1. Thank you Prof Chong for your very illuminating opening remarks. I must say I was listening intently to his opening remarks and I was waiting with bated breath to see what solutions he was going to present to me when he talked about the falling fertility rates in Singapore and it was on a cliffhanger that he stopped his presentation. So what I would do right now is to talk about the many efforts that Singapore Government is doing – working with stakeholders to create an ecosystem of support around women and the larger society, women working in partnership with men. Because just like what Prof Chong said, fertility for women is not only just a women’s issue. Obviously, a woman needs a man to be part of the equation to have children. And the whole point about how do couples come together, what is the ecosystem of support around them and their families? These are very practical questions that ultimately will impact on a woman’s decision, whether or not and when to have children.
2. So, I’d first like to start off by acknowledging the efforts of Professor Chong Yap Seng, Dean, NUS School of Medicine, Professor Bryan Kennedy, also from the NUS School of Medicine, and Zhongwei, distinguished guests, ladies and gentlemen, I am very delighted to join all of you today at the NUS Bia-Echo Asia Centre for Reproductive Longevity & Equality (or ACRLE) Conference.
3. The theme of this year’s conference is ‘The Science and Art of Reproductive Ageing’. I am glad the conference has brought together scientists, clinicians, epidemiologists, social scientists and women’s advocates across various disciplines, to discuss reproductive longevity and equality.
4. Just now, Professor Chong had shared with us some rather confidence-giving statistics, such as women who are able to deliver at age 59, 74 and in Singapore, 58 years old. At the same time, we had talked about the limits of IVF. So, we do know what are the possibilities that science, biology, research and health professionals can help women about and on. Nevertheless, we have to look beyond healthcare and medical research to see how we can help women get around the practical concerns they have so that they are willing to start families earlier and also successfully.
5. Decades ago, the topics we are discussing today might have only been talked about behind closed doors, especially in Asia. Even up till today, when I talk to couples, some say that they feel shy about going for fertility screening. Sometimes there is a little bit of finger-pointing – is it a woman or man’s job to go for screening. You would notice that in our hospitals, the fertility clinics are often sited on the women’s floor, not the men’s floor. The men’s floor, there’s urology, if I’m not wrong, as if these are two very separate conversations we are having here. I shall not go into the tirade of women’s equality now, just thinking about what are the things we see around us.
6. I am glad that today, with advances in medical science and also shifts in societal mindsets, there is much more discussion and information available of women’s health and specifically on reproductive health, but we do need to take this a step further.
7. This was also one of the thinkings we had when we launched the Conversations on Singapore Women’s Development. We involved about 6,000 participants, both men and women across all segments of society. But I must say 80% of the participants were women and 20% were men. We stated on the onset that this is a partnership between women and men but the men were a little shy about coming forth with their suggestions. So we are continuously working on how we can strengthen this concept of partnership because women can only really succeed in society if men partner them, whether as a spouse, whether as a father giving them confidence, whether as a teacher in school to support them, enable them, or whether as a boss or a colleague in the workplace to support their work and family aspirations.
8. As a country, Singapore has made great strides in terms of our progress in women’s development, we see it across a range of indicators, education, health and employment. As an illustration, the employment rate of women between the ages of 25 and 64 has increased from 53% in 1994 to 75% in 2021 – which is a significant change within the short space of 25 years. While this is an encouraging increase, many women continue to face challenges juggling their career and family.
9. This was even more pronounced during the COVID-19 pandemic when women had to work at home. We were all very accustomed to having meetings over Zoom. The women around us, perhaps, like myself, are accustomed to the fact that, if you do have children, your children “zoom-bombing” you in the middle of conversations. I’m not sure whether the men experience that as well, but I think the women had to juggle making meals at home, doing the supermarket shopping, tending to the children especially when the children were studying at home because we did close the schools for about two months. I remember I was at the Ministry of Education then, many women wrote to me. Women who are teachers wrote to me because they had to come up with teaching curriculum where they could upload online, and they still had to be a wife, a mother, a cook. At the same time, we have women on the receiving end – the parents of the children on home-based learning. They had to teach very young kids about how to use a mouse, how to upload materials, so there was a lot of stress during that period. I am going to come back on the point about stress because we all know that stress does have an impact on reproductive health.
White Paper on SG Women’s Development
10. We recognise the challenges that women face managing work and family, and we hope to better support women to pursue both family and career aspirations.
11. Just now, Professor Chong had already helpfully shown a Straits Times article that laid out five domains and 25 action plans to help support and uplift our women in Singapore. What are those five domains? They are equal opportunities in the workplace, which I’ve talked about earlier, about caregiving roles, protection of women from violence and harm, support for vulnerable women and lastly, about mindset shifts. Mindset shifts as a principle if something that undergirds all the other domains.
12. Specific initiatives around the 25 action plans include broadening the scope of the Household Services Scheme to cover basic child- and elder-minding services. Why am I talking about this? Unfortunately, based on the surveys we have in Singapore, we had found that the caregiving burden is disproportionately weighted on women. I will check the statistics again but if I do not recall wrongly, about 60 to 65% of caregivers in Singapore are women. If you look around us, you will come across relatives, sometimes it is the single women in the family. Because she is not married, she ends up with the responsibility of taking care of aged parents. To be honest, she has in her way “passed her prime” in terms of bearing a child and starting a family. But when she takes on the caregiving responsibility of taking care of her aged parents, she also suffers from the issue of not having enough in her retirement account because oftentimes, she gives up work opportunities to take care of her aged parents. These are what we see when we conduct caregiving surveys, and we realise that the caregiving burden is disproportionately weighted on women.
13. So the Government looks at what initiatives we can have to support these women. Caregivers have two sets of responsibilities. For many in the sandwiched generation or class, they probably have to take care of young children on one end, as the caregiver, and aged parents on the other end. So what is the Government trying to do, and what are we doing right now? We have shared that there will be 10,000 more full-day preschool places created by 2023. This is important because often times, when women at a child-bearing age are considering whether or not to have children, they think about practical concerns such as whether they have family support, whether they are able to have their child placed into an infant-care playgroup or childcare that is near where they stay because if they are not able to do so and they have no family support, it means that they would probably have to give up work opportunities to be able to take care of the child. So imagine if you’re a young lady, at the prime of your life, say 27 years old, 29 years old, before the 31 years old that Prof Chong talked about, which is the median age for having children. They are thinking, “I want to have a career”, “I want to be my own financially independent woman”, “I have work aspirations”, “I have ideals”. If I have a child, and I’m not able to put the child in a childcare facility or infant care facility near my home, who is going to take care of the child after I give birth to the child? Is it myself, I look to my husband? Oftentimes, they say the man only becomes the father after the child is born. I’m not quite sure whether that’s true, I wanted to ask Prof Chong, given how many babies he’s delivered. But these are concerns that women have. So they look around them and they hear from their friends that “Oh why is there no infant care around? Nowhere you can put your child.” And if you do not have the luxury or comfort of having your mother or mother-in-law around being close around to help, it actually causes you to take a step back to think about maybe should I have children or maybe let me think about it later. That’s a very dangerous question. The later you wait, like what Prof Chong was saying, it might not come as easily as you would like it to. Having children is not like that, it is a confluence of many factors, so the government tries to help by putting in place adequate infant care playgroup and childcare services.
14. But at the same time, we also have to work on the family support, talking to men, inviting men to conversations, reminding men that your job is not just about being the second half of the equation to reproduce the child but also the responsibilities that come after you have the child. I think the good news is, for many of the young ladies here who are married, I hope that the men that you are seeing around you are a little bit more hands-on when it comes to taking care of children. I was going to say “hands-up” to those who perhaps have the luxury or the benefit of having men like that around you. I’m thinking, what about the women who are not putting up their hands, I think I do not want to start a gender war right now. But these are very practical concerns that young women have.
15. And on the other side of the spectrum, about women taking care of the older folks, what can we do in terms of forming caregiving alliances or networks around them, so that they know that there is someone to also take care of their elderly, aged parents, so that they can go to work with peace of mind, knowing that both sides, the young children and the seniors are taken care of. And of course, if the men are part of the equation, with two hands, makes much less work.
16. I was reading an article about longevity and this is a topic that Professor Chong is very knowledgeable about. He just basically launched the Centre for Healthy Longevity just a week ago. I was very struck when I read the article aboutfactors which are cited as “longevity practices”. I think if you have a healthier lifestyle, it impacts general reproductive health, it also impacts your happiness level, does something to your stress level and all that might lead to better outcomes for women in general, that could impact their child-bearing abilities and the concerns they may have about having children. So what are the factors? moving naturally (exercise), a sense of purpose in life, managing stress, eating and nutrition and interestingly, putting family first and having a social community around you.
17. I’m putting an emphasis on the last two parts and not going to talk about exercise and nutrition because all of you are the experts. I’m no scientist, no researcher, and am here to talk about the social aspects, that was the assurance that Prof Chong gave to me. So family and social community, why is it important? The research suggests that when you have good quality family relationships, it comes back to the point about having family support. You feel a lot more adequate, in terms of being able to take on and manage the various stresses you may have in life. You also know that family becomes that fallback that you have, when you have situations. Like what I’ve mentioned, if suddenly the child is unable to go to childcare because the child is sick, who can you fall upon back in your family to help take care of the child, for instance. And about having healthy relationships with the spouse, about having healthy relationships with your mother, mother-in-law, your parents and having that social community around you.
18. Actually for many of the women, I think, like myself, we actually hold the keys to these relationships. Oftentimes, relationships are very important to women. But when we try to juggle so many things at one go, oftentimes we suffer. We forget about self-care. We run from one end to the other end. My kids engage in this game, they pretend play, they act out something and somebody has to guess who they are acting out. I recall all sorts of funny things, and then suddenly they acted out this person who was rushing around to find a bag, rushing out to put on shoes, to get out of the house, rushing back in because the person forgot something, and everybody shouted “Mummy!”. I was like “wow”, this is the impression my kids have of me. I must say that probably was a common example that many women experience themselves. A lot of stress trying to juggle all of this. Actually if you are able to hopefully slow down and think a little bit about how we can work with our family members, how we can have that trust, how we can share about what is it that we need from them. Be open with our emotional needs, and to ask for help. I think all these are very important because for all we know, our husbands may be a lot more helpful than they may come across on the onset.
19. We women hold the keys to our own health, our reproductive health, emotional health, our pursuit of happiness and purpose. All that can lead to basically, our overall sense of purpose and mission in life and with happiness levels up, stress levels down, I think that impacts our reproductive health at the end of the day. Hopefully when you have children, it is not going to be a stressful experience, it’s something that you enjoy, that empowers you and further gives you that purpose. That you wake up everyday, when you see your children, it brings you happiness and you’re also able to go to work with peace of mind.
Year of Celebrating SG Families
20. Just now, I think Prof Chong had talked about the White Paper. I also wanted to mention that knowing the importance of family support, knowing the importance of families, the Singapore govt had designated this year, 2022 as the Year of Celebrating SG Families. We all know the importance of families, and have spoken about it but oftentimes it is easy for us take families for granted. So, the Singapore government designated 2022 as the year for celebrating families. What are the actions that we have undertaken? Myself and my team at the Ministry of Social and Family Development, we formed the Alliance for Action to Strengthen Marriages and Family Relationships (AFAM). Why? Because we wanted to bring various stakeholders on board to co-create family-centric activities so that young couples with children, or families with grandparents, they can all come together and enjoy family life. At the same time, just recall, reiterate and remind each other about the family values that we hold dear, which helps strengthen relationships. Very simple things, listening to each other, practising respect, being committed to each other, support each other during downtimes. All these are important factors that keep the families together and helps build resilient individuals.
21. One of the Focal Areas under AFAM is about “Support for Young Couples”. In this area of work, MSF is rolling out marriage preparation programmes, and also engaging in conversations with couples on issues close to their hearts, such as fertility. Also arising from those conversations, we had proposed elective egg-freezing. I must say that we are only rolling out elective egg-freezing next year and actually based on the numbers we see, the number of women currently as we know it who are enquiring about elective egg-freezing are not high. But then again I do not want to prejudge the outcome because there could be only very little requests because it was not allowed in Singapore in the first place other than for medical purpose. So I do not quite know what would be a steady state for elective egg freezing. But what we have been very careful about is to say that even as we allow elective egg freezing for non-medical reasons, we do not want to give women the wrong impression that just because we now have the option of egg freezing that you would be definitely be able to have a child when you want to do so. There are medical experts around, and as what Prof Chong said, there’s a certain limit to IVF. I believe he will share about it further later. So this is not a blank cheque. It is not that once you embark on elective egg freezing (EEF), that the children will come naturally. Part of what we’re going to do next year when we roll this out, we’re going to make sure that our women receive adequate counselling, that they know what are the benefits and the risks. Because ultimately it’s an invasive procedure.
22. Currently, based on my understanding and the medical researchers, doctors can correct me if I’m wrong, I think the success rate is anywhere from 2 to 12%. That is what I gathered from research. It’s not a high percentage. But to a woman who desires to have a child, I think any percent is better than 0 percent. But that number, 2 to 12%, is useful to remind our women because EEF and subsequently IVF is not without pain, not without trauma, in the sense because there is some emotion when you go through the process, and also it’s not inexpensive. And this is elective egg-freezing, in other words, there’s no subsidies, IVF is subsidised, EEF is not. So women have to consider all these issues when they embark on it. Most important point is the probability of success. We are very careful that we do not want to go the way whereby it becomes almost gimmicky in terms of marketing, advertisements on TV whereby it looks like you’re empowering the women but actually when you think about the rates of success, it can be very disempowering. To think that you have the option to do it and only to then be disappointed if it doesn’t work out. These are things that we have to consider.
23. In conclusion, women in Singapore have made significant progress, education, work opportunities, a greater sense of equality in our society, but this is really work-in-progress. We always have to be mindful of the new challenges that can arise. We are monitoring the situation as what Prof Chong mentioned, it’s a ten-year roadmap that we have, arising from the White Paper on Singapore Women’s Development that we have. We will be looking at the indicators and one important indicator is how women feel about themselves – whether they’re feeling empowered, whether they’re feeling supported, what it means for their family life and how do they feel themselves as individuals. I’m looking forward to hearing from the rest of you during the conversations in our conference this morning and I thank you for your indulgence listening to me as I share about the social environment around this very interesting topic that we’re talking about which is about reproductive longevity.
24. Thank you very much.