Health Benefits of Appropriate Timing, Spacing and Avoiding High Parity and Risks of Unplanned Fertility for the Mother

Abstract

Singapore has seen a marked decline in population with a fall in total births from 50,000 in 1967 to 39,000 in 1978. The crude birthrate decreased from 42.7 to 16.9 and was accompanied by an unequivocal fall in maternal mortality. There has been a decrease in multiparous women in the last 15 years with the median birth order falling to 1.75. There has been a distinct increase in the number and proportion of 1st and 2nd order births since 1967. The percentage of 1st order births increased from 23% in 1967 to 28% in 1970 and to almost 42% in 1978. The 2nd order births increased from 19% in 1967 to 23% in 1970, and 33% in 1978. 3rd order births increased but at a slower pace from 14% in 1967 to approximately 16% for 1975-78 period. Higher order births showed a persistent decline. This decline is attributed to literate and health conscious young mothers in Singapore in contrast to neighboring countries. Singapore, compared to that of neighboring countries, is currently dealing with a more sophisticated, affluent, and educated population. Singapore's population policies, incentives and disincentives, abortion and sterilization laws contributed to the fall in the crude birthrate. The higher crude birthrate from 1970-73 is the result of a significant increase among childbearing age group of 20-29 years. The general decrease in crude birthrate is clearly reflected in a drop of annual growth rate from 3.3% in 1966 to 1.6% in 1978 and 1.4% in 1980. From 1966-77, the fertility rate also fell by 31%, and this fall continued until 1976. The fertility rate dropped sharply in 1974-75 because of the introduction of legalized abortion, sterilization, and social disincentives. The social disincentives are in the form of higher delivery fees, reduction of paid maternity leaves, lower priority for choice of school for children, and removal of income tax relief for children of higher parity. In Singapore an effective sterilization program amounting to nearly 7000-8000 sterilizations a year and control of fertility (1400-5000/year) has led to 1 of the most effective means of avoiding high parity and limiting family size. The liberalized abortions laws have led to 1 of the most effective means of fertility control. This, coupled with advice on contraception and provision of heavily subsidized contraceptives by trained personnel, have complemented other methods of fertility control. The most important result of family limitation possibly is the decline in maternal mortality reaching figures as low as 2/10,000 births. (Copyright applies to all Abstracts.)