THE SOCIAL TRANSFORMATION OF BIRTH IN SINGAPORE 19601980

1
THE SOCIAL TRANSFORMATION OF BIRTH IN
SINGAPORE 1960-1980
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How did this social transformation occur?

• Home to Hospital
• Midwife to Obstetrician
• Low Technology to High Technology

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My Question

• How and why did the government promote hospital
  birth over other forms of birthing practices?
• Why did the population accept this move?

4
My Claim

• Hospital birth was promoted by the state given
  its conformity to the ideals of modernization.
• Reduction of infant and maternal mortality rates
  were the not main reasons behind why hospitals
  were promoted by the state and the medical
  profession in the 60s as the ideal place for
  birth

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Importance of this thesis

• Challenge certain taken for granted notions of
  risk in birth which lead to the development of
  the hospital system
• Give the alternative stories of this history a
  voice
• To provide information for policy makers in hope
  that they can make more informed decisions

6
If we want high morale, we must have high
standards. there will be no squatters and no
beggars, sleeping in and doing their ablutions in
our drains. People will be housed and cared for.
Hawkers will not clog up the main streets.
Source Lee Kuan Yew, Address to President, 1968
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Government, Modernisation and Social Change

• In terms of birth, concern for maternal and child
  health was related to the need to build a strong
  nation
• If this clinic can help produce healthier
  mothers and children, it will have served its
  purpose. A nation can never be strong if it has
  sickly mothers and children. Children are rulers
  of tomorrow and no investment is better than to
  lay a strong foundation for their health.
• Source Mr Lee Koon Choy, Parliamentary
  Secretary to Ministry of Education in 1962

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Hospitals and Modernisation

• Hospitals as symbol of modernity through the
  acquisition and application of western technology
  and techniques
• Native methods devalued as inferior, irrational
  and dangerous

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It will appear that the risk of a Malaysian
mother dying from childbirth in this State is
approximately 8 to 10 times greater than other
racial counterparts. Some reasons must be found
for this apparently high risk, but probably lack
of good antenatal care, a peculiar restraint from
institutional confinements, ignorance, generally
poor resistance and a tremendous tendency to
reply on the local bidan and home
confinementall accounting for the high mortality
ratio. Source Maternal Mortality in Singapore
1955-1959 ,TH Lean
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During a five-year period of 1963-67, the death
rate for Malays was three times higher than the
overall figure for all races. Hemorrhage was the
leading cause of death in Malay mothers, followed
by toxemia and medical complications. An analysis
of avoidable factors showed that antenatal care,
high parity, prejudice against hospital
confinement, and the lack of a Flying Squad
Service have contributed to some deaths.
  Source S.P Wong, Pattern of Obstetric Death
in Malay Patients in Singapore, 1968
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Why did the population decide to accept
hospitalisation?

• Push towards hospitals given the resettlement of
  the population in the main city area
• Over time, birth in hospitals became a class
  issue

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Historical Comparative Method

• Study of how past influences and shapes the
  present
• Emphasis on temporal connections, causal
  connections and comparisons with other contexts

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Robust Process(Hospitalisation in other
countries)

• Macro Level Question(How did birth move from
  home to hospitals?)?
• Path Dependency Theory (How did the governments
  policy affect this transition?)?
• Forks in the road(When did the number of
  deliveries in hospital start rapidly increase?)

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(No Transcript)
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• Primary documents
• Microfilms containing the birth records of
  midwives, Government records/files Newspapers
  Medical JournalsAnnual reports of the Maternal
  and Child Health clinics, Kandang Kerbau Hospital
  and the Ministry of Health
• Secondary DocumentsOral History Interviews
  (National Archives of Singapore)Oral History
  Interviews (self-conducted)Literature on the
  history of medical services in Singapore and
  other countries