Friday, 14 February 2014

There's a problem... but we're not going to find out more.

For a government that constantly harps on Singapore's low fertility rate, the Singapore government sure isn't interested in doing more research on the reasons behind low fertility in Singapore.

In the spirit of disclosure of relevant facts, I am a woman who is TTC (trying to conceive). The husband and I have been trying since December 2012 without any success. I will not go on about the details of TTC here. The information can be found in the numerous other blogs that highlight the ups and downs in this crucial period of one's childbearing years. Instead, in this post, I want to highlight some flaws in the political narrative about our low fertility rate.

The Singapore government's narrative is that the low fertility rate is the people's fault (what's new). According to the narrative, many Singaporean couples do not want to have kids because they cherish their free-and-easy lifestyle even after marriage. Another common reason given is that many couples are putting off marriage till it is too late. By the time they are married and wish to conceive, they often face problems as their fertility has declined. I cannot speak for the former group, but as a member of the latter group, I would like to argue that such views propagated by the government and the media are unproven. There are no statistics to prove that late marriages is the cause of low fertility in Singapore. Further, I think saying that late marriage causes low fertility is like saying old age causes death. It appears to be true, but it's not scientifically accurate. Yet, such sweeping views have gained credence because it is what the government says, and because there is a lack of a national study on infertility. 

When someone tells me that he or she has a problem, my first question is, what are you going to do about it? Therefore, it strikes me as very strange why a doctor from a public hospital like the Singapore General Hospital (SGH), quoted here, would say that there are no statistics on infertility in Singapore. No statistics on a problem that could be threatening our national survival? The article was from some time back, but numerous Google searches made me none the wiser. There are many stats on fertility rates from the government, but all these stats are not helpful in solving the population problem that Singapore is facing, as they merely tell us that there's a low fertility rate. They do not offer any insight on the possible medical causes for the low fertility rate.

Yet there is definitely a tacit acknowledgement from the authorities that fertility problems are on the rise, as apparent in the government's expansion of Medisave coverage to include fertility treatments as outlined on the Ministry of Health (MOH)'s website. In addition, we've also seen articles such as this one, which sheds light on the lucrative fertility business as well as provides us with data from MOH about the number of women seeking Assisted Reproduction treatments and the number of test-tube babies born. I have no idea where the reporter got the data from. It doesn't seem to be available for the public on the Internet. Was it given to the reporter by special request? 

Now, compare that primitive-looking chart in the healthxchange report above, with this report of infertility from the UK. Hmm.... see the difference?

Since low fertility is a problem that has been bugging Singapore for years, there should be a more substantial and significant study done nationally to illuminate its causes from a medical point of view. Attributing low fertility to changing social norms, as this very interesting article by Paulin Tay-Straughan has done, is one way to analyse the situation. But again, the stats are on fertility rates interpreted from a sociological perspective. They do little to highlight the medical causes of low fertility. 

It may be that I am wrong, maybe there are statistics by the various hospitals on infertility. I am told by my doctor friend that the doctors in the public hospitals are required to complete a number of research projects. Perhaps someone has done the research on the causes of infertility and shared it among the doctors? If there is any such research, I do hope some kind soul out there lets me know about it. It would be better if the statistics are national, instead of based on hospital-by-hospital case studies.

If you are a medical specialist on infertility, or someone from MOH, here are some questions: 
What medical problems do the women and men in Singapore who can't conceive suffer from? 
How old are they when they seek help? (I think some people may be surprised that many couples whom I've read about in the TTC forums who seek help are only in their 20s.) 
How many successfully conceive before they are recommended IVF? 
How many fail to conceive even after IVF and other invasive methods? 
How many give up, and for what reason? 
Also, overlapping with sociology, what are their occupations and working hours? 

Infertility is a first world problem. As with all first world problems, it doesn't threaten our survival as human beings. My husband and I can still lead pretty successful lives without kids. However, we want to have kids. If Singapore is seeking to increase our fertility rate, I think it is imperative for us to investigate the causes of infertility. Although a scroll through the TTC forums in Singapore will illuminate the trouble that many couples go through to start a family, such as the stories of women who bear the scars of several miscarriages, such discourse has been all but ignored by the state media. Why is the media not carrying more stories about couples who yearn for kids but can't conceive? Why is our first world government not publishing national stats on a problem that plagues many couples in Singapore? Your guess is as good as mine.

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