First posted on Sg Review
12 June 2005
http://www.hsph.harvard.edu/Organizations/healthnet/WoC/reproductive/trombley2.h\
tml
Singapore
Singapore presently has one of the most Coercive state sponsored
eugenic sterilization programmes in operation anywhere in the world.
By 1977, 21 per cent of women of child-bearing age in Singapore had
been sterilized. The figure for men was one per cent.
The origins of Singapore’s sterilization programme lie, as with
India, in a visit from Margaret Sanger. In February 1936 she
advocated that family planning should be an essential part of the
state’s public health programme. In 1944 the Singapore Family
Planning Association (SFPA) was founded. In February 1959, Professor
B. H. Sheares told Sanger’s IPPF congress in New Delhi that
sterilization rather than birth control was the way forward for
Singapore. Sheares published his views in Singapore in June when
Sanger happened to be in the country to lend support. These events
coincided with the election of the People’s Action Party (PAP)
government, which proclaimed its support in July. By 1965 the
Ministry of Health had taken over all responsibility for family
planning from the SFPA. It became the sole executive agency for
family planning, and had the power to take over the functions and
seize the assets of any other family planning agencies. The State
became the sole authority with control over fertility.
The Government published a white paper on family planning in 1965, at
a time when there were only 5,000 sterilization ‘acceptors’ per
annum. By 1969 Prime minister Lee Kuan Yew had pushed through bills
legalizing abortion in ‘voluntary’ sterilization. The sterilization
bill became increasingly liberalized. At first it applied to women
with six or more children. By 1972 it applied to women with two
children, or to women with only one child if there were sufficient
medical, therapeutic or environmental grounds. From 1974 the law was
amended to include any woman who was either married or over twenty-
one.
In a speech in support of the 1969 acts, Lee expressed the
degenerationist’s support for eugenic policies, both in terms of
raising the quality of racial stock and in reducing public
expenditure on welfare programmes:
One of the crucial yardsticks by which we shall have to judge the
results of the new abortion law combined with the voluntary
sterilization law will be whether it tends to raise or lower the
total quality of our population. We must encourage those who earn
less than $200 per month and cannot afford to nurture and educate
many children never to have more than two. Intelligent application of
these laws can help reduce the distortion that has already set in …
we will regret the time lost, if we do not now take the first
tentative step towards correcting a trend which can leave our society
with a large number of the physically, intellectually and culturally
anaemic.
The 1969 sterilization act set up a five-man Eugenics Board to
authorize sterilizations. While it included two doctors, a social
worker and one ‘other’, it was chaired by a district judge. With the
final liberalization of the law in 1974, the Eugenics Board was
disbanded, and authority for all sterilization decisions was vested
in individual doctors.
In 1969, there were 14,000 sterilizations in Singapore. In 1970 this
increased to 24,000. The numbers increased steadily and by 1973 the
annual figure was 93,000. This trend continued to a peak in 1976 of
99,000 sterilizations. Saw Swee-Hock describes the typical profile of
sterilized women in 1976: ‘ 86 per cent were Singapore citizens and
85 percent were not working, presumably performing home housework.
About 81 percent had practiced birth control either at the time of
sterilization or previous to that, and almost all of them, 97
percent, were being sterilized for socioeconomic reasons such
as “financial difficulties” and “family completed”. As high as 70
percent had their sterilization performed during the postpartum
period and another 19 percent during the post-abortal period… Some
92 per cent of all sterilization operations were performed in
government institutions.’
The financial elements of Lee’s eugenic plan are reflected in
Singapore’s policies of incentives and disincentives. These are
designed to motivate people ‘voluntarily’ to limit their families to
two children or less. Each is, in reality, a coercive policy designed
to motivate sterilization ‘acceptance’. (1) Maternity leave. In 1973
the government withdrew the right to paid maternity leave for the
delivery of third and subsequent children. Within the Civil Service,
the conditions are modified so that maternity leave for third and
subsequent children is paid, provided the woman agrees to be
sterilized at delivery. Alternatively, seven days un-recorded paid
leave is offered to male and female civil servants for the purpose of
accepting a sterilization operation.
(2) Accouchement fees. From 1969 these had been progressively raised
for second and subsequent children. In July 1975 they were raised as
follows:
Birth order Class of hospital ward
A B C
1st child $300 $120 $60
2nd child $360 $180 $90
3rd child $420 $240 $120
4th child $480 $300 $240
Subsequent $480 $360 $300
The significance of these figures is that the proportionate increase
is highest in class C wards, i.e. those used by the poorest patients
who are least able to afford the increase. The ‘ stick’ of
increasingly higher fees is matched by the ‘carrot’ of sterilization.
Ward fees for classes Band C are waived if either husband or wife
agrees to sterilization within six months of delivery. Ward charges
for class C patients are reimbursed upon application after
sterilization. Another aspect of this policy is that women expecting
their third or subsequent children are not entitled to free antenatal
care, but are charged $10 per visit.
(3) Income tax. In 1973 the government announced that $750 tax relief
would be granted for the first and second children, with $500 relief
for the third. Fourth or subsequent children do not qualify for any
tax relief. As Saw notes, ‘By comparison with the measures
incorporated in maternity leave and accouchement fee, the tax relief
measure has a wider and more lasting influence because it applies to
all payers with children and penalizes those affected every year in
their tax returns instead of just once.’
(4) Housing. Prior to 1973 housing was allocated on a points system,
with higher priority given to those with larger families. Deciding
that this policy encouraged fertility, the government modified the
rules so that families regardless of size had equal priority in
housing. Rules regarding sub-letting were also revised, so that only
families with three or fewer children were allowed to sub-let rooms
and earn extra income. This policy had the effect, again, of
penalizing most those who could least afford the penalty.
(5) Education. Prime Minister Lee places a very high value on an
educated ?ite. A keen supporter of the British class-based system of
public schools and admission to the universities of Oxford and
Cambridge, Lee created model schools in Singapore during his first
years as Prime Minister. In 1973 his government introduced new rules
for admission to the superior ‘ Primary One’ places in certain
schools. The first three children were to be eligible, but the fourth
would not be eligible unless one of the parents ‘agreed’ to be
sterilized. A series of complex amendments were made to this rule,
some of which resulted in arbitrary inequalities, quite apart from
being coercive.
Saw noted that the measure penalizes parents retrospectively since it
applies to parents who had their children many years ago when such a
rule did not exist. Parents affected by this measure have to send
their fourth and subsequent children to less desired schools, apart
from the daily trouble of sending them to different schools from
their first three children. Among all the measures, this measure
appears to be the only one that imposes a penalty on the children
directly by depriving them of being with their brothers/sisters in
the same school, and all the inconveniences that go with it. But the
measure does act as a deterrent to some couples thinking of having a
fourth or higher parity children.
The immediate outcome of giving priority to children whose parents
were sterilized was that in 1975 there was a conspicuous rush by
parents, more often than not the mother, to undergo sterilization in
order to take advantage of this new ruling.
…In the 1975 registration exercise many children of old boys or
girls, staff and parents who had direct connections with the schools
were not given places in the good schools of their choice. Instead,
these schools, particularly the mission schools, found they had a
sizeable number of pupils who were complete ‘strangers’ to the
schools but were admitted on the basis of their parents having been
sterilized.
(6) Work permits. Foreigners who earn less than $750 in Singapore are
obliged to register with the ministry of labour for a work permit.
Since 1973 guest workers wanting to marry a Singapore citizen and
take up permanent residence were required to obtain the permission of
the Commissioner of Employment. Many applications in the 1970s were
rejected, and thousands of guest workers were expecting children out
of wedlock. In 1976 the government introduced a rule where by
permission to marry (and, importantly, access to social services like
health care) would be granted provided one member of the couple
agreed to be sterilized at the birth of the Second child. Failure to
comply could result in the withdrawal of all of all benefits,
including the work permit. The family would also be denied access to
housing, education and health services.
Lee’s eugenic programme has probably been one of the most effective
ever undertaken. The birth rate in Singapore dropped from 6.5 per
woman in 1957 to 1.9 per woman in 1977. Within twenty years his
programme has put the country on course to exceed zero population
growth and achieve negative population growth. One figure that the
government does not like to quote is that a 1973 survey revealed that
more than 46 per cent of married women between the ages of fifteen
and forty-four disagreed with Lee’s two-child policy, believing that
they should be allowed to have more than two children if they wished
to.
Meanwhile, new incentives are introduced, such as Lee’s scheme to pay
the dinner bills of courting – couples of the right social and
intellectual attainment – a positive eugenic policy to help create
a ‘superior’ race.