Terminating a pregnancy is not an easy decision; in Singapore, the number of abortions has declined over the years, with about 10,000 abortions per year. There is no minimum or maximum age for abortion in Singapore, nor legal requirement for parental consent. However, mandatory pre-abortion counseling is required and this has to be conducted at the Health Promotion Board Counseling Centre for those below 16 years old (except for rape victims).
Different circumstances for the unplanned pregnancy will have its own considerations; however, abortion is prohibited after 24 weeks of pregnancy unless it is a medical emergency. Therefore, there is a time limit to decide and the medical options available also differ during different trimesters.
Common reasons for abortion
– Teenage pregnancy, and impact on school and ability to care for the baby
– Lack of finances or unsuitable family situation
– Difficulty with being a single parent or existing issues with partner
– Medical considerations
Common questions to ask yourself before an abortion
• Would I consider putting the child up for adoption?
• Do I have strong religious beliefs about abortion?
• Can I handle the experience of having an abortion?
• Am I being pressured to have/ not to have an abortion?
• Am I willing to have a record of me going for an abortion?
You have to go to the doctor or gynecologist to discuss the options and understand about abortion. You may have your partner, family or close friends to be with you during this time. There is no study that show abortion is more traumatizing than going through with the pregnancy, particularly if the circumstances surrounding an unplanned pregnancy may also be stressful or distressing. In Singapore, there is a mandatory waiting period of 48 hours after the medical counseling before the abortion can be done.
Medical options for abortion
Medical Abortion – First trimester, up to about 8 weeks
This refers to medicine being administered either vaginally or orally over a period of two days. The medication causes strong contractions of the uterus, dilation of the cervix and expulsion of the pregnancy. The first medicine is mifepristone, usually taken at the doctor clinic and the second medicine is misoprostol, administered several hours later.
The side effects of the medicine include abdominal pain, cramps, vaginal bleeding and these may be mild or strong. Some women also have fever, nausea, vomiting, or diarrhea. You can take 600 to 800 mg of ibuprofen every 6 to 8 hours for pain, or may be prescribed a stronger pain medication to use if needed. You can also use a heating pad on your abdomen. If you have severe pain that is not relieved by these treatments, call your clinic immediately. If you have severe bleeding or do not have bleeding at all after you take the medications, you should also call your doctor.
Surgical Abortion – Up to second trimester
This refers to vacuum aspiration where (i) a local anesthetic is inserted into the cervix, (ii) the cervix is dilated, (iii) a thin tube is passed through the cervix and into the uterus, (iv) pregnancy tissue is suction out of the uterus and (v) a curette may then be used to ensure the complete removal of pregnancy tissues. Preparation is required before the procedure, such as conducting another scan and medication to stop the fetus’ heart.
It is important to discuss with your doctor what you would expect for the procedure; for instance, a 10-week fetus is about the size of a grape and if you’re worried about what you’d see when the pregnancy is expelled after the medical abortion, let the doctor know. Some women prefer the surgical abortion even early in the pregnancy as there is less pain and all is conducted at the clinic. However, a surgical abortion may feel more invasive and may also require the fetus to have developed.
A declaration of marital status, educational level and number of living children is required to be signed. The Ministry of health maintains a register of all treatments to terminate pregnancy that records the patient’s name, date of procedure, and method of termination. An abortion can cost from $800 to $5000, depending on the procedure and whether the procedure is conducted in a restructured hospital or private clinic.
Complications of abortion
An abortion is a fairly safe procedure, especially if it is performed in the first trimester and by a trained professional. However, to check for complications, there is usually a post-abortion counseling and consultation session a week after the procedure. There is also higher risk of infection and therefore sex is best avoided up to two weeks after the procedure. The possible medical complications of abortion are:
i. Hemorrhage (excessive bleeding) – occurs in about one in every 1,000 abortions
ii. Damage to the cervix – occurs in no more than 10 in every 1,000 abortions
iii. Damage to the womb – occurs in up to four in every 1,000 abortions during surgical abortion, and less than one in 1,000 medical abortions carried out at 12-24 weeks
iv Uterine perforation – where a probe goes through the wall of the womb, which requires repair via keyhole surgery, rare complication
v. Incomplete abortion – part of the pregnancy is left inside the uterus
Apart from medical complications, some people do experience guilt and sadness after an abortion. These feelings are legitimate and in Singapore, you can call the Pregnancy Crisis Service, Alife or Babes.