Singapore’s IVF fertility drive: symbolic but ultimately impotent?

After trying to get pregnant naturally for five years, Hazzny Gani decided to visit a fertility clinic when she was 35. She felt she was no longer young and decided to undergo in vitro fertilisation (IVF) out of a fear that waiting to conceive naturally would raise the risk of birth complications. Hazzny, now 45 and a housewife, counts herself lucky to have been successful on her first attempt. Even so, the treatment cost her about S$9,000 (US$6,500). As Singapore’s fertility rate falls, its baby businesses boom “After the whole process, and when we realised this was the amount of money we had to spend … we were just thankful we had to do it only once,” she said, adding that friends of hers had undergone several cycles of treatment with no luck. “The government should help more low-income families as some of them are eager to have their own child but just cannot afford it,” she said. Reducing the cost of IVF was one of the measures announced by the Singapore government in August in its continuing drive to boost birth rates in what is the world’s second-fastest ageing society after South Korea. The move, said Manpower Minister Josephine Teo, was aimed at helping couples conceive even as more decided to marry later in life. Subsidies to be introduced from next year will contribute up to 75 per cent of the cost of IVF treatment for Singaporean couples, or up to S$7,700 per cycle. In addition, the health ministry will remove the age limit on IVF, which is currently 45 years, and the cap of 10 cycles per woman. Last year, there were 992 cycles of assisted reproduction techniques – including but not limited to IVF – performed on women aged between 41 and 45, according to the health ministry. In 2014, there were just 709. Singapore is the world’s best country for children to grow up in The move follows reports in the Singapore media that women older than 45 had been crossing the causeway to Malaysia, where there is a cluster of fertility clinics just 10 minutes from the Woodlands Checkpoint. Procedures in Malaysia are reputedly cheaper and clinics are allowed to test embryos before they are implanted in the uterus, which can improve the chances of success. But experts say the government’s new measures, which would benefit a small minority of women, will do little to boost the country’s declining fertility rate in the short run, though it might have a greater effect in the longer term. According to its latest population figures, released last month, Singapore recorded 32,413 citizen births in 2018, a slight rise from 32,356 the year before. However, during the same period, the total fertility rate – the number of births per woman – fell from 1.16 to 1.14. The reason for the discrepancy is that there were more women of reproductive age – classed as 15 to 49 – who did not give birth. The figures show that Singapore has one of the world’s lowest fertility rates and is lagging Asian neighbours Malaysia, Indonesia and Japan, which in 2017 had fertility rates of 2, 2.3 and 1.4 respectively, according to the World Bank. Hong Kong and South Korea both had rates of 1.1. For a population to replace itself, a fertility rate of 2.1 is needed. Referring to the latest IVF initiatives to promote parenthood at a later age, Leong Chan-Hoong, a senior research fellow at the National University of Singapore’s (NUS’s) Institute of Policy Studies, said the measures were symbolic of the government’s efforts but would do little to reverse the falling birth numbers. He said the measures catered only to a “minority group” of older couples who had a greater need for them. “The more important message is that the government is trying to do the best it can to support fertility growth.” Here’s why Hong Kong’s low fertility rate poses a threat to its very future Singapore had a fertility rate of 3.07 in the 1970s. But the country then started to aggressively promote family planning methods and two-child families to control its population amid the boom in births after the second world war. Campaigns such as “Stop-at-Two”, launched by its family planning unit, were successful, but the effects can still be felt today. The health ministry declined to comment on what it hoped to achieve with the changes to its IVF policies, but NUS sociologist Tan Ern Ser said they could “somewhat” boost Singapore’s fertility rate in the long run, especially when Singaporeans were getting married at a later age. Data from the same population report revealed that the median age for marriage last year was 30.2 for men, and 28.5 for women. This compared to 28.7 and 27.7 respectively in 2000. Leong said long working hours were one reason couples were putting parenthood on hold. Singaporeans worked about 44.9 hours a week last year, according to the manpower ministry, or about nine hours a day. Leong said policymakers could look into how to make the workplace “more pro-family”. He cited the example of Singapore changing its five-and-a-half-day work week to a five-day one for civil servants in 2004. Another reason was that many young Singaporeans were perfectionists, Leong said. They wanted perfect careers and financial standing before starting a family, but Leong said there was “no perfect time”. Young Singaporeans also perceived parenthood as the end of a “linear progression of life priorities”, in which they obtain a degree, secure a job, marry, find the perfect home, and only then consider having children. This mentality stopped people from having more babies and needed to be rethought, he said. Other Singaporeans are simply deciding that parenthood is not for them. Among them is Chris Tan, a 38-year-old creative head at a Singaporean advertising agency. She said having children was a “big commitment”, and she could help “a lot more children” using the resources it would take to raise just one of her own. She pointed out that giving birth at 45 would require a lot of financial planning. Tan, who has been married for seven years, said: “When you’re 60 and your kid is only 15, that is not even the age for [enlistment] or university. That would mean 10 more years of expenses. “Unless you have very good savings and buying policies to ensure that the kid’s education is taken care of, then there is no way you can keep up. You can stop working only when you’re 70.” Finances also weigh heavily on the minds of young would-be parents. “At the end of the day, you can have [subsidies], you can have all the support that you need, but if the couple doesn’t have confidence in themselves, then [whatever amount of] subsidies is not going to make a difference,” Leong said. ■