The Singapore government should reconsider its ban on social egg freezing, said gender equality advocacy group AWARE Singapore on Thursday (10 June).
In a statement on Facebook, the group noted that many women who are unhappy with the ban in Singapore—which only allows women to freeze their eggs for medical reasons—have decided to seek the service abroad instead.
Arguing that the ban on social egg freezing “restricts the reproductive rights of women”, AWARE said: “Men can reproduce well into middle or even advanced age, while women have an age limit because of biology.
“Socio-economic conditions create barriers to having children earlier in life for both women and men, and by not allowing social egg freezing, we are denying some women the opportunity to become a parent.”
The group went on to counter five commonly cited arguments in favour of the ban. First, that allowing social egg freezing would encourage women to delay parenthood.
AWARE said that this argument “imagines fertility as a purely biological decision, divorced from social and economic considerations.”
Dismissing it as “inaccurate”, the group notes that surveys have shown that the decision to become a parent is influenced first and foremost by a person’s ability to achieve economic stability and find a suitable romantic partner.
“Anyway, even with the ban in place, the median age of first-time mothers in Singapore rose from 29.7 years in 2009 to 30.6 years in 2018,” it added.
The second argument AWARE countered was that women who choose to freeze their eggs are not aware of the low rate of successful conception and that ‘geriatric’ pregnancies tend to have more complications.
To this, the group responded: “The solution here is to mandate that doctors provide comprehensive information about the possible medical and other risks involved, instead of taking the option off the table entirely.”
It also noted that the connection between chronological and biological age is not straightforward as there are many women who are able to convince naturally in their 40s and others in their 20s for whom pregnancies “do not stick”.
On the argument that social egg freezing would “erode Asian family values” and turn pregnancy into a commodity, AWARE merely cited adoption and IVF which has led to familial connections. It asked, “Why should this be different?”
Next, there is the argument that social egg freezing is an individual solution to a social problem that women face in the workplace.
AWARE noted its agreement to this point, highlighting that to really support women who want to have children, the country should focus on advocating for progressive labour policies.
“However, there’s no reason why we can’t have both structural change and individual solutions simultaneously,” it added.
Finally, on the argument that reproductive technologies then to have class biases and would only allow a narrow category of women to reproduce, thus deepening inequality among women if there are no effective policies in place.
Acknowledging this as a “good point”, AWARE went on to stress that social egg freezing should be made accessible to all women regardless of marital status, financial capacity and educational status should the ban be lifted.
These recommendations follow the 2019 enhancements to co-funding for IVF treatments as announced by the government, the group noted.
The statement concluded, “Ultimately, the government should reconsider its ban on social egg freezing.
“Women should have the right to choose how and when to bear children, based on informed decisions.”
Back in 2017, Member of Parliament, Cheng Li Hui asked the Minister for Health about the number of egg freezing procedures carried out at Singapore’s public and private hospitals respectively over the last three years and how prevalent are the risks of the procedure, such as infection and bleeding.
Then-Senior Minister of State for Health (Dr Amy Khor Lean Suan) answered on behalf of the Minister for Health, saying that egg freezing is currently only allowed either as part of an in-vitro fertilisation (IVF) procedure for married women; or for women diagnosed with medical conditions, such as cancer, for which the treatment may damage or destroy their ovarian functions.
She added that from 2013 to 2015, an annual average of 2,700 and 1,400 fresh IVF cycles was carried out respectively in public and private assisted reproduction (AR) centres. Noting that the Ministry of Health (MOH) monitors the number of IVF cycles carried out, rather than the egg freezing procedures conducted.
Based on estimates from licensed centres conducting IVF, complications from over-stimulation of ovaries, which could result in abdominal pain and vomiting in severe cases, occur in less than 1% of the cases. Likewise, the risk of infection and bleeding is low, with a prevalence of less than 1%.
Dr Khor said that this is consistent with the low prevalence of operative risks conducted overseas. Studies overseas indicate that the prevalence of complications from over-stimulation of ovaries ranges from 0.1% to 2%, and that of infection and bleeding at about 1% of cases.
Miss Cheng then asked if MOH would consider allowing egg freezing for young healthy women with no medical needs.
She said, “Singapore is a premier healthcare service provider in the region and countries like US, Australia, Thailand and Malaysia allow this. So, I hope that our health policy can reflect the changing trends and allow this with proper counselling.”
Dr Khor Lean Suan said, “Whilst the medical risks can be addressed through regulation as well as enhanced public education and counselling of potential users, there are social and ethical implications that have to be considered carefully. Couples may delay marriage and parenthood thinking that egg freezing would assure them that they can have a child later on in life when they wish to conceive.”
“Age-related fertility issues actually affect both men and women. The best way to ensure having a healthy child, really, is when couples are relatively young and healthy. Nonetheless, we note the feedback that we have received. We are currently carefully considering the implications of allowing social egg freezing. We are monitoring international developments in the field of social egg freezing. We will review our position, taking into account the experiences of countries that have implemented this, as well as of course the proper safeguards that we need − the regulatory framework, for instance − to ensure or safeguard patients’ safety should social egg freezing be allowed, as well as social and medical implications, and the prevailing societal norms and culture.”