Fertility and Infertility Research News Portal

1 November 2021

Unlike in the West, many Asian countries adopt conservative and traditionalist policies towards motherhood and female reproduction. In Singapore, official government policy explicitly discourages and penalises reproduction by single women and same-sex couples, by excluding them from tax rebates, housing, and childcare subsidies that are accessible only to traditional families formed by married heterosexual couples. To date, elective egg freezing for the fertility preservation of single women is still banned in Singapore, as the Government fears that permitting the procedure might encourage delayed marriage and childbearing among the younger generation.

In 2020, Singapore recorded its lowest ever Total Fertility Rate (TFR) of 1.1. Although this anomaly may be partly attributed to disruption of normal social and economic life by the COVID-19 pandemic, the country's TFR has been sliding downwards over the past few years, due to the increasing societal trend of late marriages and delayed childbearing within the country. This in turn has caused much consternation among government policymakers, as Singapore's future economic prospects, social stability and available manpower for military conscription may be severely jeopardised by the impending transition into a super-aged society brought about by this demographic crunch.

To counter this worrying demographic trend, the Youth and Women's wing of the ruling People's Action Party called for lifting of the ban on social egg freezing, where eggs are harvested from single women and stored for future use without a medical need. Proponents of this elective medical procedure often point to the fact that the competitive and fast-paced society of modern Singapore, coupled with the high costs of living, childcare and education, exert unique pressures on women that make it difficult for them to start a family at a younger age. Instead many are forced to wait or prefer to wait until their financial situation becomes more secure with further career progression and accumulation of more savings.

Hence, the Singapore Government is presently considering lifting the ban on social egg freezing. Although this will undoubtedly be a boon to some women having difficulties in finding a suitable life partner, doubts have been raised on whether new reproductive technologies such as egg freezing could have any significant long-term impact in raising the country's TFR. A few years ago, a Singaporean academic Dr Leong Chan Hoong (National University of Singapore Institute of Policy Studies) warned that Singapore's IVF fertility drive that focused on a minority of older couples is largely symbolic and ultimately impotent. His warning seems to have been borne out by the continual slide of the country's fertility rate, despite generous government subsidies of IVF treatment for married couples.

Lifting the ban on social egg freezing would require the Singapore government to draft comprehensive laws and regulations to address the various potential ethical problems and social issues associated with this elective medical procedure, as I wrote in an article in The Home Ground. Nevertheless, it is must be noted that not everything can be regulated by law.

One potential issue is the possibility of an increased generation gap between parents and children, and the reduced ability of older parents to cope with the physical rigors of raising young children. Moreover, there is also the unhappy prospect of young adults being burdened with the care of elderly parents, when they are just finishing their studies and embarking on their careers. Under Singapore law, it is obligatory for adult children to financially support their elderly parents. Hence delayed parenthood through egg freezing may not exactly be in the best interests of the child, and yet the child has no say or choice in this matter.

A potential social ill that is difficult to resolve is the frustration of single women who want to opt for single motherhood with their frozen eggs, after failing to find a suitable life partner. It must be noted that most single women who freeze their eggs, do so with the strong expectation of using them one day, regardless of their eventual marital status. Yet, there are strict laws that ban single women from undergoing IVF procedures in Singapore, which are near impossible to amend, given that both the Singapore Government and society-at-large are vehemently opposed to single motherhood by choice. If social egg freezing is permitted in Singapore, it is very likely that single women will be banned from exporting their frozen eggs abroad for IVF with donor sperm. This may possibly drive such single women with frozen eggs to undergo sham or temporary marriages out of desperation, to fulfill their dreams of motherhood. Otherwise, they have to face the agonising dilemma of disposing of their frozen eggs after spending so much of their hard-earned money as well as time and health risk, if they eventually decide to remain single rather than marry an incompatible life partner in order to be able to access IVF.

Then, there is also the unhappy prospect of some women being unable to conceive any children with their frozen eggs after spending so much money, and the consequent heartbreak and emotional distress that they have to undergo. No doubt, some laws and regulations can be implemented to weed out poor candidates for egg freezing, such as women above 40 years of age, or those with pertinent fertility problems. But at the end of the day, the results of egg freezing are still highly unpredictable, and there will definitely be some women who will fail to conceive children with their frozen eggs. Can any laws and regulations be drafted to provide consolation to these women?

Yet another contentious social issue is unequal accessibility to elective egg freezing, given the high costs of the procedure, which would likely make it unaffordable to poorer women. The only way to guarantee equal access to women of all socio-economic classes would be for the government to heavily subsidise it, which is difficult to justify, given that it is an elective medical procedure based on personal life choices that is not essential for sustenance of life or health. Hence to date, there is no country in the world where social egg freezing is being subsidised by the state. There are of course some employers who are willing to subsidise egg freezing for their workers, for example tech firms such as Apple and Facebook. Yet, such privileges are often restricted to highly-educated and high-value employees, which could spark accusations of elitism.

The spectre of employer-subsidised egg freezing thus brings about another potential social ill that is difficult to regulate by law, which is the unfair expectation that some employers place on women to put aside their plans of having kids, so that they can devote more of their time and energy to the company. There is probably a dark side to company perks on subsidised egg freezing for their female employees. The unwritten rule if such perks are around, is that female employees are expected not to take maternity leave and should deliberately delay having kids; or else they should expect to not be promoted, and be the first to be laid off when the opportunity arises.

To provide some financial assistance for egg freezing, Singapore may consider the much-vaunted freeze and share scheme that is available in some countries such as the UK and USA, which provides heavily subsidised egg freezing for single women in return for donation of some of their eggs to infertile patients. Nevertheless, such a scheme is unlikely to equalise accessibility of this expensive procedure to poorer and disadvantaged women. Because like commercialised egg donation, freeze and share is also subjected to market forces, and prospective recipient patients would definitely prefer certain desirable traits in donors, such as high education, good jobs, and beauty standards related to height and complexion. Hence, freeze and share is in fact highly-selective and would likely exclude poorer women with less education and fewer desirable traits.

Finally, there is also an increasing trend for single women to expect and demand their parents to help pay for social egg freezing, as highlighted by stories in the American news media. There is a subtle element of emotional blackmail here, as it would be like saying: 'Help me pay to freeze my eggs, or you may never have any grandchildren'.

Therefore, it is just not enough for the Singapore Government to focus only on potential ethical problems and social ills that can be regulated by law. Instead, they should look at the 'big picture' and have a far-sighted holistic view of what permitting social egg freezing would entail for Singapore in the long-term, and its lasting ramifications on society.

Read the original here:
The egg freezing conundrum in Singapore not all social and ethical issues can be regulated by law - BioNews