The Population of Singapore (Third Edition)

9. Family Planning, Abortion and Sterilisation

187 9 Family Planning, Abortion and Sterilisation Population policies refer to those adopted by a government to influence the course of population trends and patterns in the country.1 Some examples are immigration policies regulating the inflow of foreigners into the country, mortality policies affecting the general health of the people, population distribution policies governing the movement of people within the country, and fertility policies affecting the reproductive behaviour of the population. There are two types of fertility policies — those designed to encourage childbearing and those meant to discourage childbearing. Those policies adopted by the government to persuade people to produce more children in order to raise the rate of population growth are known as pronatalist policies, while those meant to do the exact opposite are known as antinatalist policies. In Singapore, the government adopted a strong antinatalist stance in the mid-sixties and introduced a comprehensive population control programme over the years to accelerate the decline in fertility and hence the rate of population growth. The programme consisted of four major components: government family planning, induced abortion, voluntary sterilisation, and incentives and disincentives aimed at reducing fertility.2 The rapid decline in fertility to replacement level in 1975 and the continuation of fertility below this level led to major changes in the programme in 1987 in order to encourage more births. Before this, some eugenic measures were introduced in 1984 to improve the quality of the population. PRIVATE FAMILY PLANNING PROGRAMME Birth control as a means of spacing children and limiting family size has long been practised by couples in Singapore on an individual basis, sometimes with 188 POPULATION OF SINGAPORE the advice of doctors and friends and the use of family planning literature. The idea of providing family planning services to the masses was discussed probably in the thirties, culminating in the suggestion for the establishment of a family planning society in the leading article of an English newspaper in 1938.3 But nothing positive came out of this recommendation and it was not until a decade later that such a society was formed. The need for providing family planning services to the general public was debated again immediately after World War II when the country was confronted with widespread social and economic problems, particularly food shortages. The Social Welfare Department, with the assistance of voluntary workers, set up numerous food centres to feed the starving population, especially the children. The voluntary workers assisting in the scheme were convinced that feeding the hungry children would not solve the problem and a better solution was to help parents plan their family size according to their means. In response to their request, the Municipal Council agreed in May 1949 to permit its infant welfare clinics to provide family planning services once a week in three of the five clinics.4 This fell short of the work envisaged and the group of volunteers, mainly doctors and social workers, gathered together on 22 July 1949 to form the Family Planning Association (FPA). The primary aim of the Association was to provide family planning services to the masses to help them avoid unplanned childbearing, and thus to improve the health of the mothers and the general welfare of the family. The objects of the Association as incorporated in its constitution were as follows:5 1. To educate the people in family planning and to provide facilities for scientific contraception so that married people may space or limit their families and thus promote their happiness in married life and mitigate the evils of ill-health and overcrowding; 2. To advocate and promote the establishment of family planning centres at which, in addition to advice on scientific contraception, women can obtain advice on and, when necessary, treatment for any or all of the following: a. involuntary sterility b. minor gynaecological ailments c. difficulties connected with the marriage relationship. 3. To encourage the production of healthy children who would be an asset to the nation, provided that their parents have the health and means to give them a reasonable chance in life. 4. To examine some other problems as are relevant to the above, and to take such action as may be considered advisable. Family Planning, Abortion and Sterilisation 189 The Association commenced work after office hours in three clinics, located in the private dispensaries of three of its members. This was followed shortly by another three clinics which opened at the Municipal Health...