One in three women in Singapore who underwent abortions from 2003 to 2011, have had previous abortions, This is according to statistics from the Ministry of Health (MOH).
Of the 11,940 abortions in 2011, 3,904 were done on women who had undergone one or more abortions earlier. There were 382 women who underwent abortions for the fourth time or more.
This scenario was reflected in the statistics for the other years as well.
Experts say that many women who have had multiple abortions are likely to be ignorant of contraception.
"Some women have misconceptions that certain sexual practices will prevent pregnancy, such as having unprotected sex during a certain time of a woman's menstrual cycle," says Dr Tan Poh Kok, gynaecologist and obstetrician at PK Women's Specialist Clinic, who has 15 years experience in the field.
He adds: "There is sex education in schools, but I think understanding of sex has not improved."
Counsellor Jennifer Chee from pregnancy assistance and counselling centre aLife, spoke of how she once counselled a woman in her 20s who had undergone five abortions: "She was ignorant of contraception, and treated abortion as something 'easy' because she was not aware of the possible effects abortion could have on her body."
Dr Ben Choey, gynaecologist at SBCC Women's Clinic (Clementi) however had more cutting words. He noted that as these women would have had to undergo counselling prior to abortions, they would have at least a rudimentary understanding of contraception.
In his view, some have a "couldn't care less" attitude towards contraception or choose not to use contraception because of the possible side effects.
Women have abortions for a variety of reasons explained Ms Karen Vincent, manager of Pregnancy Crisis Service which supports people who have unwanted pregnancies. Among them, a sense that they are not financially able to keep the baby or that they need to further their careers and studies before having a child. Their boyfriends may also have abandoned them or there may be a perceived lack of support from the family.
Ms Chee of aLife notes that many women think that abortion is the only option open to them.
Doctors warn against multiple abortions, noting that there are real physical and psychological effects. Dr Christopher Chong, obstetrician, gynaecologist and urogynaecologist at Gleneagles Hospital, explains that repeated abortions can lead to infections of the reproductive organs, and can cause infertility.
Future pregnancies may also be at risk, Dr Chong says: "(Multiple abortions) can also cause the cervix to be damaged and lax, leading to miscarriages and prematurity.
"The more abortions, the womb is more likely to rupture during the abortion process and if one goes into labour."
Besides physical effects, women may also suffer psychologically. Clinical psychologist Dr Carol Balhetchet adds that women who undergo abortions more than once face an "accumulation of guilt".
She says: "One abortion is emotionally traumatic, as much as the person is prepared. Imagine that multiplied by so many times."
At least one change seems to be in the offing.
Currently, pre-abortion counselling, which was introduced in 1987, is mandatory only for Singapore citizens or permanent residents who have passed the Primary School Leaving Examination, have at least some secondary education, and have fewer than three children.
Responding to Non-Constituency Member of Parliament Gerald Giam's query on why women who were less educated were excluded, Health Minister Gan Kim Yong indicated that changes were on the way.
"Some of the criteria are no longer relevant and should be reviewed", he said in his reply, revealing that MOH began a review in early March.
Most experts TNPS contacted agree that the criteria should be reviewed.
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