VOLUNTARY STERILIZATION BILL

Order for Second Reading read.

6.15 p.m.

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

In contrast to the Abortion Act, the passage of the Voluntary Sterilization Act through Parliament in 1969 was a smooth one. It came into effect on 20th March, 1970. The Act is now in its fifth year of operation.

Like the Abortion Act it was given a limited lease of life, for the same reasons that the House should have an opportunity to review the operation of the Act and to determine how it has served its objectives and its impact on our society.

Unlike the Abortion Act, however, it was soon evident that the safeguards written in to protect persons from a hasty decision to be sterilized which they might regret later, were found to be excessive. These checks were found to operate against the objectives of the Act.

Accordingly, Parliament approved amendments lifting some of the more restrictive provisions in the Act on 23rd March, 1972. These amendments were brought into effect on 12th May, 1972. The effect of lifting these restrictions became immediately evident. The immediate result was a noticeable increase in the flow of persons who came for sterilization.

The statistics given in the form of tables are in the Addendum* (*Appendix II, cols, 1155-8) to my speech which I have distributed earlier. It is evident from the yearly figures that they clearly fall into two parts. The early part is comprised of figures before the amendments were brought into effect on 12th May, 1972. The second phase is after the amendments Act had come into effect.

The number of sterilizations has increased tremendously, particularly in the last two years. However, male sterilization is still relatively unpopular compared with female sterilizations.

A total of 4,787 applications for sterilization on women were approved of which only about three-quarters were carried out. It would be noted that in the first or restrictive phase the numbers approved and performed were less than 70 per cent of total applications. After some of the restrictions had been removed by amendments, the numbers approved and performed went up to about 75 per cent. The fact that there are still sizable numbers who have been approved for sterilization but do not undergo the operation probably reflects the effects of the residual restrictions imposed by the existing law.

Figures on the number of sterilizations undertaken for therapeutic reasons are also given. It is interesting to note that the proportion of female sterilization on therapeutic indications increased from 66.8 per cent of total female sterilization in 1970 but jumped to 90.1 per cent in 1973. This indicates that women will be prepared to be sterilized if it is more easily obtainable such as on therapeutic grounds, rather than having to go through the Eugenics Board.

The age of sterilizations for those sterilized on socio-economic grounds has been decreasing since 1970. In 1970, 35 per cent of those sterilized were on APPENDIX II - CHARACTERISTICS OF FEMALE STERILIZATIONS 1970-1973 (Cols 1155-1156)

APPENDIX II - RESULT OF APPLIATION FOR FEMALE STERILIZATION (Cols 1157-1158) females aged under 30. In 1971, the figure increased to 38 per cent; in 1972 40 per cent and 1973 49 per cent. The median and mean age show similar trends.

Sterilizations on therapeutic indications were carried out on older females, as expected, since the main therapeutic indication is too many pregnancies. The hazards of pregnancies increase as birth order increases.

Only 22 per cent of females sterilized on socio-economic applications had two or less children in 1970. But the figure increased to 35 per cent in 1971, 48 per cent in 1972 and 81 per cent in 1973. The increase in 1972 and particularly in 1973 reflected the effect of the amendment to the Act.

In total nearly 11 per cent of all women aged 15 to 44 years have been voluntarily sterilized. The demographic impact of sterilization on such a large proportion of women in the fertile ages is of particular significance. It would of course be difficult to assess what would have been the re-productive behaviour of these sterilized group of persons if they had not been sterilized. Such an exercise is often conjectural and speculative. Nevertheless there are mathematical methods, no doubt presumptive, which can be applied in such cases. For purposes of comparison of demographic impacts of the various direct components of a fertility reproductivity programme a method has been used to compute the births averted by contraception. Using such methodology it has been estimated that the number of births averted by sterilization in females was as follows: - Births Averted by Sterilizations in Government Hospitals 1970 1971 1972 1973 Number 1,486 2,465 4,035 6,436 Percentage of all averted births 5.2 8.2 13.2 18.3

For comparison, using the same methods of estimation, the number of births averted by abortions and contraceptions is as follows:- Births Averted by National Family Planning Abortions No. % No. % 1970 15,648 54.6 1,733 6.1 1971 15,798 54.6 1,972 6.6 1972 16,046 52.3 1,912 6.2 1973 17,441 49.6 2,167 6.2

It is clear that irreversible contraception is now an accepted method of family planning. It is also an important method. Its role in preventing births is, if the trends continue, going to be a more significant and an increasing one. This is as it should be. It rids the parents once and for all, the inconvenience of having to use contraceptives, and freeing them permanently from the tyranny of unwanted pregnancies.

We have come some way along the path on family planning and the control of population. We have passed two important milestones. The first was when we adopted, as a national programme, measures for family planning when the Act on Family Planning was passed by Parliament in 1965. The next milestone was when the laws on abortions and voluntary sterilization were liberalised in 1970. At the time when we passed these historic pieces of legislation there was expressed concern whether we were not too advanced of our times. Sometimes as a Government we should be in advance of the times. If we think it is right and have thought through these problems and carefully weighed the pros and cons, we should give the lead.

As events turned out we need not have been too concerned. We were not too far ahead of our people. They have accepted family planning and taken to voluntary sterilizations in a way quite beyond our fondest hopes and expectations. We had offered the full range of methods of contraception, from the reversible to the irreversible which is sterilization. We knew that sterilization would be the preferable procedure where the person had completed her family. A person was freed from the inconvenience of adopting the inconvenient measures of contraception. Sterilization was the method advocated by the family planners and by doctors as the best and preferred measure in such cases.

As it turned out these advantages spoke for themselves and a large segment of our married women have now been voluntarily sterilised. In fact, a sample survey of our married women has shown that more than 42 per cent of them know about sterilization and will accept it when they have completed their families. This being the case, we have a duty to make this form of contraception freely available to those who have given sober thought to this as a means of family planning and who have considered it as the method which they will adopt.

However, from our experience we know that many of them would not be prepared to do so if there are too many restrictions on their applications. We know for instance that the need to apply to a Board or panel of persons is repugnant as it interposes a third party in a matter which is essentially of a very private and personal nature. The delays which have been imposed, that is, seven days under the existing Act together with all the waiting time in processing the applications before sterilizations can be done, are also unacceptable to many. In fact, a sizable number, approximately 25 per cent, did not undergo sterilizations after the Board had approved them.

Sterilization under the Bill, as is proposed in the case of abortions, will be entirely a private matter between the person applying for it and the registered medical practitioner. It will be undertaken entirely on the volition of the person wanting it. A valid consent will be given by the person if he is an adult. It will not require the further consent of the spouse as is provided in the existing law. Consent is only required in the case of the person who is below the age of discretion, that is, under 21 years of age and if he or she is unmarried.

Under the Bill, the procedures are accordingly simplified considerably by removing all the unnecessary strictures. These are: -

(1) Abolition of the Eugenics Board which, in the existing law, authorises all applications for sterilizations. Decision for sterilization will now be made between the patient and the registered medical practitioner;

(2) Removing the restrictions requiring the persons to have at least two children before sterilization can be done; and

(3) Not requiring consent of the spouse for sterilization. However, consent of a parent or guardian will be required by those persons who are unmarried and are under 21 years of age.

Sir, I beg to move.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill-[Mr Chua Sian Chin].

Bill considered in Committee; reported without amendment; read a Third time and passed..