VOLUNTARY STERILIZATION BILL

[Mr Speaker in the Chair]

Order for Second Reading read.

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, introduced concurrently with the Abortion Bill, forms, together with the Singapore Family Planning and Population Board Act of 1965, a trio of social legislation of major importance. The three laws are a charter to liberate women from unwanted pregnancies and are as far-reaching in their social import as the Employment Act, the Central Provident Fund (Amendment) Act and the industrial Relations (Amendment) Act are to the working community.

The Voluntary Sterilization Bill provides for a means of preventing the unwanted or harmful pregnancy by the sterilization of either the female or male partner of a union. Female sterilization is at present practised quite frequently, in this country, the need for it, and possibly for male sterilization, is likely to increase progressively. There are far fewer ethical objections to these operations than those to the termination of pregnancies.

But our present law in regard to sterilization is obscure and much open to criticism. There is no specific reference in the Penal Code to sterilization except reference to emasculation, which is an offence defined as a grevious hurt.

At present, sterilization is probably not unlawful provided there is full and valid consent for the operation and that it was done for the benefit or well-being of the person. But this is by no means certain.

Unless sterilization is performed for the purpose of treatment, it might however be considered an assault on the person if performed for any other reasons, such as for family limitation, social and economic pressures, high parity and eugenic considerations. In such circunistances, the operation is not made lawful even if consent is given in such cases.

This proposition, however, has no direct judicial authority to support it, because it has never been tested in a court of law, Therefore, the state of the law on the subject is such that no one can say with certainty what the law is. Meanwhile, doctors have to take responsibility for the sterilization operations which they have to perform to protect the health of women and to protect mothers from giving birth to potentially abnormal babies.

The object of the Bill, therefore, is to correct the ambiguity in the laws regarding sterilization. It will make it lawful for sterilization operations to he performed for purely medical conditions as a form of treatment if the registered practitioner in consultation with another practitioner agrees that it is necessary.

In any other case, the operation can be performed on any person so long as the person is (a) above 21 years of age; (b) has the valid consent not only of himself but of his wife, if he is married; and (c) has three or more living children. If the person is under age, the operation can be performed only if the parents or guardians of the person signify consent for such treatment; or if the person is afflicted with any hereditary form of illness that is recurrent, mental deficiency or epilepsy.

Sterilization has such a vital part to play in the prevention of pregnancy from the stand-point of the health of the individual or the happiness of the family and for population control, that the need for new legislation to cover its performance is as urgently required as that for the Abortion Bill.

It is essential that the Abortion Bill should be complemented with the simultaneous passage of a law on sterilization.

Mention was made in describing the Abortion Bill that it was the experience in some countries which had liberalized their laws on abortions that a significant number of women were having repeated abortions. For such women, it would be preferable to undergo sterilization than be allowed to go through repeated ordeals of abortions.

It would be infinitely simpler if niarried couples submit to sterilization after they have the number of children they have planned for. For a relatively simple operation they are rid once and for all of the worry of a possible unplanned pregnancy. For them, they are once and for all rid of the inconvenience of practising contraception. They will also he free from any further expenditure for birth-control measures.

For the woman burdened with the care of too many children, where her health is sapped by repeated pregnancies, it is a relief to be free from the tyranny of fertility.

A recent report of a series of 186 sterilised women from the Medical Research Council, Medical Sociology Research Unit, in the University of Aberdeen, showed that most of the women were satisfied with and were enthusiastic advocates of sterilization.

Sterilization will also be permitted for eugenic reasons. For example, it would be permitted where there is a likelihood of transmission of hereditary diseases or where one of the partners is insane, or manic-depressive, or schizophrenic, or feeble-minded. In words that have become memorable, Mr Justice Oliver Wendell Holmes, a great jurist, delivered the following opinion:

'It is better for all the world, if instead of waiting to execute a degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind.'

The operation in the male is a simple one. It is done under local anaesthetic and can be done in any out-patient surgery. Perhaps the Member for Joo Chiat will know this better. In the operation, each of the two small tubes, known as the vas deferens, leading from the testes are cut. In this way, sterility is achieved without affecting the man's libido or virility and there is a good chance that the tubes may be re-joined, if required, successfully at a later date. This operation is medically known as vasectomy. It is important to point out here that this is entirely different from castration, which is a form of emasculation.

In women, the operation is less simple as the tubes leading from the woman's ovaries, known as the Fallopian tubes, are within the abdominal cavity. The operation requires a small incision into the abdomen, but the other part of the operation is nearly as simple as for a male. Here again, I think the Member for Joo Chiat will know this better. The operation is required to be done under general anaesthesia and the patient has to be warded. Needless to say, the operation carries slightly more risk compared with the negligible risks of the operation on the male. The operation on the female is called a ligation.

Like the Abortion Bill, there are certain safeguards written into the Voluntary Sterilization Bill which will effectively prevent abuse. One of the important safeguards is never to permit sterilization of persons against the person's will. We must never get into the position where the Bill, introduced with such high ideals and good intentions, is exploited by unscrupulous and cruel persons as had- happened in the mad days of Nazi Germany during the Second World War where several thousands of persons were sterilized without their consent. We must never get into the position where this law can be used against particular persons or against a community.

The law is to allow for sterilization of persons to be done entirely voluntarily and at the person's request. Coercion will be an offence. Since there are both serious social and medical implications for the operations of sterilization which have essentially a permanent result and cannot be so easily undone, very careful safeguards have been introduced and these are:

(i) The authority of a Eugenics Board will be required to authorise the sterilization of persons. The Board will consist of five members who will include a Judge, two registered medical practitioners and two others appointed by the Minister, one of whom must have had experience in social welfare work.

(ii) Consent of the person, parent or guardian in case the applicant is below 21 years of age, and of the spouse should the person be married, will be required. The reason for requiring consent of the marital partner is that the operation without the consent of the spouse can be considered a marital offence.

(iii) Sterilization will be carried out only in Government hospitals or an approved institution.

(iv) The operation will be carried out only after a period of 30 days has elapsed from the day of the application in order to give time should the applicant change his mind.

(v) For the medical practitioner and other medical staff, a conscience clause is included in the Bill so that no person will be obliged to participate in such an operation if it is against his conscience.

(vi) The Bill will continue to be in force for a period of four years, which may be extended for a further period of one year, which in effect means that a critical assessment can be made as to the effectiveness of the legislation and Parliament will have the opportunity for debate on it again if it is to be re-enacted.

In summary, the Bill makes provisions making it legal to carry out the operations of sterilization on a male or female person on application and by approval of a Eugenics Board. Sterilization does not carry the same emotional and ethical considerations as those raised by legalised abortion. Sterilization is a form of contraception which is virtually sterilization for life. As such, it has the advantage over the other forms of contraceptive techniques which are less convenient, and not completely effective. But being irreversible, serious thought must be given by the applicant and great care must be taken by the Board in approving the application before the operation is undertaken so that it is never regretted. It has therefore been necessary for careful safeguards to be written into the Bill.

Mr Speaker, Sir, I beg to move.

Question proposed.

5.45 p.m.

The Minister for Communications (Mr Yong Nyuk Lin): Mr Speaker, Sir, it is with pleasure that I rise again to speak in full support of the Voluntary Sterilization Bill now before this House.

Surgical sterilization through ligation is the most reliable contraceptive method, as it involves the snipping-off and tying up of either the Fallopian tubes in the case of the female, or the seminal tubes in the case of the male. This method is generally asked for by women who already have more children than they can adequately care for, and the simple operation is normally done immediately after childbirth. I have witnessed such an operation. It is the most convenient contraceptive method for women, especially:

(a) those in the low income group who need a reliable family planning method which is permanent and without incurring any recurrent cost;

(b) those whose education is low and therefore have difficulty understanding the anatomy of the body and the whys and wherefores of conception; and

(c) those whose husbands, unfortunately, are most uncooperative and show little understanding and feeling, by refusing to countenance any visible form of contraception being practised.

Surgical sterilization, fortunately, is not a controversial issue as mentioned by my colleague, the Minister for Health, as in the case of legalisation of abortion and is generally being accepted as the most reliable method for family planning purposes. This is nothing new therefore and is, in fact, offered as the number three order of priority to women in Singapore as a family planning method under the Government's Five-Year Mass Family Planning programme.

I would now like to quote the following relevant paragraph of the White Paper on Family Planning (Command Paper No. 22 of 1965) tabled in this Parliament on 27th September, 1965:

Choice of Family Planning Methods

'5.2 It is the aim of this Plan therefore to be both bold and imaginative by offering all who want Family Planning a "menu card" as it were, of choices in the following order of preference: (a) Intrauterine Contraceptive Device (IUCD). (b) Contraceptive Pill (CP). (c) Surgical sterilisation through ligation, etc.(for those with 6 or more children). (d) Diaphragm with Paste. (e) Vaginal tablet types. (f) Condoms. (g) Rhythm method. but the whole emphasis of the Plan is to offer IUCD.'

For some years now, our Kandang Kerbau Maternity Hospital has been performing a few hundred of such cases each year, at the request of the mothers concerned.

In the case of surgical sterilization for males, which in medical jargon is called vasectomy, the method seems to be popular in some countries like India, where it has recently been reported that as many as 5,7 million have been sterilized, of whom 80 per cent are males, in Singapore, however, vasectomy has not quite caught on. I think this House will be interested in a true case history which occurred when I was in the Ministry of Health.

On 11th December, 1967, I received a letter in Chinese from a Naval Base worker and the free English translation goes as follows:

'Dear Minister Yong,

I shall be pleased if you could let me know whether our Government Hospitals provide services for the sterilization of men - i.e. vasectomy. I intend to undergo this sterilization as a means of family planning. I am a Singapore Citizen and I now have six children already, their ages ranging from 15 years, 14 years, 13 years, 11 years, 7 years and l½ years. I am now 41 years of age and my wife is 34 years old. According to information given to me she is in the most fertile age group.

When I had my fourth child, I had starteti to practise birth control. Despite this I had two more children. This is most distressing. I have tried all the methods of birth control, and the latest method used was the oral pills, which my wife had been taking for the past few years. But unfortunately she did not agree with the pills and developed rashes all over her body. She had consulted a doctor who gave her injections and medicines to take by mouth but these were of no avail. This is most distressing.

When the Family Planning Board held its exhibition at the Victoria Memorial Hall this year, I specially went there to learn more about family planning. At that exhibition I bought a book on "The hows and whys of modern family planning". After carefully studying this book I am convinced that vasectomy as described in that book is the best method of birth control for me. So I went to the Family Planning Clinic at the Kandang Kerbau Hospital for advice and service.

I was told by a nurse in the clinic that at the moment the Government does not provide this service and that if I wanted this service I should write to you and perhaps you may be able to give me some guidance. Finally she also recommended me to Youngberg Memorial Hospital where this service is being provided.

Mr Minister, when I went to the Youngberg Hospital to enquire about this service, I was surprised to hear from a member of the staff there that the operation fee alone was $108.00, and inclusive of medicines and injections the total charges would come to about $130.00. My monthly salary is only $252.00 with which I have to feed a family of eight. Moreover, three of my children are in middle schools and two in primary schools. To meet daily expenses is already a difficult task, and to spend half of one month's salary on this operation would be impossible. Because I am in dire need of this operation and have therefore taken the liberty to write to you, and I hope that you will he able to recommend me to one of the Government Hospitals to have this safe and simple operation done.'

Sir, I was indeed touched by the highly responsible outlook of this man, over his deep concern over the welfare of his wife and family. I therefore gave instructions that this man's wishes for vasectomy be met at the earliest possible date.

I am pleased to state that the simple and successful operation was performed by none other than the Professor of Surgery, Mr Chan Kong Thoe, of the University of Singapore, and I was privileged to be present at the operation which took place in the Outram Road General Hospital on 26th January, 1968. I understand that both the Professor and the patient are most happy and satisfied with the results of the operation.

The operation was done free of charge for this man. Of course, under this Bill, we shall be asking for a nominal fee of $5, hereafter, for such operations.

5.55 p.m.

Mr Ng Kah Ting (Punggol): Mr Speaker, Sir, I am not going to say anything on this Bill, However, lest it be construed that my silence on the Bill means consent, I rise merely to have my abstention on record.

Mr Chua Sian Chin: Mr Speaker, Sir, I do not propose to say anything except to thank my colleague, the Minister for Communications, for having further amplified the objectives of the Voluntary Sterilization Bill, May I just add that there has been some talk recently about there not being sufficient facilities for sterilization in the hospitals. But may I give an assurance that after the Bill is passed every person who needs sterilization will be in a position to have his or her sterili zation performed in Government hospitals.

Question put, and agreed to.

Bill accordingly read a Second time.

Resolved, "That this Bill be committed to the Select Committee to be appointed to consider the Abortion Bill."-[Mr Chua Sian Chin].