INCREASE OF ACCOUCHEMENT CHARGES FOR HIGHER ORDER OF DELIVERY (Statement by the Minister for Health)

2.40 p.m.

Mr Chua Sian Chin: Mr Speaker, Sir, our President's address to this House emphasised the need in the next five years to strive for higher standards in everything. We want higher quality in jobs, schools, hospitals, social and recreational amenities and homes. The crucial pre-condition for fulfilling these objectives is smaller families. Only then can more resources and care be given to each child, by the parents and by the State.

Our National Family Planning Programme has in the last six years been able to achieve some measure of success. It has brought down the high birth rate of 28.8 per thousand in 1966 to 22.3 per thousand in 1971. But there are many people who do not practise family planning. These couples still want large families. About 35 per cent of children born are of a fourth or higher order born to the family. The problem is made worse because most of these children are born to families who are least able to feed them and nurture them. These parents cannot give their children opportunities equal to those of children in smaller families.

In an industrialised and highly urbanised Singapore of the 1970's, a large family is a tragedy for the children, a burden to their parents, and a drag on the whole society. Infant mortality in Singapore is one of the lowest in the world. It is not necessary to have large numbers of children to ensure the continuity of the family line.

A study of the incidence of anaemia cases among children revealed that 25 per cent of the cases were from families with three or less children. Seventy-five per cent of them were from families with more than three children. The majority of the parents with three or more children cannot afford to provide their children with adequate and proper nourishment.

Children suffering from inadequate protein, iron and vitamins during their formative years, tend to be seriously retarded in their brain development. This is clearly reflected in a study of Primary VI examination results among a group of 1,123 children. This study showed that among children who are well-nourished 77 per cent of them passed, and only 23 per cent failed. Those who are averagely nourished 51.4 per cent passed, 48.6 per cent failed. But of those who are under-nourished only 23.9 per cent passed, and 76.1 per cent failed. Health and malnutrition factors were compounded by lack of maternal care and of books and recreational toys of educative value.

The Government plans to eradicate the present pockets of malnutrition in children to ensure the mental and physical development of our young. But these plans can only be partially successful. The problem must be tackled at source, by preventing such large families.

As our economy expands, wages will go up, But the rise in wages will not bring a better life to those families who increase their burdens by having more children to feed, clothe, and nurture.

When parents have more children than they can adequately feed and care for, these children will have poorer diet and health. Their education and training will suffer and they will remain at the lower levels of lower incomes in unskilled jobs.

No amount of subsidies by the Government can remedy the lack of adequate food and care at home. Subsidised meals in schools cannot make up for what they should get at home. Children do not go to school until the age of six, by which time permanent damage would already have been done. One meal in school for slightly more than half the year, excluding holidays, cannot repair the damage.

In fact, the greater the feather-bedding of large anti-social families, the greater will be the numbers of large families. The costs of the subsidies will be compounded all along the line, from housing, to nutrition, to education. In effect, the Government has to increase taxes to subsidise people with low incomes and large families. It is a vicious cycle which we must break. It is kinder in the long run to put disincentives on large families. Certainly it will carry less danger of social tension, overcrowding and generally lowered standards in the very limited space of Singapore. The quality of the environment and standards of life must suffer unless we take strong measures now to stop large families.

Moreover, social friction and tensions will increase between those with small families whose children will in turn do well, because of better health and social factors, and those with large families whose numerous children will do poorly because they are deprived of adequate food and care. To bring up each child up to his or her fullest potential, we must break this vicious cycle.

Further, too frequent child-bearing means physical exhaustion and adverse effect on the mother's health. The incidence of women dying as a result of child birth rises sharply after the fourth pregnancy. Weakened mothers are unable to work and supplement the family income.

If our society is to become more just and equal, smaller families must be actively encouraged, and large ones actively discouraged.

Accouchement fees, maternity leave, priority points for homes will be so adjusted to encourage two children per family. The third child is a luxury for all but those who can afford to lavish the same care on three as they can on two children. Singapore cannot afford the fourth and fifth child for parents without the ability to bring them up properly housed, clothed, fed and educated. The results will be disastrous, in juvenile delinquency, social resentments and tension, as differences in earnings and circumstances widen between the children of the successful small families and those of the unsuccessful large ones.

Housing Board priorities for allocation of flats will be changed so that those with two or less children will have the highest priorities. Families with three will drop slightly in priority. Families with four or more will have little priority. This, however, will be implemented so as to be kinder to those who already have large families.

In accordance with this policy of encouraging small families, income tax relief in respect of children will in future be reduced, from the present five, to only the first three children. Those who already are enjoying income tax relief on five children will, of course, continue to do so. My colleague, the Minister for Finance, will make a statement on this after all the details have been worked out.

Paid maternity leave both in Government Service and under the Employment Act will be reduced from three to two confinements after 1st August next year.

The Government's duty is to encourage family planning and to discourage large families. The Government has decided to increase the accouchement charges for deliveries of higher orders of children in the Government hospitals. Parents must be made more aware of the actual costs of bringing their third, fourth or fifth child into society. If they find the new subsidised rates difficult to bear, then they will never be able to bring up the children properly to earn a decent living. The new rates will be as follows:- ACCOUCHEMENT CHARGES A B C Class Class Class Singapore Non-Resident Resident $ $ $ $ 1st 200 100 40 2nd 200 150 75 No 3rd 250 150 100 acceptance 4th 300 250 200 5th or 350 300 250 higher order

The term "Singapore resident" means Singapore citizens and includes persons in possession of Singapore blue Identity Cards, or married to a Singapore resident. Non-residents will not be accepted in our C and B class maternity wards. Expectant mothers who have come into Singapore specially to deliver their children will be taken in only into the maximum fee-paying A class wards.

I must point out that these new rates still mean heavy Government subsidies for the delivery of the first and second child in C class wards. They are less for the third child and none for the fourth.

There will be a waiver of these fees on condition the woman or her husband undergoes sterilization.

More use of sterilization as a means of family planning for those who have completed their families must be encouraged.

These new rates will be brought into effect about 9 1/2 months from today, that is, 1st of August, 1973.

The National Family Planning and Population Board have made birth control services freely available to all over the last seven years through its network of family planning clinics in the Maternal and Child Health Services. A nation-wide mass family planning campaign was launched only recently to urge parents to have small families. Abortion is available at little or no cost to those who need them, especially in cases where contraceptives have failed. This policy of the two-child per family will be encouraged in all aspects of social and economic policy. Conversely, the large family will be actively discouraged in every way. This is for the good of our nation as a whole, and kinder to those who still ignorantly believe that the more children they have, the more benefits they will get from them.

2.55 p.m.

Mr P. Govindaswamy (Anson): Mr Speaker, Sir, I am very glad to listen to the Minister for Health's explanation on family planning. I quite agree with what he has said. But what about the couple who have two girls? Therefore, if they want to have a boy, then most probably they have to adopt a boy from another country, if the couple is limited to two children. This restriction is very bad, because we are going against nature. The Minister should consider this matter over again. He can tell the people to go for sterilization or abortion. That is a different matter. But he should not introduce a policy saying that each family should have only two children, because this restriction is bad for our country. Why do the Western countries, such as America, not have such a policy? It is because they want people for national service. If we have too many females at present, in future it may be difficult for us to find the men needed for national service.

Sir, the increase in accouchement charges is also ridiculous. This is very dangerous for the country. I warn the Minister that if the charges are raised, the people will cry out, saying that the PAP Government with full 65 seats are bringing in all sorts of measures. I do not object, but it should be done step by step. This is unfair to the people. I do not know whether my colleagues in this House will agree with me, but this policy should be modified in order to help the people. I hope the Minister will consider this Smatter.

Mr Seah Mui Kok (Bukit Ho Swee): Mr Speaker, Sir, I fully support the necessity of having a small family. But my personal opinion is that to limit a family to two children is a little bit too harsh. I strongly feel that the limit should go up to three, for the simple reason that if something befalls on one of the two children, then what will happen? I strongly urge that the restriction be amended from two children to three children.

As regards the increase of accouchement charges, I would strongly suggest that we spend more time educating the people on the importance of having small families, rather than imposing the increases in 9 1/2 months' time. I feel that the period is a little bit too short for them to be sufficiently educated on the need for a small family. I appeal to the Minister to give the people at least one or one and a half years of such education, together with intensive campaigns on small families.

Mr Sim Boon Woo (Changi): Mr Speaker, Sir, I agree with the Member for Bukit Ho Swee. The ones which we should educate are not the ones who are already educated. It is the people in the rural areas who are the unfortunate ones we have to educate. But to drive this point home, hon. Members and even the Minister for Health must have a lot of time, energy and effort to spare. I would like to suggest to the Minister that more intensive propaganda be carried out in the rural areas, in the kampongs, in the islands, in order that this policy of having small families be driven home to the people. And that is why I say we should not exercise our power without rational considerations.

Mr Ng Yeow Chong (Mountbatten): Mr Speaker, Sir, I fully support these measures against families having many children. I also agree with the suggestions made by the -Member for Changi that adequate propaganda should be carried out by making use of all the mass media. I have one simple question to raise on the priority for. Housing Board flats: How are we to prevent couples from having more children after they have been allotted Housing Board flats?

The Parliamentary Secretary to the Minister for Labour (Mr Fong Sip Chee): Mr Speaker, Sir, may I beg your indulgence in allowing speeches to be made on a Ministerial Statement although the Standing Orders only provide for questions to be asked? With your permission, Sir, since you have been lenient with other Members, may I be allowed to add my own comments although I know it is against the Standing Orders.

Sir, one must be very realistic in the situation that we are in. There are many basic factors that none of us can change and through no fault of our own; for example, our land area, our human resources, our financial capability, our vulnerability to factors outside Singapore. Having a large family is, and I do not like to use the word "feudalistic", I think basically a rural psychology or philosophy - the larger the family, the more hands to work in the field. Naturally the advantage is evident in a situation like in old China and in India, and even in the greater part of agricultural countries in Southeast Asia where the female offspring is normally regarded as a loss and economically non-productive, particularly in some of the older fashions of the Indian community where a handsome dowry has got to be paid when they marry off a daughter. But that is applicable in a rural agricultural society. It has no relevance to Singapore, which is cosmopolitan. The less people we have, the less tension we will create. Maybe in the next 10 or 20 years, for the next generation, we have a duty to see that the kind of society we leave behind for our children and their children in the next 20 or 50 years would be a place worth living in, a place which we can show to the world that our human energy is not only confined to producing people of our own kind but that we are quite capable of creative thinking.

Even with the relaxation of the rules as proposed by the Minister, there is one fact, I think a painful fact, which all Members must agree. However relaxed we are in the rules, we cannot ensure so-and-so that he would get a son instead of a daughter. The Minister is totally helpless in a matter like this. If hon. Members can find a solution, as a result of the relaxation of the rules, that perhaps after having four daughters the next child is guaranteed to be a son to inherit the family line, then I think that might well be worth considering. But in the absence of any solution or a breakthrough in medical science, I think none of us here can be of any help at all to ensure that everyone can have an offspring or a child to continue the family line.

Dr Tan Eng Liang (River Valley): Mr Speaker, Sir, the Minister for Health has mentioned that from August 1973, the priority point system for Housing Board flats for those with more than two children will be lowered. I was just wondering how would the priority be affected, for those who already have three or more children and who are already on the waiting list.

Mr Ho See Beng (Bras Basah): Mr Speaker, Sir, in principle, I agree that we Singaporeans should have a small family, but the method of introducing this disincentive to a big family is, I think, not fair and practical. I always believe that birth is accidental and not incidental!

Dr Ong Leong Boon (Kim Seng): Mr Speaker, Sir, I would like to support the spirit of the Statement by the Minister for Health. But I think there are certain points that we have to consider. The first and foremost point is this: we must try our level best to persuade the people of Singapore the significance of having smaller families. To my mind, we have not given sufficient attention to the methods of persuading our people. I think this is one area where we must intensify our efforts in order to have the maximum effect. We can move people much more by persuasion than by imposing additional fees or any other measures like minimising priorities or imposing higher accouchement fees.

My contention is that the family planning programme has not been sufficiently intensified. If you have worked in, say, the Kandang Kerbau Hospital, you will notice the degree of ignorance of many people who come from the rural areas. To them, family planning means nothing, it is nonexistent, or they know nothing about it at all. The Minister should, therefore, intensify this campaign in the rural areas and also, in terms of the future, get it across to the schools. I think all our youngsters must know this.

The second point is the accouchement fees which the Minister has mentioned. It seems to me that there is hardly any difference in the accouchement fee charged for the C class as compared with B or A class. A person who can afford an A class ward need pay only $250 for the third child, whereas the one who goes into C class pays $100. $100 to a C class ward patient could well mean half a month's salary, but $250 means nothing to one who can afford an A class ward. If we are to discourage large families, we must discourage everyone, not just the poor but the rich as well. I think there are many factors as to why we should have small families. The family should be kept small, irrespective of whether he is from a poor social class or the rich. I therefore say that the accouchement fee rates must be revised so that if we are to discourage the poor we must also discourage the rich.

Mr Chua Sian Chin: Sir, may I take the point brought up by the Member for Anson about a couple having two female children? Although he is rather vague and diversified in his comments. I think his point is that if you have two female children, you may want a male, then what happens? In this modern, urbanised and industrialised Singapore, the sexes of the children should not count. After all, we have the Women's Charter, and so on. We have equal pay for women. So we should not discriminate between male and female children He also mentioned that restricting the number of children to two is a rather dangerous policy. On the contrary, and I have stated this in my Ministerial Statement, if you do not limit the number, particularly in the case of families who cannot afford to bring up their children properly, you are going to create social tension between those who are poorly paid and unskilled, because their parents were not able to educate or nurture them, and those from small families because their parents have given them the best. Therefore, limiting the number of children per family will mean that in 15 or 20 years time, we will have less social tension. We will have a more just and equal society. If we do not do so, whatever we do in subsidies we cannot bring about a more just and equal society. I am sure the Member for Anson wants to have a more just and equal society in Singapore.

The point brought up by the Members for Bukit Ho Swee, Changi and Mount-batten, is that not enough time has been given to persuade the people to confine to small families. As I have stated, we have just held a mass family planning campaign. I wonder what the Member for Changi was doing then. Did he go round to his constituents to propagate the concept of the small family? As far as publicity about family planning is concerned, I have said that we have had the family planning service since 1966, six years ago. In fact, a White Paper on family planning was presented in this House by my predecessor. Campaigns on family planning had been launched before and there is no excuse for members of the public not to know anything about family planning. Our surveys have shown that although they know what family planning is, a percentage of them do not want to accept it. Therefore, it is not the case of the public being ignorant of family planning.

The point that was brought up is that we are limiting the number of children to two. What we are advocating is that two is the ideal. It does not mean that you cannot have three or four. If you can afford it, by all means, have three or four. But if you cannot afford to bring up two children properly, then I think it is criminal for you to bring up three or four. It might be satisfying to you yourself, but please remember that the third and fourth child you bring forth may have no prospects of a better life in the future.

Regarding accouchement fees, the Member for Kim Seng mentioned that there is not much difference between the C class and the A class. Well, there is a difference, but it narrows down to the point when the mother comes for her fourth child. As I have said, this is a matter of cutting down the subsidies. We subsidise the first two children. For the third child, we subsidise slightly less, but there will be no subsidy whatsoever for the fourth and fifth child. As I have said in my Ministerial Statement, if a person cannot pay the higher accouchement charges, how then can he have the means and the ability to bring up a child so that he or she will have an even chance in the future for a better life?

The point brought up by the Member for Bras Basah is that birth is an accident. I do not think I should comment on that. I hope the Member for Bras Basah has not come into the world by accident!

Dr Tan Eng Liang: Sir, the Minister has not answered my query regarding the priority of the Housing and Development Board point system.

Mr Chua Sian Chin: Sorry, I missed that point. In fact, I have already answered that in my Ministerial Statement. May I just quote it?

`Families with four or more will have little priority. This, however, will be implemented so as to be kinder to those who already have large families.'

I hope that answers the Member's point.

Mr Teong Eng Siong (Sembawang): (In Mandarin): Sir, I wish to ask the Minister about the case of twins. For example, twins were born to the family of the Member for Changi. How would the case of twins apply to these measures?

Mr Chua Sian Chin: Well, if twins were born in the first delivery, then it is counted as the first delivery and you pay the fee for the first delivery. Of course, after having got twins, if you have a third one, then the fee will be charged as for a third delivery. But if the Member for Sembawang happens to have twins, then we will be more flexible in our interpretation.