Survival Rate among Premature Babies in Singapore

The Senior Minister of State for Health (Dr Amy Khor Lean Suan)(for the Minister for Health): From 2009 to 2013, between two and five premature babies were born annually with gestation age of less than 24 weeks, out of about 40,000 live births on average.

Among such premature babies born during 2008 to 2012, 48% survived beyond one year of age, compared to 27% during 1998 to 2002. While the situation appears to have improved, given that the number of such babies is very small, we are unable to draw a definitive conclusion.

I would like to first thank the Senior Minister of State for assuring us that there has been an improvement in the survival rates for premature births. If the numbers continue to improve further down the line, it brings me to a fundamental question of whether the Ministry would also consider lowering the terms within the Termination of Pregnancy Act to reduce the term limit from 24 weeks to 20-23 weeks.

My second supplementary question relates to an announcement made earlier this year on public consultation for reviewing the guidelines on the termination of pregnancy as well as the proposal that all women seeking abortion should be counselled. Could the Senior Minister of State provide an update to the House as to the progress as well as the timeline for the consultation? I know that I have asked this on a number of occasions. So, I would ask the Senior Minister of State to indulge me.

I thank the Member for his supplementary questions. For the first question, to reiterate, the number of such preterm babies, as I have said earlier, is very small. So, we are unable to conclude with statistical confidence that there has been any real improvement in survival. In fact, this is also supported by international population-wide studies which showed that despite medical advancements in the care of preterm babies, there has not been a significant improvement in the survival rates of infants born before the 24-week time limit during the past decade. Twenty-four weeks gestational age continues to

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be generally regarded as the point of fetal viability, and this cut-off is, in fact, practised by countries like the United Kingdom, Japan and Australia. Locally, I would also like to note that only 2% of all abortions performed in 2013 were performed between the 21st and 24th weeks of gestational age. Lowering the abortion limit would have little effect on lowering the overall abortion rates here.

Lastly, a routine fetal scan is performed at 20 weeks' gestational age and this is at the stage where the foetus is sufficiently developed to enable structural abnormalities to be picked up from the scan. In fact, more than half of the abortions performed between the 21st and 24th weeks of gestational age in 2013 were performed due to fetal anomalies or other medical reasons. Keeping the abortion limit at 24 weeks will allow these mothers some time to consider the implications and make an informed decision as to whether to keep or abort the child, without being rushed to meet a shorter cut-off time. In view of the lack of evidence to show that there are improvements in the survival of such extreme preterm babies, the Ministry of Health is not considering the lowering of the abortion limit at this point in time.

Regarding the second question about the extension of pre-abortion counselling to all women seeking abortion in Singapore, we will be doing the public consultation by the end of this year. Review as to the contents of the pre-abortion counselling, the information to be provided during pre-abortion counselling and the training of the pre-abortion counsellors are also on-going, and details of these will be released once they are ready.