ABORTION BILL

Order for Second Reading read.

3.39 p.m.

The Minister for Health (Mr Chua Sian Chin): Mr Speaker. Sir, I beg to move, "That the Bill be now read a Second time."

This Bill is designated to reform and hiberalise the law of abortion in Singaport so that treatment to terminate pregnancy may be carried out, subject to certain safeguards, by registered medical practitioners acting on the authority of the Termination of Pregnancy Authorisation Board on medical, social, humanitarian and eugenic grounds, or by any registered medical practitioner acting in consultation with another registered medical practitioner on extended medical grounds, or by a registered medical practitioner as an emergency treatment to save the life or to prevent grave permanent injury to the physical or mental health of the pregnant woman. This is in summary what the Bill proposes to do. But what are its objectives? A full explanation of its underlying purposes will be given when I come to elaborate on its provisions.

First, let me give a reason why it is necessary to reform and liberalise our laws on abortion. Our laws on abortion are based on the old Indian Penal Code which in turn was derived from English law, Even the English have liberalised their laws on abortion by the passage o' the United Kingdom Abortion Act of 1967 which became operative on 27th April, 1968.

The present law on abortion in Singapore is found in our Penal Code. The relevant sections are sections 312 to 316 and section 511 of the Penal Code. Legally, an abortion is the expulsion of the foetus from the uterus at any time before the full term of pregnancy. To induce an abortion, i.e., an artificial abortion, is a statutory crime. The problem of induced abortion is that it is governed by criminal law rather than medical knowledge.

The law in Singapore does not specifically recognise any interference with pregnancy on any grounds except "in good faith for the purpose of saving the lifc of the woman", it has, however, been interpreted by general definition and by judicial authority, that the phrase "to save life" has the meaning of "to preserve health", and since life depends on health, abortions may be performed to preserve the physical and mental health of the mother. In other words, induced abortion may be done for the purpose of treatment and these are usually termed "therapeutic abortions".

Judicial precedent, however, forms a rather flimsy basis for the performance of therapeutic abortions. It is said that the law cannot expect medicine to be practised under sufferance.

Under the existing law, therefore, an obstetrician can be considered to have infringed it in the performance of an abortion other than for the purpose of saving the life of the pregnant woman. If his action is ever questioned, his sole defence to justify his action in performing the operation is that it was not only for the reason that it was necessary in his opinion, but also to prove that it was done to save the life of the mother.

The present law, therefore, presents serious conflicts to the practitioner -between a duty to serve the patient and a duty to obey the law. Doctors who are fearful of the possible consequences may fail to recommend termination of pregnancy. The result is that an abortion which should be done for the sake of the mother is not done, or if done is done too late and when the pregnant woman's life is endangered.

The Bill seeks to correct the present legal ambiguities by stating in clear terms the medical conditions under which abortions can be performed; to permit the prompt operation which will be performed under the best possible conditions.

The intent of the Bill is to promote the well-being of the woman and to avoid impairment of her health, in the interests of humanity and human progress.

The Bill, therefore, seeks to codify what is now generally accepted as the medical reasons for treatment by termination of pregnancy. In clause 5 (2) (a) the conditions under which therapeutic abortion can be done are unambiguously stated. It may be done where the pregnancy would involve risk to the life of the pregnant woman or injury to her physical or mental health.

The common practice where two practitioners consult together before termination of pregnancy is advised is also recognised under clause 5 (3) which provides for an abortion if two practitioners in consultation and, acting in good faith, advise that the abortion is necessary on medical grounds.

And in clause 5 (5) , a medical practitioner may terminate pregnancy in an emergency where it is immediately necessary to save the life or to prevent grave permanent injury to the physical or mental health of the pregnant mother.

The provisions therefore permit abortions if there is any medical reason to warrant an operation because such an operation will safeguard the life and health of the mother. It does not need any complicated arguments other than common sense to tell us that such abortions are justifiable as there is no reason why the pregnant woman should be forced to go through the ordeal and anguish of pregnancy and child birth which can endanger her life, or have serious repercussions on her physical and mental health.

[Mr Deputy Speaker in the Chair]

3.45 p.m.

The Minister for Health (Mr Chua Sian Chin): Let me now turn to the other conditions on which the termination of pregnancy may be authorised under clause 5 (2) . Let me first deal with the eugenic considerations. There are several conditions which are known to carry a high risk of the birth of a mentally handicapped child or the birth of a deformed child normally termed a "monster" or the birth of a "mongol". Certain of these are due to inherited conditions. In others, the affliction might be due to an infection of the mother in the early stages of pregnancy. German measles in a pregnant woman especially in the very early months of pregnancy carries a high probability that the child will be born with some severe abnormalities. Certain drugs or X-ray examinations taken in early pregnancy are also known to cause such defects. The disastrous effects of the thalidomide drug is well known and are still fresh in our memory.

In conditions where there is a likelihood of the birth of a mentally or physically deformed child, few can deny that it would be an act of kindness or even a moral obligation to avoid the tragedy and the serious repercussions to the parents, the child, and society alike by permitting abortion. It is also fully justified by a further reason that it is an acknowledged social evil to countenance the breeding of defectives in society. This consideration may be described as the eugenic reason for abortion, and the provision is embodied in clause 5 (2) (c) of the Bill.

Of course, there will always be the few who will on religious and ethical grounds oppose permitting abortion even under these conditions. These minority groups in their opposition will no doubt advance their familiar arguments which are highly theoretical and often emotional, of divine creation and the sanctity of the fertilised ovum or the foetus which is quite different from a living person, (concepts which have sprung from the Middle Ages and beyond). To enter into such types of arguments for or against, to justify or oppose abortion is, to my mind, entirely futile and to ignore completely the realities of the modern world and its problems. I would just like to invite these groups to visit the Mental Defective Section of the Woodbridge Hospital to see for themselves the mental defectives or "mongols" whom we have to care for. Perhaps then they may begin to think in more rational terms and start to question the very purpose of the Divine creating such mental defectives, the nature of whose existence in this world is just to vegetate.

Similarly, where pregnancy has been caused by sexual crimes such as rape, incest, or following intercourse with an insane or feeble-minded person, who is not accountable for her sexual responsibility, abortions on humanitarian grounds will be permitted under clause 5 (2) (d) of the Bill.

All the conditions which I have described, meaning the medical, eugenic and humanitarian considerations for the termination of pregnancy, would be said to be generally acceptable and justifiable on the grounds that the health and welfare of the mother is paramount and takes precedence over any consideration of the unborn foetus.

However, there are a host of other conditions for which women seek termination of an unwanted pregnancy. Common examples are - when there are already too many children in the family, when the addition of yet another will mean inability to upkeep the family; when the pregnancy occurs too close to the previous one; when the pregnancy will bring about social ruin as when the woman is unmarried, is deserted or when she is on the threshold of a career or when the woman is too young or too old; and many others.

This is the problem of an unwanted pregnancy, the gravity of which only an ostrich is unaware. Of course, there are people who would put on a straight collar and moralise and argue that she should have known better or that she should bear full responsibility for her action. Often under such circumstances the predicament and anguish of the woman is ignored. It is all very easy to pontificate on someone else's predicament. The Bill faces up to this problem and offers a solution, by providing for environmental or social considerations for permitting an abortion as set out in clause 5 (2) (b) .

Since in our present law there is no such provision for the performance of abortions for environmental or social reasons, the majority of women under such circumstances are driven to seek relief from the unwanted pregnancy by resorting to dangerous do-it-yourself home procedures or resort to back-street and illegal abortionists, usually with tragic results. Does not the real immorality lie in the restrictive laws which drive women to illegal abortions?

Let me now deal with the problem of illegal abortions in Singapore. Whereas the number of induced abortions for medical reasons in the Kandang Kerbau Hospital is small, the number done illicitly has been estimated at several thousands a year.

Criminal abortions in Singapore are not known because obviously such figures are not available as they are not reported. A study of criminal abortions admitted into Kandang Kerbau Hospital for a six-month period in 1964 recorded 1,230 patients. Projected for a year the total number of abortions would have been 2,500 in that year. This was a study made by Dr Y. K. Lee for an M.D, thesis which was published in 1965.

Since the total number of abortions is usually estimated to be 10 per cent of all pregnancies, this would have worked out to about 6,000 a year in Singa pore. Of these, 5,000 are estimated to have been criminally induced. This gives an incidence of 8.3 per cent of criminal abortions to all pregnancies in Singapore. The figures of abortions from other countries vary but have been described as high and constituting a major health problem, "abortion being the greatest epidemic of our times". In the United States it has been estimated that criminal abortions number one million a year, or number in the region of one out of four or five pregnancies (20 per cent to 25 per cent).

In the United Kingdom it has been variously estimated to number from 50,000 to 250,000 per year. In the Scandinavian countries, the incidence of criminal abortions is reported to be between 5 per cent and 10 per cent of all pregnancies.

The numbers of women submitting themselves to criminal abortions, therefore, run into several millions throughout the world. A figure quoted is 25 million a year (out of a total of 120 million live births a year).

The cost in suffering and pain to the individual and the financial burden on the state must add up to something colossal. Since the laws are flouted and violated so frequently, it might he assumed that prosecutions would be numerous. Ironically this is, however, quite the contrary. Prosecution for criminal abortion is a rare occasion, and the conviction of one is even rarer still. In Singapore in the last five years, there were three prosecutions and only one conviction; and it was not a doctor who was convicted. It is often forgotten that no law can be effective unless it has the general approval of the people. The widespread incidence of criminal abor tions suggests not only that the law is ineffective but also that abortion is generally approved by the community.

In countries which have recognised the demand for abortions for social reasons and have legalised them, the abortions performed for these reasons form approximately 70 to 95 per cent of all abortions done. Thus the problem to be faced up is the large numbers of women who for one reason or other are prepared to flout the laws and covertly seek out the back-street abortionist. The result is the terrible cost to health and the tragic consequences which are all too well known. That is the price of illegal abortions.

Further, the prohibition of abortion has a discriminatory effect. For the rich, who have the means, seem remarkably able to obtain abortions. Among the poor who cannot afford the high fees of illegal abortions, resort is made to the untrained incompetents or the back-street abortionist, or they even attempt it themselves, often with fatal results.

Perhaps if I quote a number of real life examples to illustrate the desperation of our women in Singapore caught with an unwanted pregnancy, and the lengths to which they are prepared to go to get rid of the pregnancy, I will be able to drive home my point. These examples are collected from a study on abortions made by Dr Y. K. Lee and published in his M.D, thesis entitled The Non-Clinical A spects of Induced A bortions in Singapore. They are as follows:

Case A298

27-year old Chinese housewife. Mother of three, ages ranging from 5 years to 9 months. Husband is a sailor who earns $200 per month. Was admitted with a fever of 103�F. Strongly denied interference. Later when told that there was evidence of interference she claimed that she only tried oral methods - pineapple, stout and hung hua. When shown, after the curettage. the products of conception with a stick in them, she sheepishly admitted interference, but said that it was self-inserted.

Case A237

Chinese widow, aged 28, whose husband had been killed by falling logs in February 1964. Patient was admitted on 20th October, 1964, for incomplete abor tion which she claimed was due to a fall. Mother of five children, ages 8 to 1 year.

When friends heard of her predicament, they recommended a general practitioner who was willing to abort her for $25. She was made to lie down and some liquid was pumped into her. There was no pain. She was given some tablets. She started to bleed on the very day. Bleeding persisted and she called on, the doctor again. She was given an injection, tablets and mixture, and paid $6. She returned again after a few days as the bleeding did not stop as hoped. However, it seems that the doctor took it as a big joke and told her not to worry as the baby would be aborted eventually even if it took one or two months. She came to hospital.

Case A202

27-year old Indian housewife, mother of 8 children, ages ranging from 12 years to 7 months. Husband is a gardener, earns $120 per month. Pays $20 rent.

She paid $25 to a general practitioner for an abortion on 2nd October, 1964. Said 'something' was inserted per vaginam and there was slight pain on in sertion. She was unable to give details as she was lying down and too frightened to observe anything. She was given six tablets to take home. She began to have fever on 4th October. 1964, and was admitted on 8th October, 1964.

Case A481

Chinese seamstress, aged 34. Mother of 6 children, ages ranging from 11 to 2 years. Husband is a carpenter who earns $150 per month. Has been using vaginal tablets for contraception since the birth of the youngest child.

She paid a Malay woman $10 to abort her baby on 21st December, 1964. This woman called at her house and brought along with her a thin rubber piece about a foot in length. This was inserted per vagina and patient was told to take it out only when bleeding became excessive. She was advised not to give infor mation to her friends or relatives. Patient did as she was told.

She was admitted to hospital on 22nd December, 1964, with a temperature of 105�F.

[Mr Speaker in the Chair]

4.00 p.m.

The Minister for Health (Mr Chua Sian Chin): Case A122

33-year old Chinese housewife. Roman Catholic. Mother of 6 children, ages from 12 years to 4 years. Had a previous abortion before this present one last year. Was admitted with a fever of 103�F. Refused to change her story - which was this - she bought some pills from a Chinese medicine shop but does not know what they are called. Said she took the same pills for her previous abortion and they worked wonderfully she had a complete abortion and she did not come to hospital, in addition to the pills she took 5 whole pineapples and 3 bottles of beer. When the inter viewer suggested to her that this would not cause her high fever, she reluctantly said that she had inserted a finger into her womb and dislodged the foetus!

Case A345

A 29-year old Malay housewife. Mother of 8 children, ages ranging from 14 years to 11 months. Husband is a pensioner.

Patient was reluctant to divulge who the abortionist was or where she practised and told this story - A Malay woman hawker came to the patient's home to sell mats. She saw the patient surrounded and harried by many children, and enquired if she was pregnant and if so whether she wanted to be relieved of her burden. Said that she did this as a social service and not for gain.

She massaged the patient's abdomen and squeezed the uterus at the same time inserting a finger into the vagina. She felt some pain and started to bleed. She paid the woman a token sum of $5. Bleeding increased and she began to bleed profusely and was admitted. On admission she had a temperature of 101�F. and a foul discharge and there was evidence of forcible dilatation of the cervix.

A description of do-it-yourself and back-street abortion is contained in Dr Lee's publication which is as follows:

'All sorts of substances have been inserted, e.g., bamboo leaves, bamboo slivers soaked in alcohol, hair pins, catheters, lidi (veins of palm leaf), roots, stems of leaves, e.g., sireh, grasses, fruits, vegetables, e.g., brinjals, rumput rendang, three stems of daun dedap tied together, sticks wrapped in cotton wool sometimes soaked in oil or some antiseptic.

The Malays practise a form of local interference known as urut (massage). Here the uterus is vigorously massaged in order to dislodge the foetus. The practitioners of this are quite efficient. The uterus is kneaded if possible, and massaged with the thumbs downwards and towards the vagina. Bruises can be seen on the abdomen of patients. Thereafter, if necessary, a hard object, e.g., a stone, is pressed against the uterus and bound down tightly to the abdomen or wedged into the pelvis. Sometimes this technique is combined with insertion of a foreign body in the cervix.'

Mr Speaker, Sir, I have many more such examples, but because of the time factor, I think the examples that I have given will suffice at the moment.

Such examples of human anguish, suffering and tragedy perhaps may anger some at the unenlightened laws on abortions that we have here. But they do also serve to put the arguments advanced on ethical or religious grounds of opposing abortion under these circumstances in their proper perspective, that is, these opposing arguments are in comparison rather petty and highly theoretical and academic.

Contrary to popular belief, we can see from the examples that the majority of the women who sought illegal abortions are married women who had already too many children and who for socio-economic reasons are not able and cannot afford to face the birth of another child. This category of women will certainly come under the clause which will allow them an abortion on socioeconomic grounds and thereby save them front the suffering and the great risk to their lives in resorting to the back-street abortionist.

However, I wish to make it quite clear here that I am not claiming that the Bill will completely wipe out illegal abortions in Singapore. What I am saying is that clause 5 (2) (b) will offer an alternative solution for a comparatively safe abortion under aseptic conditions for the woman who qualifies on socio-economic grounds and who would otherwise in her desperation resort to the back-street abortionist. Needless to say, this will certainly reduce drastically the number of illegal abortions if it does not eliminate it altogether and with it the consequent toll of mortality and morbidity amongst our women.

The Bill recognises these problems and faces up to them squarely. Clause S (2) (b) in fact breaks new ground by permitting abortion to be done for purely social and economic reasons. This extends beyond the provisions which appear in abortion legislation in the Scandinavian countries, (where the pregnant woman's environment must be related to a medical prognosis - i.e., abortion on a socio-medical ground). The Bill, however, is comparable to similar provisions to be found in abortion legislation in Czechoslovakia, Poland and to he as liberal as in Japan. But it has not gone as far as the legislation on abortion of the Soviet Union, Bulgaria and Hungary which authorise abortions on demand.

The Bill recognises, however, the right of every woman to choose when she wants a child; and the right to have an abortion in case of an unwanted pregnancy on socio-economic grounds.

Abortion for social reasons would therefore speed the goal of making each child a wanted child; reduce the army of neglected and rejected children; and "take the powder out of shot-gun marriages", in Poland, for example, the illegitimacy rate fell from 16 per 1,000 to 9 per 1,000 after the law was amended permitting abortions for social reasons.

Abortion offered under these reasons certainly offer a substitute of a safe medical procedure for an unsafe one offered by the illegal abortionist.

Abortion for social reasons would also remove the conditions which encourage the flagrant practice, that ferment disrespect for the law.

Up to this stage the reasons I have advanced for introducing the Bill have been those relating to the health and welfare of the pregnant woman or that of her family.

Important as these reasons are and which alone would justify the passing of this Bill, the more fundamental reason which should also be the concern of hon. Members of this House who are charged with the overall welfare of the community, is the underlying social aims or objectives of the Bill. The reasons so far described pertain to the individual and the other reasons relevant to the community have not been described. The former is based on medical opinion and the welfare of the individual and the family, while the latter is based on the community welfare.

In advancing the reasons for reforming the law, passing reference was made to the important social reasons affecting the community. The eugenic reasons for abortion, for example, would save the mother and her family the tragedy of the care of a defective child. But it also saves the state from the expenses of providing for the care of such children. For often the handicapped children are abandoned, or the families require assistance in caring for them; and expensive medical or institutional care is required throughout the life of the handicapped children. But what is even more important is that the bringing up of defectives gradually enlarges the pool of defectives in the population. As no civilised society would in its conscience abandon such children, the result is that instead of breeding the best qualities in our population the quality becomes poorer. We will, in fact, have reversed nature's process. Instead of breeding the fittest for survival, we will be breeding for our own decline.

Mr Speaker, Sir, advocating the fundamental right of a woman to have an abortion if her family circumstances are not right for the birth of a child is not therefore made merely on grounds of principles, legal or otherwise. There is also the interest of the community. Underlying all this is that every child born in our Republic should be a wanted child; a child that can be cared for, and provided for. It is needless for me to say that decently cared and provided children develop to their maximum potential, make the most of the opportunities offered by society and in return make a successful contribution to it. Conversely, it is mainly from the ranks of the unwanted children, the illegitimate and broken homes where most of the delinquents, the criminals and the antisocial elements are derived. Our society in Singapore cannot afford to breed such people. The central purpose of the Bill may, therefore, be stated thus: to assure the quality of life of children born in Singapore - to ensure that the children born are wanted children, being children who will be properly cared for and have opportunities for education and the full development of their faculties so that they can grow up to lead meaningful lives and be usef iii members of our society.

Another important benefit to our society that would result from this Bill would be to lower the rate of our population growth and help to tackle our problem of population explosion so that our population can be kept in bearable numbers where each has reasonable expectation of livelihood and a reasonable quality of life. However let me hasten to correct any mis conception that may have arisen that this Bill is intended to control population growth and replace family planning by contraceptive methods. Let me state now categorically, as I have stated before, that legalised abortion will not be a substitute for family planning but will be a vital complement to provide that ultimate security for the women who does not wish to have the unwanted child.

Although the countries of Eastern Europe and Scandinavia that permitted abortion had done it primarily to prevent the sad consequences of illegal abortions and to enable the women to decide on their pregnancy - and not in order to limit the population - in these countries it reduced the birth rate con siderably. Therefore, if in the process of the operations of our proposed abortion law our population increase is reduced, this would be one of the incidental benefits to our community.

The point of the advantage of a lower rate of population growth for Singapore need not be laboured as it is all too evident in overcrowded Singapore. Let me only state that ours is an island of limited area with one of the highest densities of population in the world -about 8,900 persons for every square mile. And the population is increasing, although at a decreasing rate, at 1.8 per cent a year. At this rate the population which now stands at two million people will double in about 39 years, i.e., by about AD 2010. Steps must, therefore, be taken now to decrease further this rate of growth if we do not wish to face the disastrous consequences of running out of land or be reduced to penury.

Mr Speaker, Sir, it is true that the Government's family planning campaign has achieved tremendous success. Family planning has been generally accepted by the population as evidenced by the number of women attending the Government Family Planning clinics over the last two years. Since Government entered this field of activity, attendances have been in excess of the target numbers. The dramatic falling birth rates are due to the acceptance of birth control techniques.

There may be some who argue that since family planning is a success in Singapore there is therefore no necessity to seek the aid of legalised abortion. The answer to this is quite simple. Apart from the fact that the Bill is not intended as a means of population control, there is an additional important reason for the Bill. Contraceptive techniques are not yet completely effective. There are failures even though instructions are followed closely in any one of the techniques used. It would, therefore. stimulate the practice of contraception if failed contraception is regarded as a criterion for abortion. It would be logical where there are failures in the method used as advised or provided through Family Planning clinics that pregnancies occurring should be allowed to be aborted. In the studies of women using the intra-uterine devices immediately after birth at the Kandang Kerbau Hospital, it was demonstrated that 40 pregnancies have resulted out of 3,044 women; and 177 pregnancies out of 5,694 women. While in demographic terms this was small, between two and three per cent of the women, the problem is a real one, and a personal tragedy. These women did not want to be pregnant again. It is not known if they sought termination of their pregnancy elsewhere. The concept of failed contraception as a criterion for a permissive abortion would motivate more women to seek family planning advice and endeavour to follow it. In other words, "failed contraception" is one of the reasons for liberalising the laws on abortion. It will not be a substitute for family planning by con traceptive methods but a vital complement to provide that ultimate clinical security for the woman who does not wish to have an unwanted child. Abortions should be permitted as a logical and ultimate step for contraceptive failures.

So it is that this Bill must be looked upon as a social Bill which must be regarded as an adjunct to family planning. In this respect, it must be read together with the Family Planning and Population Board Act, 1965, the Sterilization Bill which is being introduced concurrently with the Abortion Bill and other steps taken or will be taken to encourage small families. Often people who criticise the Bill ignore the Sterilization Bill which is also before Parliament.

Mr Speaker, Sir, now I would like to deal with the arguments against liberalising and reforming our law on abortion. I must say that there has been quite a lot of public debate and discussions going on on this controversial subject of abortion outside this House even before the Bill was presented to Parliament. At the same time, there have been quite a number of loose arguments being bandied about resulting in some misconceptions. I shall, of course, try to correct these misconceptions that have arisen.

I shall now dispose of the opposing arguments. No doubt some hon. Members who oppose this Bill will advance further arguments in the course of the debate in this House. I shall, of course, deal with them in my reply.

Mr Speaker, Sir, opposition views fall under three main categories:

The first category is religious. Briefly the basis of objection is that abortions destroy the life of a foetus. Since the foetus is the beginning of human life, induction of abortion is equivalent to murder. This is a matter of view-point. Learned men, medical or otherwise, for centuries have not been able to agree on whether the foetus is human life.

In my view abortion is not murder. The destruction of the early conceptus differs in no essential way from destruction of the sperm cell or egg cell before the act of fertilization. No one mourns for a sperm killed by a spermatoxic contraceptive cream or an ovum permitted to die twelve hours after ovulation, because the woman from whose ovary it came knew how to prevent its survival by practising the rhythm technique of birth control. Further, few also mourn the death of the fertilized ovum when it is prevented from implantation by the intra-uterine device or certain contraceptive "pills" - for such is the action, it is surmised, by which these contraceptives work. Sperm and egg are living cells before fertilization; otherwise, conception could not occur.

An early conception is not a human being; it is a potential human being. The difference between an early embryo and a living person is immense. The embryo has no consciousness, no life experience. Therefore, equating the elimination of a mass of developing cells with infanticide, euthanasia, and genocide is offensive and patently fallacious. The further charge that the liberalisation of abortion laws will inevitably lead to these practices is a non sequitur and is illogical and wickedly inflammatory. Has liberalisation of divorce laws led to the abolition of marriage, if I may ask?

The end-point when abortion is no longer permissible, as provided by the Bill, is not governed by intangibles like the exact day or week when the foetus is assumed to receive its soul or when its mind is thought first to function, but by purely medical considerations. Rarely a 27-week foetus lives after a natural birth, and a surviving foetus so small, fragile, and immature has grave likelihood of serious brain damage. Therefore, to forestall this possibility a full 3-week leeway is given in producing an aborted foetus. Abortion up to the 24th week, but not beyond, is therefore allowed under clause 6 of the Bill. From the technical view-point of the operation, abortion before the 16th week of pregnancy is simple and virtually danger-free, and between the 16th and the 24th week it is more complicated and slightly more hazardous.

The religious view-point is, of course, respected. It is precisely for this reason that persons with conscientious objections to performing the operation may refuse to do so. But such persons might also ponder their responsibility. While they may have a conscientious objection to perform the operation, it does not absolve them from advising on whether or not an abortion is necessary as a method of treatment.

However, as I have stated just now, to allow ourselves to be tied up with the religious arguments for or against abortion which in any case will never result in any satisfactory conclusions, even if the debate goes on till the cows come home, is entirely futile. I am sure hon. Members of this House who are charged with the welfare of the community will look at this issue on a realistic and rational basis and judge what is to the best interest of the community. I would like to emphasise here that the Bill does not force anyone to have, or to perform, an abortion. While the woman is given a freedom of choice, and the individual medical practitioner the freedom to act within his conscience, is it right, may I ask, Mr Speaker, Sir, in our multi-racial and multi-religious society for opponents to the liberalisation of the laws on abortion to impose their moral or religious standards upon the entire community?

If the United Kingdom experience is an indication - where legal abortions have increased several-fold since the Abortion Act was passed a year ago -it proves that the public have endorsed the Act and are asking that it be implemented more liberally.

Ethical, moral and social reasons form the second category. Based on religious premises, moral reasons are advocated against abortions and these reasons are further extended to social issues. The arguments may be stated as follows:

(a) Abortion is destruction of life; allowing abortions to be done reduces respect for the sanctity of life resulting in a degrading of character which will lead to a lowering of morality, licentiousness and increased promiscuity.

A recent variation of the argument brought up by a medical man is that abortion is the destruction of life and is completely at variance with a doctor's fundamental ethics. Allowing it will blunt this sensitivity towards the importance of saving life and may have disastrous results, turning doctors into dangerous persons.

Those who predict these dire consequences have very flimsy grounds indeed. Their conclusions must surely be purely conjectural. They have indeed allowed themselves to run away with fantasies.

The same arguments were raised by the opponents of birth control. It cannot be said that these practices have resulted in licentiousness, a break-up of families and homes. In countries which have adopted very liberal laws on family planning and abortions such as in Japan, the East European countries and Scandinavia, these conclusions have not been justified. There have been no essential differences between human values and moral judgments between these countries and others which have not liberalized their laws. There is the same sense of family unity and parental urge towards their children. Births, marriages and deaths have been the same.

To those who take this line that legalised abortion will bring about degradation of human life, I would like to suggest that they should themselves just as well ponder the fact that by allowing a child to be born into this world unwanted and uncared for, condemned to a life of squalor, misery and crime, is this not just as surely to destroy the person or his personality and his family? Will this not more surely bring about the degradation of human life?

(b) Another moral argument is that abortions should not be made available as persons should be made responsible for their acts. Abortions are an easy way out from their responsibility for the care of children and again will tend towards moral decay. This argument is also quite ludicrous. If a similar line of argument is accepted, then persons suffering from, say, venereal disease, should not be treated because he should be made to bear the responsibility for his foolishness.

(c) Another small argument which is just as fallacious is that legalised abortion will encourage promiscuity. If this argument is valid, will not family planning by contraceptive methods encourage promiscuity even more? Common sense will tell us that if a person wants to be promiscuous - and you cannot prevent it - the pill which is freely available will be a better safeguard. Is it not a fact that promiscuity is a matter that must depend upon the moral fibre and character of the particular individual and the type of society that individual comes from rather than the availability of contra ceptive measures or legalised abortion?

(d) And finally, the opponents state that the moral principle cannot he sacrificed for "economic expediency" and that the practice of abortion will undermine the family planning programme.

This view again is equally fallacious. In all countries which have liberalised their laws on abortion, it has been shown that the numbers of abortions declined when family planning programmes were instituted. This was particularly seen in Japan. Often it is forgotten that in Japan abortion laws were liberalised before family planning was generally accepted by the population. After the passage of the Eugenics Law in 1949, amended in 1952, giving even greater liberty, abortions rapidly increased in numbers in Japan. But after 1955, when family planning programmes were instituted, abortions have declined steadily. Another important point with regard to the experience in Japan which is often overlooked is that their family planning programme is still backward. The present laws in Japan forbid the use of the pill and the intra-uterine device in family planning. This fact is stated in the publication entitled Japan's Experience in Family Planning - Past or Present edited by M. Muramatsu. Therefore, Japanese women have little choice in the family planning methods since the pill and the I.U.D. are illegal. As we know from our experience of family planning in Singapore, the majority of the women who have accepted family planning are on the pill and the I.U.D. Yet when family planning was introduced in Japan abortions have declined.

Therefore, the argument that legalised abortion will undermine family planning is yet another piece of fantasy and does not take into account the experience of women who have had abortions. Few of them would choose an abortion in preference to contraceptive practice. In our Singapore society in particular we know that there is always the fear of undergoing an operation and our women will certainly not submit to an operation unless as a last resort. Persons who think otherwise have probably no knowledge of these matters.

If I may repeat again, the nature of the relationship of our family planning campaign and the Abortion Bill is that family planning is prevention and legalised abortion is the cure. Perhaps another analogy from the game of cricket might drive home the point -family planning is the wicket-keeper whereas legalised abortion is the long stop.

The third category is medical objections. They say that induced abortion is a surgical procedure which, like all surgical procedures, carries a degree of risk to the life and health of the woman. Figures quoted should be looked at with great care and with a critical eye. For one thing, the hazards of abortion differ, depending on the stage of pregnancy.

In the early stages - up to about 16 weeks of pregnancy - the abortion is induced by scraping out the contents of the womb. This is a comparatively simple operation which in some cases can be done as an operative procedure in an Outpatient Department. Under the circumstances the mortality rate is excessively low.

Evacuation of the uterus at a slightly more developed stage will require an operation on the pregnant uterus. Obviously such a procedure carries a slightly higher risk.

An interesting comparison may be made of the number of abortions done in the countries which have liberalised their abortion laws against their maternal mortality rates. In every country which has done so, although the incidence of abortions increased after its laws were enacted, the maternal mortality rates decreased. This is quite surprising as one would expect that with the increased number of interferences of pregnancies, maternal mortality rates would have increased instead of decreased. The reason is that previously many of the deaths were due to the women subjecting themselves to illegal abortions with all the attendant dangers. Perhaps I may explain here that maternal mortality figures include deaths to mothers due to deliveries as well as during pregnancy. It might be justifiably surmised that a result of liberalising the laws of abortion is that women will turn to abortions legally done in the safe, sterile facilities of hospitals rather than resort to an illegal abortionist.

Further, it is clear that more recent figures on abortion mortality are coin-parable to, if not better than, those of maternal mortality. In Singapore, no death from abortions induced in the hospital was recorded out of 820 and 1,376 cases in 1967 and 1968 respectively. In Czechoslovakia a similar experience was recorded for the same years. In Scandinavia the overall mortality rate for abortion is 0.7 to 1,000 which compares favourably with maternal mortality rates in other countries. In comparison, the maternal mortality rates in Singapore stood at 0.32 per 1,000 in 1967.

Another medical objection is that there will be recurrent demands for abortion by the same women. In a series of 13 cases studied in Japan, 20 per cent of the women on whom abortions were induced were pregnant again within six months, and 50 per cent within 12 or 18 months. From Sweden it is reported that 38 per cent of the women whose pregnancies were terminated had a second unwanted pregnancy within two to four years. In Czechoslovakia it is said that 50 per cent of the women on whom abortions are induced are having a second operation and 12 per cent a third operation within two years.

These are pertinent arguments. It is for these reasons that a Bill on Voluntary Sterilization is being introduced concurrently. Where a woman requires repeated abortions, sterilization will be advised.

I would like to reveal here that the Government has already decided, even before the Bill was presented to Parliament, that in order to prevent repeated abortions where a woman who presents herself for an abortion has three children or more, the abortion will be permitted on condition that she agrees to sterilization subsequently. This policy will be adopted as standing practice by the Termination of Pregnancy Authorisation Board.

A third objection to abortion is the frequent undesirable psychic and physical reactions following its legal performance. I bring this matter up to lay a ghost. Three excellent studies, published during 1966, by Niswander and Patterson, Pack and Marcus, and Baird all show that "in women who had a pregnancy terminated, psychiatric and neurotic symptoms were no more common than one might expect in the population generally." In his study, Sir Dougald Baird, who is a distinguished emeritus professor of obstetrics in Scotland, states: "In most unmarried women the crisis is resolved by termination of pregnancy, and the benefit is immediate and very pronounced."

Mr Speaker, Sir, these quotations are from learned journals and if Members are interested, they are in front of me.

In many young married women the effects of termination are equally gratifying and the benefits to the whole marriage situation may be very consider able. In older married women who do not want more children and are strained to the breaking point by the occurrence of another pregnancy, the results of termination plus tubal ligation are most satisfactory. There is striking improvement in the woman's physical and mental health and in the well-being of the whole family.

In summary, the Bill offers a safe alternative to an unwanted pregnancy where there is none now; where the abortion is carried out expeditiously, cheaply and confidentially.

A cautionary note has been injected by many suggesting that abortions should not be made freely available, that is, that abortion should not be made on demand, The reasons for this reservation range from religious, moral to medical grounds described above. Whatever the reasons, may I repeat again that it is not the intention of the Bill to make abortions on demand. To presume so is a misrepresentation or a misunderstanding of the purpose of the Bill. If it was the purpose to make abortions on demand, there would have been no necessity to introduce such an elaborate Bill with its several conditions and safe guards. All that would have been required would be to pass a short amending Bill deleting the relevant sections of the Penal Code referring to illegality of abortions.

Certain safeguards have, however, been written into the Bill which would, amongst other things, effectively prevent abortions being procurable on demand. These safeguards are:

(a) The establishment under clause 3 of the Bill of an Authorisation Board known as the Termination of Pregnancy Authorisation Board. Every abortion will have to be authorised by the Board unless it is carried out as an emergency under clause 5 (5) or if two medical practitioners in consultation deem it necessary to do so under clause 5 (3) .

The Board will consist of 11 members; six are officials, and five are appointed by the Minister. Its composition is well balanced and representative. The medical representation would naturally dominate, with the three medical directors from the Ministry of Health; an obstetrician and a psychiatrist. Social workers are represented in the person of the Director of Social Welfare and a female person who has had experience in social welfare work. At least one more female member is guaranteed and she will be nominated by the Minister.

As it will be essential that the Board is able to fulfil its functions and to complete its work expeditiously, provision is made for it to form committees which will be delegated powers to perform any specific function of the Board.

(b) It is also required - under clause 5 (4) - that the abortion is done in a Government hospital or in an approved institution. And under clause 9, abor tions approved by the Board are to be done only by a medical practitioner with specialist qualifications or who has the necessary experience. This will ensure that abortions are done under the best possible conditions.

(c) Abortions will not be authorised where the duration of pregnancy has gone beyond a certain period of time unless such treatment is immediately necessary to save the life or prevent grave injury to the physical or mental health of the pregnant woman. This is provided in clause 6. As this time factor is important, it is also written into the Bill in sub-clause (6) of clause 7 that the termination of pregnancy must be carried out within seven days of its authorisation. The objective of this provision is to minimise the danger to the health of the woman seeking abortion as it is known that abortions carried out late in pregnancy carries with them a high mortality and morbidity rate.

(d) Consent is required of the person to have abortion - this is provided in clause 8 - and in case of feeblemindedness or where the woman is unable to give a valid consent if she is below 18 years of age, the parent or guardian or, in the absence of either one, the Board, after consultation with the husband, may authorise the abortion. Consent may, however, be withdrawn any time before abortion is carried out.

(e) Secrecy is guaranteed for any application for treatment for termination of pregnancy. Disclosure of any facts or information without the consent of the pregnant woman is an offence.

(f) The medical practitioner who has conscientious objection in carrying out abortions is protected under clause 10 which provides that he may refuse to do so unless such treatment is to save the life or preserve the physical or mental health of the pregnant woman. It should be elaborated further that the practitioner has a general duty towards his patient. Once a doctor/patient relationship has been created when the practitioner accepts the patient, he must provide advice as well as treatment with reasonable care and skill.

However, under clause 10 (3) the medical practitioner has a duty to participate in such treatment in an emergency where no other doctor is available and which is necessary to save the life or to prevent grave permanent injury to the physical and mental health of a pregnant woman. The Singapore Medical Association in their memorandum have expressed strong opposition to this sub-clause. According to them, their Roman Catholic members will find themselves accountable and this will not, as has been envisaged by clause 10, allow them a way out without breaking the law. But I cannot really see any justification to the objection to clause 10 (3) since it, in fact, restates our existing law in which all doctors have a legal duty to preserve life. This legal duty must certainly over-ride all religious dogmas and beliefs. It is the Roman Catholic dogma that the foetus has the right to life as the born child. This assumption can, if I may point out, lead the Roman Catholic doctor into a great moral dilemma, for sometimes he has to choose between destroying the foetus in order to save the mother's life and allowing the mother to die in the hope of saving the foetus. As has been well said and I quote: "The Catholic preference of doing nothing to assist the mother amounts in fact to a preference of the foetus over the mother and may amount to a sentence of death for both."

As a matter of fact, a member of the public who participated in a recent public forum on Medical Ethics organised by the Singapore Medical Association had stated that, by insisting on absolute freedom to refuse to act against conscience even in an emergency to save the life or prevent grave permanent injury to the pregnant woman, the Singapore Medical Association seemed to have overlooked the Declaration of Geneva where a doctor is required solemnly to pledge that he would not permit considerations of religion, nationality, race, party political affiliations or social standing to intervene between his duty and his patient.

Mr Speaker: Order, Mr Chua, I propose to take the suspension for tea at a quarter to five. You have just exceeded one hour. I will obtain the general assent of Members for you to -

Mr Chua Sian Chin: I will take another five minutes.

Mr Speaker: I will, in any case, have to obtain the general assent of Members. May I suggest that I obtain the general assent now? I will take the suspension and I suggest you finish your speech on resumption. Do I have the general assent of Members for the Minister to exceed one hour?

Hon. Members indicated assent.

Mr Speaker: I will suspend the sitting now and take the Chair again at 20 minutes past five o'clock.

Sitting accordingly suspended at 4.45 p.m, until 5.20 p.m. Sitting resumed at 5.20 p.m.