Unplanned pregnancies are prevalent in Singapore, according to a local first-of-itskind research, which examined data of over 9,700 antenatal patients at public healthcare institutions. The women, aged 15 to 54 years old, visited eight polyclinics around Singapore between 2017 and 2020.

Called SAFE (Surveillance on Abortion and Family planning in primary carE), the study was published by SingHealth Polyclinics (SHP) in 2022. It found that one in 10 of these women had sought gynaecological referrals to manage unintended pregnancies. These individuals were predominantly single women aged below 20, above 40 years, CHAS cardholders, or of Indian ethnicity. With these findings, SHP has introduced video consultations to improve access to oral contraception for women, making family planning more convenient. Video consultations are also available for new mothers who have recently delivered, opening up opportunities for timely support for family planning.

According to the study, there was an upward trend for abortion referrals within the same three-year period. From 2017 to 2018, the increase was 26, 28.9 and 47.6 per cent among citizens of Chinese, Malay and Indian ethnicities respectively; from 2019 to 2020, the increase was 33.3, 4.3 and 48.4 per cent respectively.

The research also revealed that women of foreign nationalities comprised 15.7 per cent of those referred for unplanned pregnancy, nearly doubling in cases between 2017 and 2019. The report noted that this “sharp increase” is a concern as it not only constitutes a breach of legislation, but may indicate poor awareness of health knowledge among these women.

In addition, over 10 per cent of the patients had records of repeated referrals to terminate their pregnancies, which is a worrying trend.

Abortion risks

Abortions, though generally safe, carry preventable risks. According to Clinical Associate Professor Tan Ngiap Chuan, Director of Research, SingHealth Polyclinics, Vice-Chair of Research, SingHealth-Duke NUS Family Medicine Academic Clinical Programme, and the corresponding author of the paper, the issue of unplanned pregnancies is pertinent, particularly when it occurs among adolescents, as abortion is tied to complications such as anaemia, stillbirths, preterm deliveries, and low birth weights in subsequent pregnancies.

Repeated abortions can also lead to spontaneous abortions or the possibility of miscarriages in subsequent pregnancies, said Clin Assoc Prof Tan. Besides the physical implications, there are also the mental and emotional harms that women suffer, such as feelings of shame and guilt, or in extreme cases, depression, he added.

Clin Assoc Prof Tan added that many cases of unplanned pregnancies stem from a lack of education about contraceptive measures and family planning. There is also correlation to one’s socio-economic status. “Those from a lower socio-economic status tend to have lower levels of education and literacy; they may not be cognisant of family planning options, especially emergency contraception (commonly known as the ‘morning after pill’), resulting in unwanted pregnancies,” said Clin Assoc Prof Tan.

Managing unplanned pregnancy

Reasons for abortion are varied and solutions have to be individualised, Clin Assoc Prof Tan highlighted.

Victims of sexual violence and statutory rape notwithstanding, there are women who are not ready to start a family, as well as those who have completed their family and do not wish to have another child, he said.

Women who request for abortion referrals at the polyclinics are provided counselling on options and alternatives based on their stage of pregnancy. There are also Care Managers, who are nurses by training, on hand to offer advice to patients when needed.

In cases of advanced pregnancies where abortions are prohibited, social workers may also be activated as the pregnancy will have to be brought to term. Support, such as housing placements, for these women can be made for those who require help during their pregnancy. Discussions about whether they would like to keep the baby or consider adoption will also be carried out and the necessary support will be provided.

The study noted that an accessible community-based healthcare service to educate and counsel women on family planning is urgently needed to reduce the incidence of unplanned pregnancies. “Family Physicians and primary care professionals are usually the frontliners providing family planning services in the local communities. They are also often the healthcare providers receiving women’s requests for gynaecologist referrals to manage unplanned pregnancy. Family physicians play a key role in optimising women's health,” said Clin Assoc Prof Tan. There will thus be “ample opportunities” in the primary care setting to mitigate this issue.

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