindication). These procedures are carried out in a clinical setting by trained medical professionals and include:

• Vacuum aspiration: 

  • This procedure is used up to 12-14 weeks of pregnancy. 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, and the majority of patients experience a quick and painless recovery.

• Dilation and evacuation (D&E): 

  • For pregnancies beyond 14 weeks. It involves dilating and evacuating 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

The choice to have an abortion can be made for many reasons, including:

1. Personal choice

   • Individuals may choose to terminate a pregnancy for personal, social, or financial reasons.

2. Health risks

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

3. Fetal abnormalities

   • If the foetus has any serious abnormalities or conditions that may have an adverse effect on its survival after birth.

4. Unwanted pregnancy

   • Situations where the pregnancy is unwanted and has resulted from an undesired situation, such as sexual assault.

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 reduce the risk of infection.

2. Heavy bleeding

   • Some women may experience heavy bleeding, particularly with surgical procedures. Bleeding can last between 8 and 10 days and range from light to heavy and is usually heavier than a normal period. Once the pregnancy has ended, the bleeding will usually subside.

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 manage any emotional distress.

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 contraceptive methods and practising safe sex can significantly reduce the risk of unplanned pregnancies. 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.