What are the top reasons for having an abortion among Singaporean women?

Married women cite having enough children and the lack of financial capability to afford another child as the main reasons for having an abortion, according to a Singapore study, noting the need for better family planning and contraceptive counselling to prevent unwanted pregnancies.

“Recommendations to support women ought to be personalized and comprehensive in addressing their needs,” the researchers said. “Rather than offering a standardized support method, recommendations should be based on a multifaceted approach that provides the women with more perceivable alternatives outside of abortion.”

Sociodemographic data of 802 women who underwent termination of pregnancy (TOP) for social reasons at an institution in Singapore from January 2016 to September 2018 were retrospectively evaluated. The researchers compared the sociodemographic variables, response for and methods of TOP between married and single/divorced women.

Of the women, 524 (65.3 percent) were married and 278 were single/divorced (34.7 percent). Married women were more likely to be older (29.5 vs 24.5 years; p<0.001), have more living children, and have higher educational qualifications. [Singapore Med J 2023;64:302-306]

Among married women, the most common reasons for abortions were having enough children (42.0 percent) and the inability to afford another child (18.7 percent).

“We have a special interest in understanding the sociodemographic characteristics of married women, as no specific studies have been conducted in this group of women,” the researchers said.

“Marital status appears to be a significant predictor of TOP. This is because married and single women have different unmet needs when making the decision to abort. Understanding the characteristics of the women who present for abortion is important in helping policymakers in providing targeted support,” they added.

Furthermore, married women are generally in their early 30s, with two to three living children. In Singapore, the average age at which women marry is between 25 and 29 years, which explains why those who go through TOP are mostly in their early 30s. [https://www.singstat.gov.sg/-/media/files/publications/population/smd2017.pdf]

Among single women, the top two reasons for undergoing TOP were being single and not ready to start a family. Strong traditional family and cultural values of having children only after marriage could explain these reasons. Another explanation could be a perceived lack of familial support for the child and the woman should she not have a partner or the intention to start a family, according to the researchers.

In multivariate analysis, women aged >19 years and having more living children each correlated with recurrent TOPs. On the other hand, having a tertiary education was associated with less recurrent TOPs.

“These findings suggest that the family planning component of abortion counselling may not have been effective in convincing this group of women to utilize effective contraception,” the researchers said. “More studies should be conducted to identify reasons for recurrent TOPs and the effectiveness of the abortion counselling in reducing recurrent TOPs.”