COULD Singaporeans be relying on abortion to prevent childbirth, or are the women here just less fertile than usual? Because despite the high literacy rate here, it still seems that there's a low rate of use of effective contraception methods - or so companies producing contraceptions say.

Last reported abortion figures in 2008 peg it at slightly over 12,000 reported abortions, which works out to be about 23 per cent of the population; or, one in four pregnancies being terminated.

Contrast this to the fact that less than 10 per cent use oral contraceptive pills - which has a 99 per cent success rate of preventing pregnancies. In the US, over 20 per cent of women take oral contraception.

Based on his personal observation, Beh Suan Tiong, consultant obstetrician and gynaecologist at Beh's Clinic for Women at Thomson Medical Centre, about 95 per cent of women who come for abortions will do so within the first trimester. "And these are women in their early 20s and mid-30s," he notes, not teenagers as most people expect.

The reason, he contends, most often is that these women aren't prepared for pregnancy and they don't take sufficient precautions against it. "Then some may use some kinds of contraception methods which aren't reliable, but they've been erroneously led to believe that it works," he says.

The withdrawal method, for example, seems to be highly popular here, but there's a 40 per cent chance of failure. "If you're going to be sexually active, then sooner or later, it'll end in a pregnancy," he points out.

Crisis of knowledge

There is a "crisis of knowledge" in contraceptive use, Dr Beh notes, a view which is echoed in recent surveys such as the World Contraception Day 2011 survey sponsored by Bayer Healthcare and supported by an alliance of 10 international organisations involved in sexual health, including the Asia Pacific Council of Contraception.

The survey revealed that eight in 10 young adults from Singapore had sex with a new partner without contraception - a statistic which is among the highest in Asia-Pacific, and that a significant number of young adults from Singapore has been given erroneous information on contraception, gleaned mostly from the Internet, friends and religious/spiritual leaders.

The WCD 2011 survey involved over 1,800 young adults between 20 and 35 years old from nine countries in Asia-Pacific, including 100 males and 100 females from Singapore.

In Singapore, it's estimated that about 40 per cent of people who want to prevent pregnancy would use the condom, while it's a single digit percentage rate for those on oral contraception. A very small minority go for permanent methods such as sterilisation, says P C Wong, council member of the Asia Pacific Council of Contraception.

There shouldn't be such high rates of abortion in a first world country like Singapore, where its people should be educated enough, notes Christopher Chong, consultant obstetrician,gynaecologist and urogynaecologist, and chairman of the Aesthetics in Gynaecology Section, Obstetrical & Gynaecological Society of Singapore.

"There are some very wrong ideas about contraception floating around. I've seen a university student in my practice who discovered she was pregnant although she was technically still a virgin and there was no penetration. Contact itself is risky as secretion can have more sperm than ejaculation," Dr Chong says, adding that that's why the withdrawal method isn't reliable.

And there are ways to improve the use of condoms - such as squeezing away the air pocket at the tip before using. "The air can create pressure and cause the condom to burst," he says.

As for birth control pills and its low popularity in Singapore, doctors note that women tend not to like to have to take it daily, and they also have misconceptions about its safety.

"The new generation pills now do much more - such as reducing the risk of cancer of the womb and ovaries, besides reducing menstrual flow," Dr Beh notes.

The message that doctors give is that there's no one "best" contraception method, but to use at least one effective method if you don't want to get pregnant. "There are different methods for people with different lifestyles. For those who are forgetful, oral contraception isn't going to be effective then," he adds.

But abortion is definitely not a first-line method. Abortions are legal in Singapore up to 24 weeks of pregnancy, but not "abortion pills" to tackle early pregnancy. Abortions might have a high success rate, but there still risks involved.

"Time and again, we see the same person having a second abortion so it's clearly a "lifestyle" thing for them. Some folks are stubborn and think it won't happen again," says Dr Chong.