In this chapter, the knowledge, attitudes, and practice of married women in respect of family planning, abortion, sterilization, and government population policies will be examined. The source of data for this study is the First National Survey on Family Planning conducted in 1973 on a sample basis. By means of a two-stage stratified sample design, a slightly less than 1 per cent sample of 2,167 married women aged 15 to 44 were selected for the survey which was conducted from 7 to 29 September 1973. During this period, 2,078 of the selected women were successfully interviewed and the remaining 89 were refusals and non-contact cases, giving a response rate of 96 per cent, which is quite satisfactory as compared to similar surveys conducted in other countries. During the data processing stage, a few completed questionnaires had to be rejected for various reasons and the number finally accepted for tabulation amounted to 2,076. A wealth of information pertaining to these 2,076 married women was published in the report, but only the more important features that are relevant to this study will be discussed here.

FAMILY PLANNING

In the survey, the respondents were asked the number of birth control methods they had heard about but need not necessarily know how to use. Some 97.4 per cent of the 2,076 married women replied that they had heard of at least one contraceptive method. This was a very satisfactory figure as compared to the corresponding proportion of 94.7 per cent in Japan (1973) and 84.5 per cent in Peninsular Malaysia (1970).The almost universal knowledge of contraceptive methods among Singapore women was not surprising in view of the continuous clinical, information, and educational activities of the Family Planning Association since 1949 and subsequently the Singapore Family Planning and Population Board (SFPPB) since 1966. In addition, there was the high literacy rate and excellent mass communication channels in a small compact cosmopolitan community.

The detailed figures in Table 7.1 show that contraceptive knowledge had indeed permeated all strata of the community. The married women in each of the three main races had equally high levels of contraceptive knowledge, above 97 per cent, and so did the married women in each of the three age groups.

Our long-term demographic goal is to stabilize the population at a certain number sometime in the first half of the 21st century. To attain this goal, two conditions must be fulfilled.

The first is that we must reduce our fertility to the replacement level, or the two-child family level; the other is to maintain it at this level indefinitely.

The first condition was accomplished in 1975 when our fertility was reduced to the two-child family level. But we were not able to realise the second condition in that fertility continued to fall below this level to reach the low point of 1.5-child family level in 1985.

The continuous decline of our fertility below that two-child family level can be attributed to our comprehensive population control programme as well as to many economic, social and cultural factors favouring a small family size among our general population.

To elaborate on the above points, I have prepared three alternative population projections based on three different fertility assumptions.

In the first projection, it is assumed that our fertility will move back from the 1.5-child family level in 1985 to the replacement level of the two-child family in the year 2000, and will continue to be at this level indefinitely.

In the second projection, fertility is assumed to remain constant indefinitely at the 1.5-child family level.

In the third, it is assumed that fertility will continue to decline slightly from the 1.5-child family level in 1985 to the 1.3-child level in the year 2000.

If we succeed in moving fertility back to the two-child family level in the year 2000, the total population of Singapore will reach the peak of about 3.39 million in the year 2030 and will remain just slightly below this figure indefinitely. This means that zero population growth will be experienced from the year 2030 onwards, with births equalling deaths each year.

If our fertility is not pushed back to the two-child family level and is allowed to continue indefinitely at the 1.5-child level, our population will peak at about 3.02 million in the year 2015. After that, it will decline continuously until it reaches 2.46 million in the year 2050. During this period, deaths will progressively exceed births each year.

The national population policies in Singapore have been dominated by fertility policies in the form of antinatalist measures commencing from the mid-1960s and postnatalist measures from the 1980s. The recent recognition that, despite the introduction of a comprehensive postnatalist policy, fertility will never return to replacement level to sustain the population size in the future resulted in a big shift in the national population programme towards immigration as the key answer to replenishing the population in the years ahead. Not surprisingly, immigration rules were expanded and relaxed to attract foreigners, especially professionals and businessmen, to relocate to Singapore and become permanent residents. Citizenship laws and procedures were liberalized to make it easier for those who had become permanent residents to take up Singapore citizenship by naturalization. The various schemes designed to lure foreigners to work and settle in the country resulted in a surge in the foreign population and, consequently, frequent grumbling about the city-state becoming too overcrowded. Lately, some of the rules meant to attract foreigners were tightened.

NEED FOR IMMIGRATION

If a population is closed against migration and is subject to a total fertility rate (TFR) of 2.1 and a constant mortality indefinitely, the population will eventually reach a state where it will experience a rate of population growth equivalent to zero. At this point of time and thereafter, the population is said to be a stationary population possessing certain inherent properties. The size of the population willremain constant, the annual number of births and deaths will remain not only constant but equal, the age structure will be invariable, and the crude death rate equal to the inverse of the expectation of life at birth. We have observed in the previous chapter that the total fertility rate not only remained below replacement during the last forty years, but moved downward over time to touch the low of 1.2 in recent years. We also showed that this below-replacement fertility had resulted in a shortfall in the annual number of births, which would not allow the population to replenish itself in the future.

Indeed, the results of population projections prepared by the author in the 3rd edition of his book entitled The Population of Singapore revealed that the resident population of Singapore would begin to decline by around 2025 or 2030.

NEED FOR FURTHER CHANGE

We had observed that on the basis of the recommendations of the Inter-Ministerial Population Committee, the government implemented a wide range of incentive measures in 1987 aimed at encouraging women to produce more children. This was subsequently followed by a few pronatalist measures announced by the Prime Minister at the National Day Rally held in August 2000. The effectiveness of all the measures had not been very encouraging mainly because they were formulated to loosen some of the old antinatalist measures and to introduce some limited pronatalist measures. Furthermore, the socioeconomic factors favouring small family norms had continued to exert a strong influence in prolonging the movement of low fertility below the replacement level.

In an attempt to evaluate the effectiveness of the above measures, one must take into account the influence of the Tiger Year and Dragon Year in the Chinese lunar calendar during the period under consideration. Viewed in terms of producing babies among the Chinese community, the Tiger Year in 1998 was an inauspicious year and the Dragon Year in 2000 an auspicious year. This resulted in some distortions in the annual movement of fertility during the period from 1997 onwards. The total fertility rate (TFR) was recorded as 1.68 in 1997 when the above measures were first implemented, and one would expect an increase to be registered the very next year. Instead, the TFR witnessed a pronounced decline of 8.3 per cent to 1.54 in the Tiger Year 1998, and remained at this level in the following year. The Dragon Year 2000 experienced a break in the fertility downtrend when the TFR rose to 1.68. Despite the introduction of some pronatalist measures in 2000, the TFR resumed its downward movement in the next few years, falling to 1.48 in 2001, 1.45 in 2002, and 1.33 in 2003.

The government became extremely concerned about the continuous decline of the low fertility below the replacement level and the attendant fall in the number of births from 46,997 in 2000 to the second low of 37,485 in 2003.

In an earlier article (“When couples have fewer than two”, the Sunday Times, June 15) I discussed the impact of fertility trends in Singapore on the future size of our population.

Singapore women, as a whole, have been having too few babies to keep our population from declining in the future. But there are differences in birth patterns among women from the different ethnic and educational groups.

For instance, while Malay and Indian women have been having children at a rate of about two per family (the population replacement rate), Chinese women, on average, have been having fewer and fewer.

I will consider the implications of this trend later in the article. First, in order to understand better the population problem that faces Singapore, we need to look at some fertility figures.

Those who watch population trends find a number called the GRR (gross reproduction rate) to be a particularly useful measure of fertility.

It is the average number of daughters a woman will produce during her childbearing years — provided that she lives through the entire period.

Of course, not all women live until the end of their child-bearing period. So the actual average number of daughters born to women in the population can be calculated from the GRR by taking into account the death rate of women in this age group.

The resulting figure is the net reproduction rate (NRR).

If the NRR is exactly 1 (commonly referred to as the two-child family level, since each woman has one son and one daughter on the average), we can expect the population to replace itself in the future.

If it is less than 1, too few daughters are being born for the population to replace itself.

If it is more than 1, the size of the population will grow, since there will be more daughters than mothers.

When the NRR is exactly 1 in Singapore, the GRR will be about 1.025. This is the replacement fertility level.

Women in Singapore have been having fewer and fewer children since 1958. This decline continued into the early 1970s. In 1970, the average woman had 1.505 daughters over her lifetime.

In 1975, when the fertility rate first dropped below the replacement level of 1.025, the average woman had 1.006 daughters.

The package of pronatalist incentives implemented soon after the National Day Rally held in August 2004 could be separated into two broad groups. As noted in the previous chapter, the first group consisted of incentives designed to implement some changes to the measures introduced in the past so as to make them stronger and more effective. The second group contained entirely new measures that were quite essential for preventing any further deterioration of the exceedingly low level of fertility prevailing at the time. The formulation of the overall package in terms of financial and non-financial incentives was, in fact, viewed by the government as a “holistic and coherent approach” towards creating a more congenial environment for couples to produce and raise children in Singapore.

CHILDCARE LEAVE

One of the new pronatalist incentives introduced in 2004 was the two days of statutory childcare leave granted to each working parent, provided for by an amendment to the Employment Act passed in Parliament on 21 September 2004. With effect from 1 October 2004, parents were entitled to take two days per year of this statutory employer-paid leave if they had at least a child under seven years of age. In late 2008, the leave was extended to six days, with the first three days paid by the employer and the other three days by the government, capped at S$500 per day. The leave was granted on the basis of per parent and not per child, i.e. each parent could only take two days in a year even if there were more than one child under seven years old in the family. However, parents had full flexibility to use this leave to spend time with their children for whatever purpose since it was not predicated on other conditions such as illness of the child.

As part of the overall package of measures to support parenthood, the childcare leave allowed working parents to take time off to care for their children without any loss of income and to achieve a more harmonious work-life environment.

The childcare leave was also made available to working parents with any stepchildren or legally adopted children below the age of seven. The parents could be married, divorced, or widowed, and they could be regular employees, fixed-term contract workers, or temporary or part-time employees.

INTRODUCTION

After the attainment of replacement fertility in 1975, no changes to the national population control programme were made until the mid-1980s when measures designed to encourage the better-educated women to produce more babies and the lesser-educated to bear fewer babies were introduced. These measures were meant to influence the quality rather than the quantity of the future population to ensure an adequate supply of talented people for the small island state. The genesis of the shift towards the qualitative aspect of the population can be traced to the traditional address delivered by the Prime Minister, Lee Kuan Yew, at the National Day Rally attended by a gathering of People's Action Party members and other specially invited guests on 14 August 1983. Appendix A reproduces the full text of his speech.

Touching on the prevailing problems and issues confronting Singapore, he talked at considerable length about the differences in fertility according to the educational level of mothers as reflected in the 1980 Population Census data. He also cited the findings, particularly those of Thomas Bouchard of the University of Minnesota, which seem to indicate that the intelligence of a child is determined more by nature (about 80 per cent) than by nurture (about 20 per cent). He expressed his concern about the lopsided pattern of procreation in Singapore where the better-educated mothers were bearing too few children, which would eventually have the undesirable effect of lowering the quality of the population in the long run. He emphasized the need to change “our policies, and try to reshape our demographic configuration so that our better-educated women will have more children to be adequately represented in the next generation”.

The Prime Minister's remarks on the above population issue in the much-heralded National Day Rally beamed live over television and reported prominently in the newspapers provoked a great debate among the general public. The debate centred on the validity of the hypothesis that the intelligence of the children is determined by the educational level of their mothers and that intelligence is dependent more on nature than nurture. As to be expected, there was no consensus among the people regarding these somewhat controversial and emotional issues.

Population Policies and Programmes in Singapore is a vastly expanded version of my earlier book published some twenty-five years ago by Oxford University Press under the old title of Population Control for Zero Growth in Singapore. This revised edition of the book has been divided into two distinct sections — Part One: Anti-natalist Period and Part Two: Pronatalist Period. The former deals with the period when the main concern was the need to lower the high and above-replacement fertility in the early years, and the latter covers the more recent period when the focus of attention was centred on preventing fertility from continuing to move forward at a level too low below-replacement fertility. The chapters included in Part One have been reproduced, with some revisions, from my earlier book, while Part Two contains the new chapters and appendices.

The enlarged book has therefore been structured in such a manner as to present a comprehensive account of the initiatives undertaken by the government to influence the course of fertility, and hence the rate of population growth, in the island state of Singapore during the last four decades or so. The book may be viewed as a case study of the public policy of a country in the area of population with regard to fertility and population growth. Hopefully, the book will enable the people of Singapore to comprehend the fundamental population issue of the day and to recognize the rather low below-replacement fertility, coupled with its adverse consequences, that will persist during their whole lifetime. More specifically, the book will be useful to married couples with children or planning to have babies since it constitutes a convenient source of detailed information on all the existing pronatalist incentives, financial or otherwise, that they are entitled to claim.

In the preparation of the two editions of the book, I was fortunate to receive the valuable assistance of many organizations and individuals. My thanks go to the Government Statistics Department, the then Family Planning and Population Board, and the Family Planning Association for supplying me with statistical data and other relevant materials. My research has been enormously facilitated by the conducive facilities offered at the London School of Economics Library, the National University of Singapore Library, and ISEAS–Yusof Ishak Institute.

Having examined at great length the nature of the population control programme with its various components introduced at different times in response to prevailing demographic trends and economic conditions, we will now proceed to investigate the levels and trends in fertility during the post-war period up to 1977, paying particular attention to the more interesting developments that had taken place in the 1970s. In this task we have been greatly assisted by the availability of accurate and comprehensive birth statistics generated from the efficient vital registration system in Singapore. For one thing, the coverage of birth statistics is known to have attained near 100 per cent completeness, and from 1953, these data have been made available according to the date of occurrence of live-births. Data on live-births by age of mother have been made available progressively in greater detail since 1943, with birth order statistics first published in 1967.

Our study of fertility levels and trends is based largely on the total fertility rate though the crude birth rate is also used. The crude birth rate, defined as the total number of live-births occurring during one calendar year per thousand population living in the middle of the same year, is easy to compute and understand, but it suffers from some inherent defects. It is distorted by differences in population structure and is not suited for assessing fertility differences over time or among various groups of the population. The total fertility rate is the average number of children that would be born per woman in a group of women if all women survived to the end of their reproductive years and bore children at each age in accordance with the age-specific fertility schedule for women of various ages. Computation of this rate requires data on the number of births during the year tabulated by the age of the mother and on the total female population at mid-year of the same year by five-year age groups. The total fertility rate, which is independent of the effect of the sex and age composition of the population, is a satisfactory measure for analysing fertility trends and differentials.

INTRODUCTION

Singapore is one of the few countries where the government has always assumed an active role in attempting to influence the course of population trends with the view of resolving any adverse consequences that may emerge. From the very beginning when the country achieved independence from the British in 1965, the Singapore Government has put in place a population control programme that offered contraceptive services in its clinics, legalized abortion, and voluntary sterilization. The programme was so comprehensive and successful that fertility was induced to tumble rapidly to replacement level in 1975.

The somewhat low fertility recorded a few years before 1975 should have been taken as a clear signal that it would not take too long for fertility to reach replacement level. It was quite obvious that the continuation of the antinatalist policies would sustain fertility at well below-replacement level, and indeed that was what actually happened. These measures were essentially left untouched for more than a decade until the mid-1980s. Moreover, the eventual implementation of the pronatalist policies was not quite decisive, with the various incentives introduced gradually at different stages over a period of thirty years. In the meantime, the group of social and economic factors favouring small family norms continued to exert a powerful influence on the reproductive behaviour of married couples.

The demographic history of Singapore had indeed reached a critical stage where fertility had consistently remained well below the replacement level. This must necessarily imply that the annual number of births produced by our women was no longer adequate to replenish the population. It was widely recognized that the only solution to this predicament was to rely on the continuous inflow of new immigrants to prevent the population from declining in the years ahead. With the inflow of newcomers under its direct management, the government was now entrusted with the important responsibility of ensuring a correct supply of newcomers to sustain economic growth as well as to enlarge the resident population.

DEMOGRAPHIC TRENDS

The total population of Singapore has been divided into resident population and non-resident population, with the former consisting of persons who are citizens and permanent residents.

We have observed the quick reaction of the government in confronting the population problems facing the country during the early postindependence period. The wide range of strong antinatalist measures proved to be very effective in rapidly pushing down fertility to replacement level within a decade or so. In sharp contrast, the government was rather slow in recognizing the necessity of removing completely the antinatalist policies. Even when the policy changes were finally put in place, they were implemented very gradually in different stages over a period of some thirty-five years.

The postnatalist era will be the focus of our attention in the remaining part of the book, with chapters dealing with the loosening of the antinatalist policies, the introduction of limited pronatalist incentives, the reinforcing of the limited pronatalist incentives, the implementation of new pronatalist measures for mothers without any restriction on the birth order of the babies and below-replacement fertility. This will be followed by a chapter on the hot button topic of immigration policies and programmes. The concluding chapter will discuss the complex demographic issues and challenges that must be tackled by the people and the nation.

NEED FOR POLICY CHANGES

It may be recalled that the population control programme was implemented in the mid-1960s. Its specific objective was to lower the level of fertility so as to reduce the rate of population growth. This was part of the national development strategy to raise the standard of living of the people. As it became increasingly obvious that this objective would be achieved by the mid-1970s, attention was focused on the wider issue of the maximum size of the population that Singapore could accommodate in the future. The extremely small land area with no endowed natural resources must necessarily imply that Singapore cannot allow the population to grow indefinitely into an unmanageable size that can threaten the very existence of the island Republic. This led to the government declaring in 1974 that the national demographic goal thereafter was to stabilize the population in the future.

In order to achieve this long-term demographic goal, it was essential to fulfil two conditions concerning fertility in accordance with stationary population theory.

FORMATION OF THE FAMILY PLANNING ASSOCIATION (FPA)

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 the advice of doctors and friends and the use of family planning literature. However, this practice was confined only to a small group of persons belonging mainly to the more educated and wealthier classes. The idea of providing family planning services to the general public was first discussed by a major correspondent in the Straits Times in January 1935, and this attracted some public comments from various interested groups about the pros and cons of family planning. Public interest in this subject was revived during the visit of Mrs Margaret Sanger, a world authority on birth control, to Singapore in February 1936 when she advocated that, among other things, family planning should be an essential part of the official public health programme. In December 1936, the Chinese Christian Association debated the matter and voted, with only three against, that birth control clinics should be established in Singapore. Some time before World War II, the establishment of a private family planning society was in fact recommended by a leading article in an English newspaper published on 21 September 1938. This suggestion did not result in any positive action and it was not until a decade later that such a society was formed.

The idea of providing family planning services for the general public on a large and organized scale was debated again during the post-war years when the country was faced with serious social and economic dislocations. Apart from housing and educational problems, the government was confronted with the problem of feeding a large number of undernourished persons, especially children roaming the streets, because of rampant food shortages. The Social Welfare Department set up numerous centres to feed the hungry children, but it soon became apparent to the group of voluntary workers assisting in this scheme that, instead of feeding the children, the parents should be given family planning advice to plan their family size according to their means.

At the invitation of the YWCA International Club, a series of lectures on birth control was delivered in April 1949 by the Head of the Social Welfare Department, the Municipal Lady Health Officer, and the wife of a senior missionary to some sixty women.

OVERVIEW

In providing every possible support, financial or otherwise, to the Family Planning Association in its attempt to assist women to plan their births and avoid having unwanted babies and to check the rapid rate of population increase in the early 1960s, the Singapore Government was aware of the conflicting nature of some government policies with respect to the general concept of family planning and the promotion of a small family norm in particular. In his opening address at the Seventh Conference of International Planned Parenthood Federation (IPPF) held in Singapore on 10 February 1963, the Prime Minister, Lee Kuan Yew, referred to the anomalies in certain government policies, carried over from the colonial period, seen from the point of view of population control. He stated,

However, these contradictory rules were not altered then as the Prime Minister felt that humanitarian values and sentiments had prevented the government from making any change.

It would appear that in the next few years, the problem of these contradictory rules was constantly occupying the minds of the government leaders as the Prime Minister brought up this question once again in his National Day message on 9 August 1967. He said,

INTRODUCTION

While the previous chapter presents an account of the changes relating to the partial reversal of the old antinatalist policies introduced during the years 1987–2000, this chapter focuses on limited pronatalist measures implemented during the same period. Apart from recommending the loosening of some of the old antinatalist policies, the Inter-Ministerial Population Committee suggested the introduction of some pronatalist measures. But these pronatalist measures, together with those implemented later, were based on the same principle of giving incentives up to at most the fourth child.

The second major group of pronatalist measures were introduced in the new millennium following the traditional address by the Prime Minister, Goh Chok Tong, in the National Day Rally held on 20 August 2000. Among other things, he said, “We must create a total environment conducive to raising a family. Our policy is to have three children or more if you can afford it.” It is important to emphasize that the somewhat restricted pronatalist policies were quite different from those completely pronatalist policies adopted in many European countries to raise the level of their below-replacement fertility.

The limited nature of the pronatalist policies would result in some additional births, but certainly not to the maximum as in the case of those with no restrictions at all. For one thing, the pronatalist benefits were not given to parents producing the fifth and subsequent children. It would appear that there still existed the concern that too many children were being produced by certain segments of the population. It was therefore not surprising that fertility had not been given the maximum possible boost and had continued to proceed well below replacement level after 2000.

LEAVE FOR PUBLIC SECTOR EMPLOYEES

A limited pronatalist measure was related to the leave of employees in the public sector, which was easier to change since government had the authority to alter the working conditions of civil servants. Soon after the National Day Rally speech by the Prime Minister, it was announced on 28 August 2000 by the Chairman of the Working Committee on Marriage and Procreation, Eddie Teo, that a government employee would be permitted to take three days' paid marriage leave when he married for the first time.

Until 1970, the performance of abortion in Singapore, like many other members of the British Commonwealth, was governed by laws based on legislation passed in the nineteenth century in Victorian England. It constituted a criminal act punishable under sections 312–316 of the Penal Code and could only be defended on the plea that the abortion was caused in good faith to safeguard the life of the woman concerned. Under such prohibitive laws, some pregnant women had no alternative but to resort to back-lane illegal abortions as a means of terminating unwanted pregnancies. Though the incidence of such criminally induced abortions performed during any period of time will always remain a mystery, the existence of such abortions is common knowledge among the public and has been confirmed by cases clinically diagnosed as “abortions with sepsis” in Kandang Kerbau Hospital. Moreover, there were numerous occasions when pregnant women approached the Family Planning Association for an abortion but were turned down.

During the early days of the national programme, some embarrassment was caused by women patients who approached the clinic staff of the Singapore Family Planning and Population Board (SFPPB) to terminate their pregnancies on account of contraceptive failure, especially from intrauterine devices (IUDs). This was particularly so in the case of women who had adopted family planning with IUD as a method of preventing further childbirth rather than spacing their children. Nothing could be done to alleviate the suffering of the women and they were persuaded to continue with their pregnancies. It was felt that this category of contraceptive failure should merit sympathetic consideration for induced abortion had the law permitted such termination of pregnancies.

MOVE TOWARDS LEGAL ABORTION

The review of the government policy concerning induced abortion was undertaken by the SFPPB soon after its establishment in January 1966. The role of induced abortion in the context of the family planning programme within the overall population control policy was discussed in some detail by the Board. It was generally agreed that induced abortion should be made available as a complement to this programme but not as an alternative to the other less drastic and preventive methods of family planning. By 1967, the Medical Committee of the SFPPB had resolved by a simple majority decision that failed sterilization and failed contraception could be accepted as criteria for legally induced abortion.