Ms Sylvia Lim (Aljunied): Madam, Singapore’s total fertility rate stands at 0.97, yet delivery costs vary widely by maternal nationality.
Foreign mothers married to Singaporean fathers whose children will be Singaporean by birth, face significantly higher expenses. At KK Women’s and Children’s Hospital, a normal delivery in a C class ward cost Singaporean mothers $1,390, which is fully MediSave covered. Permanent Residents (PRs) pay $2,870, with most of it MediSave claimable and $120 being payable in cash. Non-resident mothers must pay more than $8,000, claiming less than $3,000 from MediSave and paying about $5,300 in cash.
The gap widens for Caesarean deliveries. Singaporeans pay about $2,270, fully MediSave covered. PRs pay nearly $5,000, of which $410 must be paid in cash, and non-Residents pay nearly $12,000, with about $7,300 in cash. Many C-sections are unplanned emergencies, compounding financial stress.
Given Singapore’s low fertility rate, it seems counterproductive to impose such steep delivery fees on families whose children are Singaporeans from birth. Indeed, these costs send the wrong signals that Singaporean children are not welcome if their mothers are foreign.
This burden is heavier for citizen father, foreign mother families. The 2019 SG LEED study found that these families have the lowest per capita income at about $1,700 compared to citizen couples at about $2,600 and citizen mother, foreign father families at $3,100.
Furthermore, 17% of foreign mothers with Singaporean children still held a Long-Term Visit Pass (LTVP), despite being married for an average of eight years. The Government’s stance, as indicated in November, is that foreign spouses who do not qualify for PR can apply for LTVP or LTVP+, showing no defined pathway to permanent residency.
Madam, I request MOH to review the cost differentials for these foreign mothers of Singaporean children.
The Minister of State for Health (Ms Rahayu Mahzam): For the next part of my speech, I will focus on family and fertility, which is an issue close to the hearts of many in this House. Ms Sylvia Lim asked about the differences in maternity fees for Singapore Citizens and PRs as compared to non-residents. We understand that healthcare costs are an important consideration in setting up a family, particularly for transnational families. Hence, foreign mothers who are married to Singapore Citizen fathers, and who are PRs, or on Long-Term Visit Pass Plus, LTVP+ in short, can receive Singapore Citizen–level subsidies for the delivery episode, in recognition that their child will be a Singapore Citizen and PR-level healthcare subsidies for all inpatient services.
In fact, the vast majority of foreign mothers married to Singapore Citizens, and with Singapore Citizen children, are PRs or LTVP+ holders, and they would be eligible for these subsidies. Expectant mothers married to Singapore Citizens may apply for an LTVP, and those who are eligible for an LTVP+ will be granted subsidies accordingly.
Beyond subsidies, the MediSave Maternity Package also allows couples to use their MediSave for their delivery and pre-delivery expenses. Singapore Citizen or PR fathers whose spouses are giving birth in Singapore may tap on their MediSave to defray the out-of-pocket cost of their maternity fees.
For some individuals, however, the ability to build a family may be irreversibly compromised by medical treatments that are required to treat conditions, such as cancer. Such treatments can significantly impair one’s fertility. I thank Dr Tan Wu Meng and his healthcare worker peers for tirelessly advocating for young cancer patients seeking fertility preservation. We agree that no one should have to forgo the opportunity to have a child because of the side effects from a medically necessary treatment for a condition.
Hence, from June this year, we will extend subsidies for embryo, egg and sperm freezing for those whose fertility can be irreversibly affected by their medical treatment. From next year, we will also extend MediSave coverage for embryo freezing, and MediShield Life coverage to support embryo, egg and ovarian tissue freezing for such individuals. Those who still face challenges with the cost of their fertility preservation treatments arising from medically necessary treatments may also approach medical social workers at their public healthcare institutions for further assistance, including to apply for MediFund.
With these changes, we hope to assure patients facing medical challenges that their dreams of starting a family in the future are still within reach.
The Chairman: Ms Sylvia Lim.
Ms Sylvia Lim: Thank you, Speaker. I have a clarification for Minister of State Rahayu about the cut on maternity fees which I filed. I filed this actually based on some ground feedback that came to me from my residents who are Singaporean fathers-to-be but their wives are foreigners. They may be holding LTVP, not plus, or something lesser. And from our research on the KK Women’s and Children’s Hospital website, it does appear that the maternity fees that are charged are actually tied to the residency status of the mother.
So, I do not know whether earlier, because I did not hear her that carefully, was the Minister of State Rahayu saying that somehow the father’s status as a Singaporean can be taken into account to reduce the maternity fees in such situations? Because I did not hear that very clearly and I would like her to clarify that.
Ms Rahayu Mahzam: Let me refer to the portion that I responded to. So, actually, what I said was that foreign mothers who are married to Singapore Citizen fathers and, who are PRs or on LTVP+, can receive Singapore Citizen-level subsidies for delivery episode, in recognition that their child will be a Singapore Citizen; and PR-level healthcare subsidies for all in-patient services. So forth, for maternity care, when it is the delivery, they will actually get Singapore Citizen-level subsidies.
The Chairman: I think all the clarifications have — Well, I spoke too soon. Ms Lim.
Ms Sylvia Lim: Thank you, Sir, for your indulgence to re-clarify with Minister of State Rahayu. Earlier she, she mentioned that citizen level subsidies would be available for delivery by foreign mothers if they are PRs or LTVP+ holders, in consideration of the fact that the child will be a Singapore Citizen. But I think she will also know that there are Singapore children also being born to mothers who are LTVP, but not plus. So, can that not also be considered in the fee setting?
Ms Rahayu Mahzam: Based on the information that we have from the Immigrations and Checkpoints Authority, the vast majority of foreign spouses with Singapore Citizen husbands and have Singapore Citizen minor children are actually LTVP+. So, in that sense, the vast majority of spouses are therefore eligible for medical subsidies already.
We generally receive very few appeals each year from Singapore residents for their sponsored dependants on LTVP. If you do have some of these cases, they can be surfaced, and they can approach medical social workers to request for MediFund. [Please refer to “Clarification by Minister of State for Health“, Official Report, 7 March 2025, Vol 95, Issue 160, Correction By Written Statement section.]
The Member still looks very puzzled. I am happy to take this up separately and see if there are specific cases we can assist you with.
Ministry of Health
7 March 2025
https://sprs.parl.gov.sg/search/#/sprs3topic?reportid=budget-2621
Office of the Leader of the Opposition 