Ministry of Health to Make Pre-Abortion Counselling Mandatory

The Ministry of Health (MOH) has announced that it will make pre-abortion counselling mandatory for all women seeking an abortion. This is truly a step in the right direction. Here is the link to the news report.

Ministry of Health to Make Pre-Abortion Counselling Mandatory

SINGAPORE: The Health Ministry intends to make pre-abortion counselling compulsory for all women seeking to end their pregnancies. This comes after a month-long public consultation exercise on Pre-Abortion Counselling Criteria was completed on Dec 3.  But the ministry has not said when the change will come into effect.

The review was carried out as the Health Ministry recognised that some of its criteria needed to be in line with the shift in Singapore’s demographic and social landscape. The criteria for pre-abortion counselling was established since 1987 and has not been changed since. Currently, pre-abortion counselling is only compulsory for women who are:

  • Singaporeans and Permanent Residents
  • Those who have passed the Primary School Leaving Examination.
  • Those who have some secondary education
  • Those with fewer than three children

A cooling-off period of at least 48 hours takes place before the woman gives consent to the abortion. This allows her time to consider her options carefully before deciding.

Currently, counselling is conducted by a trained counsellor like a doctor or a nurse in institutions approved to carry out Termination of Pregnancy (TOP) under the TOP Act and Regulations. These include both public and private healthcare institutions. Unmarried pregnant women below 16 years old are counselled at the Health Promotion Board Student Centre.

In 2013, 7,177 women underwent pre-abortion counselling, and the number of pregnancies kept after counselling was about 300. There were a total of 9,282 abortions in 2013, compared to 10,624 in 2012.

While counsellors and health experts acknowledge that only a minority of women change their minds after the pre-abortion counselling, these experts say every woman still deserves the right to the counselling sessions to make a more informed decision.

“Regardless of what you feel about abortion, I suppose you wouldn’t be against the provision of information. In fact, it’s the duty of the doctor to provide such information for any procedure including this one,” said Dr Chia Shi-Lu, Chairman of the Government Parliamentary Committee for Health.

“But I suppose because of the sensitivity of this, many people do feel there should be some legislated obligations which must be documented and this counselling process is formed. So if you believe that, then we should be agnostic who gets this counselling, because a patient is a patient regardless of how many kids you have or whether you are Singaporean or not.”

Ms Jennifer Heng has had two abortions – the first when she was 17 and another at 19. She had her abortions at a private clinic and did not receive any pre-abortion counselling.

“My first abortion was a very late-term abortion. I did not know that I was going to have to go through eight hours of induced labour until the first contractions began,” she recalled. “To my horror, at 17 years old, I realised I was going to have to go through labour pains for whatever number of hours. By that time, it was too late. I might have thought twice that if (I knew) this was the kind of pain, process I would have go through.”

She believes that more social support during the pre-abortion counselling will also be very helpful. “Social and emotional support would have really helped me. At 17 years old, unwed, a student and I can’t tell my parents because I think they will kill me, you giving me medical information doesn’t really help me,” she said. “It would have been great if the counselling included social support and assurance that there are other options, and someone to help me walk through those options. I might have chosen differently.”

– CNA/xy

Here is our submission in response to the public consultation conducted by the MOH:

(A) A Step in the Right Direction: Pre-abortion Counselling

The Ministry of Health’s (“MOH”) proposal to extend pre-abortion counselling to all women seeking an abortion in Singapore is a long awaited and very welcome change. The current criteria is not only irrelevant due to the change in Singapore’s demographics and shift in social landscape, but also discriminatory as it restricts access to further healthcare options and advice for pregnant mothers who fall into certain arbitrary categories. As such, we applaud MOH’s proposal to extend pre-abortion counselling to all women regardless of citizenship status, level of education and number of children.

First, extending counselling to all pregnant women regardless of citizenship status is a compassionate change. Even as Singapore opens her doors to more migrants, we should remind ourselves that these foreign women, whether they be transient workers or employment pass holders, deserve the same access to proper healthcare and counselling as our own mothers, sisters and daughters. Abortion is a serious irreversible decision and warrants careful consideration of the consequences.

Second, the dismantling of the distinction tied to education, which was originally introduced into our laws based on outdated concepts of eugenics and population control policies in the 1970s, is another welcome move by the MOH. While the need for population control might have been deemed necessary in the preceding generations, education on the use of proper contraception, instead of abortion, should have been the solution. As for eugenics, though it was promoted by the racist founder of Planned Parenthood, Margaret Sanger, we, in the modern age, should view it as an intellectual bankrupt ideology. Thus, the removal of the PSLE and secondary school criteria for pre-abortion counselling, which is incapable of being substantiated and politically incorrect, is a wise decision.

Third, providing pre-abortion counselling for all women regardless of the number of children she already has will allow for a more internally coherent government policy and better reflect the current government’s attitude towards parenthood and children. It would be contradictory if MOH were to retain such a criterion for pre-abortion counselling when other ministries are encouraging families to have three or more children.

Fourth, the expansion of pre-abortion counselling to all women seeking an abortion and not just married women is a more accurate reflection of society’s changing attitudes and growing acceptance of single mothers. While the stigma still remains, the focus should be on combating root problems in society leading to unwed mothers instead of getting rid of unwanted babies. In tandem with this, it would be meaningful if the government could consider introducing greater measures to provide single mothers, especially those who have become so inadvertently, with a stronger safety net and support system.

We note that it is widely acknowledged in the medical field that healthcare is not restricted to operative procedures and pharmaceuticals, but a holistic delivery of care. This includes various types of counselling, therapies and other types of treatment which attend to the psychological, environmental and spiritual needs of a patient. Expectant mothers should be provided with more choices especially when they find themselves unexpectedly pregnant and lacking a proper support network to guide them through the process of pregnancy.

We approve of MOH’s step in the right direction and offer additional complementary measures that will ensure the effectiveness of this new change will not be diminished.

(B) Additional Measures to Consider: Training of Counsellors, Independence of Counsellors, Crisis Hotline

We proffer three suggestions to bolster MOH’s proposal to extend pre-abortion counselling to all women: (1) invest in the training of counsellors specialising in this area of pregnancy and motherhood; (2) safeguard the independence of counsellors; and (3) setting up of a crisis hotline where women can obtain help or resources that will allow them examine the full extent of the options available to them.

(i) Invest in the training of counsellors

The lack of trained counsellors and specialists would greatly reduce the efficacy of pre-abortion counselling. To meet the demands of the hundreds of pregnant women who would qualify under the expansion of the pre-abortion counselling criteria, MOH (in collaboration with other relevant ministries and/or NGOs, VWOs) should consider investing in the training of counsellors who will specialise in this area of pregnancy and motherhood. These counsellors will be able to give specific advice relating to the gestational age of the unborn child in the womb, information about foetal development, the risks of abortion, including the physical and mental side effects, etc. as well as direct pregnant women, especially those from low-income families, to the resources available to them, e.g. women’s shelters and adoption agencies

(ii) Independence of counsellors

To avoid any issues of conflict of interest, we urge MOH to enact strict safeguards to ensure the counsellors be independent parties who will have the welfare and best interest of the pregnant mother at heart. One clear restriction would be that the physician or any abortion provider scheduled to perform the abortion may not also provide the pre-abortion counselling. A clear separation between the abortionist and counsellor will protect the pregnant woman, who is often times at her most vulnerable state, from being taken advantage of by parties seeking to make a profit.

(iii) Crisis hotline

Another suggestion is the setting up of a crisis hotline (which could be manned jointly with other relevant ministries) where pregnant mothers can obtain help or resources that will allow them examine their options in a more rational manner. Women who face an unexpected pregnancy need a lot of care and support so that they will not be pressured into making decisions that more often than not have grave consequences on their physical and mental health and wellbeing. Alternatively, to avoid duplicating efforts, existing hotlines run by volunteers or non-profit organisations can be provided with funding and resources.

Supplying trained counsellors and guaranteeing their independence would serve to strengthen the pre-abortion counselling process and prevent it from becoming a time-wasting exercise or another procedural hoop for women seeking an abortion to jump through. The ultimate goal is ensure that pregnant mothers are aware of, and have access to, viable alternatives to abortion such that they may come to a decision free of unnecessary and undue pressures.

(C) Moving Forward

The MOH should consider reviewing three issues in the near future: (1) extending the mandatory waiting period beyond 48 hours; (2) introducing parental consent as a requirement for abortion for minors under 21 years of age; and (3) shortening the liberal 24-week term limit of abortion to be aligned with other developed nations, e.g. France, Germany, Italy, Austria, Belgium, Denmark, Luxembourg, etc.

We look forward to contributing to future discussions on the abortion laws in Singapore. Thank you.

Here are some links to insightful articles on the issue:

Public Consultation on Pre-Abortion Counselling Criteria (3 Nov 2014 – 3 Dec 2014) (Ministry of Health)

Provide support, comfort to all women mulling over abortion (Shelen Ang)

Pre-abortion counselling should be holistic, affirming (Darius Lee)

Don’t understate risks of abortion (Leo Hee Kian)

Consider complementary measures to pre-abortion counselling (Charis Seow)

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