MINISTRY OF HEALTH GUIDELINES ON

TERMINATION OF PREGNANCY

1 CARRYING OUT TREATMENT TO TERMINATE PREGNANCY

1.1 Every treatment for terminating pregnancy shall be carried out by an

authorised medical practitioner in an approved institution.

1.2 Under the Termination of Pregnancy Act, an authorised medical

practitioner shall not carry out treatment for the termination of pregnancy
on any pregnant woman other than:
(a) a citizen of Singapore or the wife of a citizen of Singapore;

(b) a holder or the wife of a holder of a work permit pass or

employment pass; or

(c) a person who has been resident in Singapore for at least 4

months

unless it is immediately necessary to save the life of the pregnant woman.

1.3 In relation to the holding of a work permit pass under paragraph (b),
the holding of a temporary work permit by the pregnant woman or her
husband is itself insufficient. The pregnant woman or her husband
must be the holder of a work permit pass issued under the Immigration
Act.

1.4 No treatment for terminating a pregnancy of more than 24 weeks can be

carried out unless the treatment is immediately necessary to save the life
or to prevent grave permanent injury to the physical or mental health of
the pregnant woman.

1.5 The termination of a pregnancy must be at the request of the pregnant

woman and with her consent.

2 APPLICATION AND QUALIFICATION AS APPROVED INSTITUTION

2.1 An application to the Minister for the approval of any institution, hospital,
maternity home, clinic or other place as an approved institution shall be in
the Form I set out in the Schedule to the Regulations or in the form set
out in the electronic licensing system of the Ministry of Health at
https://www.moh-ela.gov.sg

Guidelines on Termination of Pregnancy (updated) _ April 2004 1

 2.2 Minister may cancel the approval for the use of any place as an approved
institution and the authorisation to carry out treatment to terminate
pregnancy if any authorised medical practitioner contravenes or fails to
comply with any of the provisions of the Regulations and any conditions
specified by the Minister in authorising the medical practitioner to carry
out treatment to terminate any pregnancy.

3 APPLICATION AND QUALIFICATION AS AUTHORISED MEDICAL

PRACTITIONERS

3.1 An application to the Minister for authorisation to carry out treatment to

terminate pregnancy shall be in the Form II set out in the Schedule to the
Regulations.

3.2 Only specialists with Obstetrics & Gynaecology degrees will be given
approval to terminate pregnancies that are up to 24 weeks duration.

3.3 Each medical practitioner in private practice who applies to the Minister
for authorisation to carry out treatment to terminate pregnancy shall be
approved to carry out treatment for the termination of pregnancy at only
one specified private medical clinic. However, where such an authorised
medical practitioner is also accredited to work in a hospital approved to
carry out treatment for the termination of pregnancy, the medical
practitioner may also perform such treatment at that approved hospital.

4 APPROVED INSTITUTIONS

4.1 A hospital which is an approved institution for the carrying out of

treatment for termination of pregnancy must submit to the Ministry in
Form I of the Schedule to the Regulations the names of the authorised
medical practitioners accredited to carry out treatment for the termination
of pregnancy in that hospital.

4.2 An approved institution must maintain its premises in a reasonable state

of cleanliness and to provide a qualified medical practitioner, a nurse, a
trained counsellor and, where general anaesthesia is to be induced, an
anaesthetist during the termination of a pregnancy.

4.3 The hospital must inform the Ministry when any of its authorised doctors
resign from the hospital.

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5 MANDATORY COUNSELLING

5.1 Trained Abortion Counsellor

Every approved institution shall have amongst its personnel at least one
doctor or nurse who have undergone a course of training in termination of
pregnancy counselling conducted by the Director of Medical Services. If
the trained counsellor leaves employment, the approved institution is
required to inform Ministry of Health within 2 weeks. A maximum grace
period of 6 months will be allowed for the approved institution to have a
replacement or make arrangement to provide for the mandatory
requirement, failing which the approval to the approved institution to carry
out abortion will be cancelled.

5.2 Pre-abortion counselling1 must be provided for a pregnant woman,

regardless of her marital status, who:
(a) is a Singapore citizen or permanent resident;

(b) has passed the primary school leaving examination (PSLE);

(c) has at least some secondary education, and

(d) has less than three children.

5.3 Pre-abortion counselling for girls below 16 years of age(except for

rape victims)

It is mandatory to refer an unmarried girl below 16 years of age for pre-

abortion counselling at the Health Promotion Board Counselling Centre
when she seeks treatment to terminate pregnancy. A Certificate of
Attendance (COA) will be issued to her by Health Promotion Board
Counselling Centre. No termination of pregnancy can be performed
unless the COA is produced by the girl. The COA number should be
recorded in Part III Column 19 of the Report on Request for Treatment to
Terminate Pregnancy (Form VI set out in the Schedule to the
Regulations). The steps for pre-abortion counselling are illustrated in
Annex A.

5.4 Time Lapse

The Act requires the pregnant woman to sign a declaration that she has
been counselled and that at least 48 hours should lapse after pre-
abortion counselling before the pregnant woman can give her written
consent to treatment (Form III set out in the Schedule to the Regulations).
1
Contents of pre-abortion counselling may be adapted for women diagnosed with foetal
abnormalities.

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 5.5 Declaration Form

The woman requiring treatment to terminate her pregnancy should also

sign a declaration of her marital status, educational level and number of
living children in Form IV set out in the Schedule to the Regulations.

5.6 Post-abortion counselling2

Every authorised medical practitioner shall provide counselling to a

woman who has had her pregnancy terminated. Such counselling should
be given on the day when the abortion procedure is carried out. The
counsellor may have the flexibility to conduct the post-abortion
counselling at any time during the admission for abortion, either before or
after the procedure. The actual timing would best be determined by the
doctor, based on his assessment of the patient, her condition and type of
anaesthesia or sedation that she would be given. Where the counselling
is conducted after the procedure, it should be given only after the woman
has fully recovered from the effects of anaesthesia or sedation.

5.7 Every approved institution shall provide the following facilities for
counselling and such facilities shall, where applicable, be in proper
working condition:
(a) television set

(b) video cassette recorder / VCD player

(c) video tapes / VCD on abortion produced by Health Promotion

Board (refer to Annex B)

(d) pamphlets produced by Health Promotion Board (refer to Annex B)

5.8 Pre- and post abortion counselling shall include personal counselling by a
trained counsellor, the viewing of the video tape / VCD and reading of
appropriate educational materials produced by the Health Promotion
Board for this purpose. The procedure for counselling is illustrated in
Annex C.

2
Contents of post-abortion counselling may be adapted for women who have undergone sexual
sterilization following abortion.

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6 RETURNS / REPORTS

6.1 All authorised medical practitioners must complete and submit the Report
on Request for Treatment to Terminate Pregnancy (in Form VI set out in
the Schedule to the Regulations or in the electronic filing system of the
Ministry of Health at http://www.moh-topvsreturns.gov.sg) to the Director
of Medical Services within 30 days of the pre-termination of pregnancy
counselling if no treatment to terminate pregnancy is carried out on a
pregnant woman, or within 30 days of the post termination of pregnancy
counselling if treatment to terminate pregnancy is carried out on a
pregnant woman. The steps for completion of the report are illustrated in
Annex D.

6.2 Every authorised medical practitioner shall submit to the Director of

Medical Services annually a return on the personnel and facilities
available for counselling in the Form V set out in the Schedule to the
Regulations.

7 REGISTER

Every approved institution shall maintain a register solely for recording

particulars of all treatments to terminate pregnancy carried out in the institution
and such register shall contain the following particulars:
(a) name of operating theatre

(b) name of authorised medical practitioner who carried out the

treatment

(c) name of patient as indicated in her identity card or passport

(d) identity card or passport number of patient

(e) date of operation; and

(f) method of termination of pregnancy.

8 PHYSICAL FACILITIES / EQUIPMENT used in the premises for carrying out

the treatment to terminate pregnancy should be in accordance with the
"Guidelines on Requirements for Premises to be used for the Treatment to
Terminate Pregnancy".

9 THE IMPORTANT REQUIREMENTS under the Termination of Pregnancy Act &

Regulations are illustrated at Annex E.

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 ANNEX A

FLOW-CHART FOR PRE-ABORTION COUNSELLING

FOR UNMARRIED UNDER-16 GIRLS

Unmarried pregnant girl

(unmarried under 16 years)
seeks abortion

Authorised doctor refers girl

to Health Promotion Board
Counselling Centre using
MD155

Girl counselled by trained

counsellors at Health
Promotion Board (HPB)
Counselling Centre

HPB Counselling Centre

certifies attendance &
issues Certificate of
Attendance (COA)

Pregnant girl presents COA

to authorised doctor

Authorised doctor performs

abortion & completes
abortion report Form VI
(see Annex D)

Compulsory Post-abortion
counselling & Family
Planning education

Guidelines on Termination of Pregnancy (updated)_ April 2004

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 Annex B

EDUCATIONAL MATERIALS FOR TERMINATION OF PREGNANCY

COUNSELLING

The following are available from Health Information Centre at Level 3, Health
Promotion Board, 3 Second Hospital Avenue, Singapore 168937.

1 ABORTION COUNSELLING VIDEO

Abortion counselling video/ CD entitled “Abortion-Consider with Care”

available in 3 languages (English, Mandarin & Malay).

2 PAMPHLETS

a The Truth about Abortion**

b Contraceptive Methods which one is best for me

For request of the above print materials, please contact Health Information Centre
at Tel: 64353954 or Fax: 65361277.

** must be given to the woman to read

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 ANNEX C

PROCEDURE FOR ABORTION COUNSELLING

Pregnant
woman seeks
abortion

♦ Singapore citizen or Permanent Meets criteria

residents; for pre-abortion No
♦ has 2 or fewer children; and counselling?
♦ has passed PSLE & has at least
some secondary education

Yes
Views video &
reads
education
material on
abortion

Personal
counselling

Post-partum Continue Still requests Abortion Post-abortion

counselling & pregnancy No abortion? Yes counselling &
Family Family
planning planning
education education

Not Mandatory for

sure women who
have
undergone
abortion
Repeat
appointment
with counsellor
few days later

No Request for Yes

abortion?

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 ANNEX D

STEPS FOR COMPLETION OF REPORT ON REQUEST

FOR TREATMENT TO TERMINATE PREGNANCY (FORM VI) ONLINE AT
WEBSITE: https://www.moh-topvsreturns.gov.sg/login

Request for Call Licensing & Accreditation Branch at Tel

abortion 63251740 for User ID/Password to log on to
the Online TOP/VS System.
Complete parts I & II of the online Form VI
♦ Singapore citizen or Permanent
residents;
♦ has 2 or fewer children; and
♦ has passed PSLE & has at least
some secondary education.
Fulfils criteria for
pre-abortion
counselling

Pre-abortion Complete items 16-22 of part III

counselling
provided

Skip parts IV & Continue Abortion. Complete parts IV &

V, and submits pregnancy V, and submit the
the form online form online to
to Licensing & Post-abortion Licensing &
Accreditation, counselling Accreditation, MOH
MOH provided

Not sure.
Second
appointment given

Did not turn up for

appointment
Submit the form
online to Licensing &
Accreditation, MOH,
after allowing 1-week
grace period

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 ANNEX E

IMPORTANT REQUIREMENTS UNDER THE TERMINATION OF PREGNANCY ACT

AND REGULATIONS

Termination of Pregnancy Act

(a) Termination of pregnancy (TOP) must be done by an Section 3(1)

authorised doctor with the written consent of the woman

(b) Women who are eligible to have TOP done in Singapore Section 3(3)

(c) TOP not to be carried out if pregnancy is of more than Section 4

24 weeks duration unless in special circumstances

Termination of Pregnancy Regulations

(a) Every approved institution must have a trained abortion Regulation 4

counsellor

(b) Mandatory counselling for women who request for TOP Regulation 5(1)

(c) Mandatory pre-abortion counselling for unmarried girls Regulation 5(2) & (3)
below 16 years. No TOP to be performed unless the
girl produces a Certificate of Attendance (Form VII).
(See Flowchart at Annex A)

(d) Time lapse of 48 hours before the women give written Regulation 6(1)
consent for TOP

(e) Consent for TOP (Form III) Regulation 6(2)

(f) Declaration Form (Form IV) Regulation 6(3)

(g) Annual return on provision for TOP counselling facilities Regulation 8

(Form V)

(h) Report to the Director of Medical Services on request Regulation 9

for TOP (Form VI)

(i) Maintaining a register of treatment to terminate pregnancy Regulation 10

Note: The Termination of Pregnancy Act and Regulations can be purchased from the
SNP Corporation –Legal Publications #01-19 Valley Point, Singapore 248371 Tel
63339703

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 GUIDELINES ON REQUIREMENTS FOR PREMISES TO BE USED FOR THE
TREATMENT TO TERMINATE PREGNANCY / SEXUAL STERILIZATION

1. Operating Room

a) Room Space

At least 3 metres x 4 metres in dimensions with sufficient space for free

movement. Room should be used for operation and examination of patients.

b) Air-conditioning:

The room should be air-conditioned.

c) Lighting:

Sufficient lighting should be provided.

Angle-poised light source could be used for termination of pregnancy.

Illumination level should not be less than 20,000 LUX at task with one metre
clearance height. The colour temperature of the light should be between 3,000K
and 6,000K. For sexual sterilization, proper operating theatre light should be
used.

d) Wall & Ceiling:

For easy cleaning, the wall and ceiling should be of smooth surface. Wall should
preferably be tiled.

Wall should be covered with durable washable paint or washable impervious

material.

e) Door:

The width of the door should not be less than 1.2 metres.

f) Floor:

The floor should be covered with smooth washable material. Preferably tiled.
Wooden flooring and carpets are not permitted.

g) Partition of Room:

Full partition is required for room used for treatment.

h) Cleanliness

Tidiness and cleanliness should be maintained at all times. Room should be

thoroughly cleaned before and after each operation.

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2. Equipment

a) Proper operating table with facilities for tilting should be used.

b) Adequate and appropriate equipment should be used for termination of

pregnancy and sexual sterilization.

c) Surgical instruments used for invasive procedures should be rendered

sterile by the appropriate procedure of sterilisation such as steam
autoclaving or alternatively use sterile disposable instruments.

d) Hand brush and antiseptic preparations eg Chlorhexidine or providone-

iodine should be used for hand washing before operation.

e) Sterile gloves, gowns & hand towels should be used during the
operation. The doctor should wear mask, goggles and surgical cap.

f) Medical and surgical equipment, instruments, appliances and materials

should be functional, effective and comply with established or
recommended procedures for their maintenance and use.

g) No unnecessary equipment/furniture should be kept in the operating

room.

3. Emergency facilities

The following emergency drugs and equipment for resuscitation should be

available at all times:

a) Injection Atropine
b) Injection Adrenaline
c) Antihistamines - e.g. injection Phenergan or Piriton
d) Injection Calcium Gluconate 10 %
e) Steroids - e.g. injection Hydrocortisone or equivalent
f) Injection Sodium Bicarbonate 8.4%
g) Intravenous infusion set & cannulas
h) Intravenous solutions - eg Hartman's
i) Airviva & airways
j) Motor suction apparatus

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