The Effects of Legislation of Abortion on Maternal and Perinatal Outcome

Abstract

In general, national family planning programs in several countries have relied largely on voluntary acceptance of contraception as a means of regulating population growth. However, it is well known that voluntary family planning programs, even when highly successful, may often fail to achieve demographic goals such as zero growth. In these situations, measures have been recommended that ‘go beyond family planning’ in an attempt to influence the number of children couples choose to have. Singapore has successfully used legislation to achieve its desired demographic changes. This success, within a legal framework, is unique and may be used as a model for other countries where voluntary participation in national family planning programs has failed.

Abortion-related maternal mortality may be compared appropriately with the risk to life associated with carrying a pregnancy to term. In Singapore, the overall mortality following abortion has declined substantially—from 15 abortion related deaths between 1968-1970 to no abortion related deaths in the years 1980-1983. We believe this decline is due to the replacement of illegal by legal abortions (enhanced by liberalized legislation) and improvements in the quality of services and efficient treatment of complications.

Furthermore, with an increase in the number of legal abortions, the crude birth rate has shown a dramatic decline from 29.5 per 1,000 population in 1965 to 16.2 per 1,000 in 1983. This has resulted in smaller family sizes with greater access to socio-economic assets of the country leading to healthier mothers and a significant improvement in their reproductive performance. The perinatal mortality has declined from 25.5 per 1,000 in 1965 to 10.6 per 1,000 in 1983. Similarly the infant mortality rate has declined from 26.3 in 1965 to 9.4 per 1,000 in 1983.