The ageing population and total fertility rate have long been topics of national discussion. With elective egg freezing set to be allowed, the Institute of Policy Studies’ Kalpana Vignehsa discusses what this means for Singapore women.
SINGAPORE: If things go as we hope, my family will soon welcome our much-awaited second child. Getting here hasn’t been smooth – obstetricians consider this a “geriatric pregnancy” due to my “advanced maternal age”.
Still, I count myself lucky. Last year, I had a heartbreaking miscarriage late in my first trimester, a few months before this pregnancy. Two close friends had stillbirths and others struggled through in-vitro fertilisation (IVF).
This emotional and physical rollercoaster is not uncommon for women in their 30s and 40s. Despite this, my friends and I rarely wish that we had children earlier.
What we do wonder is if we should have frozen our eggs in our younger years and if this would have made things easier when we were ready for motherhood.
So, it was encouraging to hear that, regardless of marital status, women aged 21 to 35 will have access to elective egg freezing from early 2023, as proposed in the recently released White Paper on Singapore Women’s Development.
Currently, egg freezing in Singapore is only permitted for medical reasons, but this hasn’t stopped women who can afford it from travelling to countries like Australia, Malaysia, Thailand and the US to freeze their eggs. This is despite the oft-discussed health risks involved and the lack of certainty offered by egg freezing.
So, why is access to egg freezing such valued progress for women here?
CHANGING ASPIRATIONS OF WOMEN IN SINGAPORE
Increasingly, women here are having their first child later in life. In 2020, the median age of first-time mothers was 31, a steady increase from 28.6 in 2000 and 29.8 in 2010. Since 2010, we have also generally had more females than males graduating from university.
Changing education levels and aspirations have seen women more fully participate in society and exercise their self-autonomy. Wanting access to egg freezing is part of this trajectory. This desire stems from three main struggles women face.
First, women, particularly in their thirties, who have not yet found suitable life partners, want to preserve their ability to become biological parents. Understandably, they don’t want to feel pressured to rush into a new relationship to assuage their ticking biological clocks.
Second, women increasingly want to advance in their careers before taking time off work for child-rearing. Research shows that the “motherhood penalty” is stronger for women with less-established careers — as early child-rearing often involves curtailing education, taking more time off and passing up on promotions, which often have long-lasting negative career effects.
Third, some women (and men) may genuinely not be ready to embrace parenthood in their peak reproductive years. Life may be financially and emotionally precarious. They may be survivors of neglect or abuse, or simply unsure if parenthood is for them.
Elective egg freezing reduces the pressure that women might feel to realise their maternal aspirations at the expense of their romantic relationships, careers or personal considerations.
These are not the new concerns of entitled millennials. They have always existed among women and men. What is new is that society now recognises their concerns as valid and that we have more confidence that available technology can enable these aspirations.
IS AN AGE LIMIT NECESSARY?
Getting here has taken time. However, there remain important nuances about our elective egg freezing policy to iron out.
One is the age limit. Some question the age limit since many women have healthy babies well into their late 30s or why any upper limit is necessary. They instead espouse allowing women to choose, after considering the risks with their doctor and partner.
According to the Government, the 35-year age limit aligns with the international scientific consensus on egg quality, after which quality starts to decline sharply.
Dr SL Liow of the Virtus Fertility Centre agreed with this sentiment and told me that there is also “a high risk of miscarriages” after the age of 35. Nonetheless, he thinks the age limit could be extended to 37 years, as research showed that the rate of embryos with chromosomal defects was lowest in women aged 26 to 37.
A separate mathematical modelling study established that freezing at age 37 had the greatest improvement in the probability of a successful pregnancy from frozen eggs (given the lower probabilities of natural conception). Although freezing at a younger age maximises the chances of having a healthy baby from frozen eggs, younger women have a reasonable chance of having unassisted pregnancies and may not need their frozen eggs.
These studies show that a formal expansion of the age limit may indeed be warranted, even if patients will be able to appeal such limits, on an individual basis, through their doctors.
OTHER POLICY NUANCES TO IRON OUT
A second policy nuance is that pre-procedure counselling will specifically address the challenge of “aged parenthood”. Yet, this should be considered against the challenges of rushing into parenthood before one is emotionally, financially or professionally ready for it.
Egg freezing does raise the roof of maternal age, which involves some health risks and social implications, including more children having older parents, potentially facing health problems or retirement before their children gain independence.
Older motherhood, however, is associated with positive, responsive parenting and better cognitive and behavioural outcomes for children. With more established careers, focusing on the home without bearing heavy penalties at work is also more likely, allowing both parents to participate actively and more evenly in child-rearing.
Another policy condition is that a woman’s frozen eggs can only be used if she is married. Though consistent with the Government’s position on encouraging parenthood within marriage, this requirement seems unnecessarily exclusionary.
Rather, the policy of elective egg freezing could be inclusive, allowing all women access regardless of marital status, such that it gives women a choice, helps them achieve their aspirations and to participate in society to their fullest potential.
KEEPING THE BIGGER GOALS IN MIND
We should not lose sight of the bigger picture: Singapore must continue enacting policies and cultural change that ensure motherhood (and indeed, parenthood) isn’t penalised, regardless of age and career advancement.
After my first child, I was the beneficiary of a promotion thanks to a boss who recognised the valuable skills that one develops as a new parent.
However, this kind of visionary attitude is the exception rather than the norm. Stories of women who were denied a worthy promotion because they cannot easily burn late nights and weekends for work are, unfortunately, all too common.
Elective egg freezing also obscures the importance of early reproductive health screenings for both men and women. A lack of comprehensive sex education means that many young adults are misinformed or ignorant about this topic. And access to egg freezing may be an illusionary security blanket that exacerbates the early complacency with which we consider our reproductive health.
As eagerly anticipated as elective egg freezing is, it cannot be the panacea for the growing infertility crisis. Rather, we need policies that enable us to make informed choices based on our individual biological circumstances.
Ultimately, it is one part of the puzzle of how women can take charge of their lives. We should press on with efforts to address the social conditions that lead women to access it and take on public health opportunities to help people make more informed reproductive choices.
Dr Kalpana Vignehsa is a research fellow at the Institute of Policy Studies, National University of Singapore.
