Singapore's first family planning services



Singapore Infopedia

Background

 

Family planning services were first introduced to the Singapore population following the establishment of the Singapore Family Planning Association (SFPA) in 1949. A pioneering group of volunteers worked to introduce family planning services at municipal infant welfare clinics in urban and rural areas of Singapore. The idea of family planning was disseminated, and birth control methods and contraceptive supplies were provided to mothers.

Background
Singapore’s post-war baby boomers were in their productive years by the 1940s and the country experienced exponential rates of population growth. This led to social problems such as food and housing shortages, and raised concerns over the welfare of mothers who underwent multiple pregnancies (some as many as 19 pregnancies) and the unwanted children produced by families without the means to support them. Up till then, family planning was perceived as a personal family matter rather than a national concern.

Pioneers advocating the practice of family planning identified the problem as being the number of children produced in excess of their families’ financial means. Hence, in early 1949, several concerned volunteers suggested that family planning advice be made available to mothers at infant welfare clinics. With permission from the municipality, a weekly family planning session was introduced at three of five municipal clinics, but it soon became evident that the service should be expanded to address the problem and that a voluntary body akin to the Family Planning Association of Great Britain should spearhead the work.

The Singapore Family Planning Association
Concerned with alleviating the burden of mothers due to the endless cycle of child-bearing and raising, and the multitude of children who were poorly provided for, a meeting was held at the Young Women's Christian Association (YWCA) on 22 July 1949, presided over by Sir Percy McNeice    (head of the Social Welfare Department), that led to the formation of the SFPA. Present at this historic meeting were two women who are today regarded as pioneers of the family planning movement in Singapore: Mrs Goh Kok Kee, first chairman of the SFPA, who subsequently co-founded the International Planned Parenthood Federation; and Celeste Amstutz, president of the YWCA.

The SFPA’s objectives were three-fold:
1) To advocate the provision of facilities for scientific contraception to mitigate the evils of ill-health and overcrowding.
2) To advocate and promote the establishment of Family Planning Centres.
3) To encourage the production of healthy children who are an asset to the nation. 

The SFPA relied mainly on a group of volunteers, with funding from government grants, donations and nominal clinic takings. A government grant of S$5,000 was given in the first year, with the amount increasing steadily to S$85,000 in 1956 and S$120,000 in 1958. Subsequently, the government grant was capped at S$100,000 till 1966.

Introducing family planning services
In introducing family planning in Singapore, the SFPA had to contend with various forms of resistance. Not only was the idea of family planning foreign to a population that perceived large families as being natural and necessary, there were religious groups that disapproved of birth control. Furthermore, the private nature of the issue meant that a mass approach was inappropriate.

To educate the population on the idea of family planning, the SFPA organised publicity programmes such as press interviews, news features, radio broadcasts, leaflet distribution and poster displays at public places. Alongside publicity measures, the SFPA also introduced family planning services such as advice on birth control methods and child spacing. These services were initially available at the municipal infant welfare clinics at Prinsep Street, Kreta Ayer and Joo Chiat as these venues had been dealing with antenatal and postnatal care and were thus a convenient avenue to raise the issue of family planning. Available for only two hours each week, these services were in great demand.

The SFPA also capitalised on doctors who were supportive of the cause to make family planning services available at their dispensaries. In November 1949, the SFPA opened its first clinic at Victory Dispensary, the clinic of Dr Goh Kok Kee (husband of Mrs Goh) at 316 South Bridge Road. The service was only available once a week for three hours in the afternoon. The next two private dispensaries to offer similar services were those of Dr Loh Poon Lip (Union Dispensary) and Dr C. J. Poh (Queen’s Dispensary).

With success in its initial efforts, the SFPA then partnered municipal clinics and eventually established an islandwide network of clinics to provide family planning advice and contraceptive supplies to 75% of the population. A total of 11 clinics were set up in the SFPA's  first year, some at dispensaries of association members and others at government hospitals or outpatient dispensaries in rural and urban areas of Singapore. By 1955, there were 14 clinics around Singapore, seven each in urban and rural areas.

To make family planning services accessible to all families, clinic charges adopted a sliding scale based on the household income of the acceptor’s family. Those who earned less than S$100, had large expenses (due to numerous children or unemployed husbands) or were receiving social welfare were given contraceptive supplies free of charge. Those with a monthly income of less than S$200 and those with large families could obtain supplies at subsidised rates. The need for family planning services in rural areas was more acute as rural mothers from lower income groups tended to have more children and were less informed of family planning ideas and methods.

Family Planning Services and Programmes
In the initial years, the SFPA targeted mainly mothers. Those who welcomed the idea of family planning nonetheless had unfounded doubts about the safety of contraceptive methods, the sinister motives of family planning workers, and the morality of using contraception.

Referrals from professionals, volunteers and SFPA staff, either formally or informally, were the most effective way of drawing potential patients to the clinics. Those who accepted family planning methods themselves also spread the word, making informal referrals an effective means of disseminating the family planning cause.

On their first visit to the clinic, patients were introduced to the major methods of contraception - the diaphragm, condom, foam tablet, and applicator and paste. They were then asked to indicate their preferred contraceptive and would receive a detailed explanation of the method. Supplies would then be given and a follow-up visit for an update on the acceptability of the selected method. Acceptors often tried several methods before settling on one. A follow-up programme was implemented to monitor an acceptor’s attitudes towards contraception and their use of the contraceptives provided. Prior to the introduction of the oral pill in 1961, the most popular contraceptive methods were the diaphragm, the condom and the foam tablet.

Patients who failed to revisit the clinics for supplies or check-ups after six months were sent a reminder letter, followed by a second letter if necessary. If these measures failed, a visit would be made to the home. Home visits were effective in persuading patients back to the clinics and to the use of contraceptives. One reason was that some found their own home environment more comfortable than the clinic and hence could better understand the family planning advice given by the staff.

However, making home visits was not easy as addresses in rural areas were difficult to locate and, unknown to SFPA staff, patients sometimes moved and re-settled elsewhere. The perseverance of the family planning workers in following up with their patients showed their dedication to the family planning cause.

Besides contraceptives, the SFPA also offered sterilisation services. As this was a drastic measure, it was clearly conveyed to patients and conducted only after careful consideration of their profile. Many pregnant women sought abortion services at the SFPA’s clinics, but the practice was illegal until 1970 and hence not available.

Family planning becomes a national concern
In 1964, the SFPA requested that the Ministry of Health take over all family planning activities conducted by the SFPA at government clinics. In 1966, the Family Planning and Population Board was established and assumed the duties of the SFPA in overseeing family planning services in 26 government clinics, signalling that family planning was now a national concern. By this time, the SFPA had provided family planning services to 88,000 women in the two decades of its existence, and was registering close to 10,000 new cases annually.



Author
Irene Lim



References
At Kandang Kerbau [Microfilm: NL2504]. (1950, October 5). The Straits Times, p. 6.

Chang, C.-T. (1974). Fertility transition in Singapore. Singapore: Singapore University Press.
(Call no.: RSING 301.321095957 CHA)

Family Planning Assn. formed [Microfilm: NL2497]. (1949, July 23). The Straits Times, p. 7.

Family planning in Singapore. [White paper] (1965) Singapore: Printed by Govt. Printer.
(Call no.: RSING 363.96095957 FAM)

First FPA clinic is opened [Microfilm: NL2499]. (1949, November 5). The Straits Times, p. 5.

F.P.A. to extend work to rural areas [Microfilm: NL2502]. (1950, June 3). The Straits Times, p. 4.

Full-time clinic for family planning [Microfilm: NL2508]. (1951, June 8). The Straits Times, p. 5.

Mrs. Robert Eu to head FPA [Microfilm: NL2506]. (1951, January 13). The Straits Times, 13 January, p. 5.

Municipal Welfare extends family planning advice clinics [Microfilm: NL2502]. (1950, May 4). The Straits Times, p. 5.

Singapore Family Planning Association 6th annual report. (1956). Singapore: Family Planning Association of Singapore.
(Call no.: RCLOS 301.426 FPASAR year 1955)

Singapore Family Planning Association 8th annual report. (1958). Singapore: Family Planning Association of Singapore.
(Call no.: RCLOS 301.426 FPASAR year 1957)

Singapore Family Planning Association 11th annual report. (1961). Singapore: Family Planning Association of Singapore.
(Call no.: RCLOS 301.426 FPASAR year 1960)

60 women vote for family planning [Microfilm: NL2496]. (1949, May 17). The Straits Times, p. 8.

United Nations Fund for Population Activities. (1976). Singapore. New York: Author.
(Call no.: RSING 301.321095957 UNI)

Zhou, M. (1997). A point of light: the life of family planning pioneer, Constance Goh. Singapore: Yuyue Enterprise.
(Call no.: RSING 363.96092 ZHO)


Further readings
Pioneer of S'pore's family planning movement dies [Microfilm: NL20145]. (1996, November 22). The Straits Times, p. 47.

Wan F. K. & Loh, M. T. F. (1979). Fertility policies and the National Family Planning and Population Programme. In P. S. J. Chen & J. T. Fawcett (Eds.), Public policy and population change in Singapore (pp. 97-108). New York: The Population Council.
(Call no.: RSING 301.3295957 PUB)

Wee, K. K. S. (1979). Legal aspects of population policies. In P. S. J. Chen & J. T. Fawcett (Eds.), Public policy and population change in Singapore (pp. 29-46.). New York: The Population Council.
(Call no.: RSING 301.3295957 PUB)



The information in this article is valid as at 2010 and correct as far as we can ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the library for further reading materials on the topic.


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