Cradle to the grave

PUBLISHED : Sunday, 29 May, 2011, 12:00am
UPDATED : Sunday, 29 May, 2011, 12:00am


It's a familiar story told too many times, and it has a tragic end.

An unmarried girl secretly gives birth. She is alone; one helpless child burdened with another. In this tale, it is the innocent who perishes, at the hands of the ignorant - a teenage mother.

Last year, seven cases of newborn babies killed by their young mothers were reported in Hong Kong, a significant number for a city in which the police logged 35 homicides (four of which were among the seven reported cases of infanticide) in the same period. Three of the cases involved teenagers, the most tragic conclusion to the often desperate circumstances that surround teen pregnancies.

In 2009, 126 babies were born to mothers under the age of 18, out of more than 1,300 born in the past decade. That year, 323 girls under the age of 18 obtained lawful abortions in Hong Kong, according to government figures, while countless others had terminations on the mainland.

A higher proportion of Hong Kong teens are having sex now than ever before - and starting at a younger age - but a conservative streak runs strong through the city, dominating the territory's response to an increasingly sexual teen population.

Hong Kong is a conservative city, a legacy of neo-Confucian culture combined with Christian education, says Emil Ng Man-lun, a psychiatrist who has advocated for stronger sex education here and in the mainland.

'It is more conservative than mainland China and Taiwan,' he says.

The territory doesn't mandate a standardised, compulsory course on sex education, leaving it up to principals and teachers to broach the topic in classrooms. The lack of comprehensive sex education or support services can isolate teen mothers, leading to dire consequences.

Shortly after midnight on March 31 last year, 17-year-old student Lai Choi-ying gave birth to a boy in the bathroom of her Tuen Mun flat, as her parents and elder brother slept. She says her pregnancy was known only to her boyfriend, also 17. She called him soon after the birth and they arranged to meet with another classmate at a short-stay hotel. It was a familiar rendezvous point for the young lovers.

Choi-ying wrapped the baby in a towel and placed him in her unzipped handbag before leaving. Later, when paramedics were called for help after Choi-ying began to feel unwell, the baby was found in the handbag, unconscious. He was declared dead hours after his birth.

Two weeks later, another teenager gave birth to a boy, in her 19-year-old boyfriend's flat. The 17-year-old waitress, named Cheung Yok-li, placed the baby in two black recycling bags and dumped them in a rubbish bin in Tsuen Wan in the early hours of the morning. A cleaning woman discovered the infant at about 6am. He was declared dead at about 6.30am.

In October, a girl was born to an unemployed 17-year-old in her Sai Kung flat. The teen claimed the baby had been stillborn, though preliminary autopsies suggested the infant may have lived briefly. She placed the child in a plastic bag and hid it under her bed while she called her boyfriend, a 16-year-old. The boy and a classmate carried the bag to a Fanling hillside. The baby girl was discovered and de- clared dead a few hours later.

'Every time we hear these news stories, we feel very sad. Sad because the baby lost its life, but also sad for the girls,' says Wong Yuen-ming, a social worker at Mother's Choice, a non-profit group that gives support to young pregnant women. 'The girls would have a lot of guilt and suicidal feelings. In addition, they might have to face legal responsibility.'

Choi-ying was arrested for infanticide but the coroner directed there should be no death inquest. She was released.

The three teens involved in the Sai Kung case have been released on bail while the police await legal advice.

Infanticide, which is defined as the killing of a child in the first year of its life, is most often associated with the poor and the oppressed and has been practised by many cultures, both Eastern and Western, through the ages. Culture and poverty remain powerful drivers of certain types of modern-day infanticide, particularly the phenomenon of gender selection that occurs in China, India and Pakistan.

Columbia University Professor Margaret G. Spinelli, author of the study 'Infanticide: Psychosocial and Legal Perspectives on Mothers Who Kill', divides contemporary infanticide into five categories: assisted/coerced; neglect-related; abuse-related; mental-illness-related; and neonaticide (the killing of a child within the first 24 hours of its life). The maternal characteristics identified with the first four categories of infanticide contain a varying mix of economic, social and mental-health problems.

Newborns found discarded in Hong Kong tend to be victims of different social and psychological forces and fit the neonaticide profile. Their mothers are usually single, young and of lower socioeconomic status. According to Susan Hatters-Friedman and Phillip J. Resnick, writing in the International Journal of Law and Psychiatry, perpetrators of neonaticide often live with their parents, lack prenatal care and deny or conceal their pregnancy.

'Neonaticide ... is a crime that typically involves young women who determine, correctly or not, that they would be completely cut off from their social support network were they to disclose their pregnancies,' Spinelli writes. 'For various reasons, including religion, culture, money, ambivalence and immaturity, these girls are unable or unwilling to pursue the alternatives of abortion or adoption. Denial of their pregnancy is so profound that, day after day, they ignore the impending birth of their child.'

It's difficult to know the full scale of the problem in Hong Kong - no official figures for newborn abandonment or neonaticide are available. According to a spokesman for the force, 'Police do not keep statistics on the number of dead babies found under the age of one and the number of cases on preventing the lawful burial of a body.'

Furthermore, there have been few studies carried out in Hong Kong. One of the few - a look at 35 women who killed their own children - describes the deaths of six newborns that occurred between 1971 and 1985. The women who killed their newborns were younger than the rest of the group (four of them were teenagers), unmarried and pregnant for the first time.

'The killing and abandonment of newborns is a serious medical and social problem that occurs in Hong Kong and elsewhere. The occurrence is poorly understood and no representative figures are available for reference,' Dr Anselm Lee Chi-wai commented in a 2006 Hong Kong Medical Journal article. 'Sex education, including teaching safe sex and abstinence in schools, had been strongly advocated because most neonaticidal women are teenagers.'

However, comprehensive, explicit sex education is a tough sell in Hong Kong, where it's not legally required.

'Those who are in power or running Hong Kong are the most conservative,' Ng says. 'They are not necessarily the bigger group; they are the stronger group.'

'In reality, the importance of sex education is still subsidiary, in that it is not a compulsory subject,' says Family Planning Association of Hong Kong (FPAHK) education officer Grace Lee Ming-ying, adding that the greatest problems are lack of parental and teacher engagement when it comes to sex matters. 'That's why we find that young people in Hong Kong, [in terms of] sex knowledge, are not doing very well.'

The Education Bureau offers guidance on the incorporation of sex education into school curriculums and has a limited budget for sex-education programmes. For the current school year, the bureau allocated only HK$150,000. The government spends significantly more on public campaigns on sexually transmitted diseases (STDs) and Aids. In addition to the Health Department's public campaigns on safer sex and condom use, the Council for the Aids Trust Fund, for HIV prevention programmes, received HK$100.1 million between 2004 and 2009.

With most of the decisions about sex education left to individual schools, the breadth and depth of what is taught varies widely - from teaching students how to use condoms by practising on bananas in one liberal private school to showing graphic late-term abortion videos in some Catholic schools, and everything in between. State schools often invite religious groups, sex-awareness NGOs and even private companies such as Procter & Gamble (makers of the Whisper brand of feminine products) to speak on issues of adolescent development and sex education, but, experts and advocacy groups report, abstinence-only training is still the most common.

The city's approach towards sex education is at odds with the wishes of the general population, according to a 2007 survey by the Chinese University. The study interviewed 821 people and found 67.9 per cent of respondents agreed that sex education should be a compulsory subject for all primary and secondary students. Moreover, 61.4 per cent of respondents agreed that information about condom use and contraceptive devices should be part of the curriculum.

As many schools continue to promote abstinence, however, more young people are having sex, and at an earlier age, according to the Youth Sexuality Study, which is conducted every five years by the FPAHK. The most recent study, from 2006, researched the number of high-school students engaging in sexual intercourse. That year, 13.2 per cent of boys said they had engaged in sexual intercourse, compared with 8.2 per cent in 2001. The percentage of girls having sex rose 60 per cent over the five years, from 5.2 per cent in 2001 to 8.2 per cent in 2006.

ONE TEEN WHO RECEIVED little, if any, sex education, started having sex early and had been pregnant twice by the time she was 15. The first pregnancy ended in abortion, the second ended in adoption, with the help of Mother's Choice. The girl, who asked to be called Cindy, says she knew about condoms but did not think about using them.

'A lot of my friends were having sex and it's not like I was having sex with a lot of people, so I didn't think a pregnancy would happen, but ...' she shrugs.

She stopped going to school in Form One and her father, the only person she lived with, worked during the day and did not seem to be able to control her behaviour. The first time she became pregnant, her parents took her to have an abortion.

A few months later, however, she fell pregnant again. This time, she told only her boyfriend and a few friends, because she was afraid to tell her family. The situation dragged on and she didn't seek help until she was about 26 weeks into the pregnancy, too late to legally have an abortion. During this pregnancy, she was caught taking ketamine and was assigned a social worker, who persuaded her to tell her father about the second pregnancy and went with her to break the news.

'My social worker just said it to him plainly, that I was pregnant,' she says. 'And he cried.'

She says she felt sad at his reaction but had seen her father cry many times over her problems.

Cindy is back in school: 'I thought if I get through the pregnancy, such a tough thing, I can get through anything. Nothing was harder to get through than this.'

Early-term abortion-on-demand is legal in Hong Kong and no parental approval is required, although the procedure can cost thousands of dollars. There is financial assistance available for those on welfare but, to claim it, a teen must prove they receive government assistance, which in many cases would require the involvement of parents.

Exacerbating the problems of more sexually active teens is a lack of knowledge about contraception. In the Youth Sexuality Study, more than half of the surveyed high-school students agreed with the incorrect statement, 'Chance of pregnancy is lower when a woman has sex two weeks before menstruation.' Students have much more awareness about STDs, however. The survey found at least three-quarters of all high-school students correctly answered questions about STDs.

In a survey conducted last year by the women's advocacy group Zi Teng, 20 per cent of the 471 respondents - of all ages - said they learned how to use condoms through their packaging instructions. Sixty-nine per cent answered incorrectly that it is acceptable to refit a loosened condom, and nearly half thought Vaseline petroleum jelly was suitable for use with condoms.

During a safe-sex workshop with young people, Zi Teng project officer Ann Lee encountered a doctoral student who believed a woman could fall pregnant by merely laying next to a man. And there are myriad foods and washing techniques young people 'invent' to prevent pregnancy, she says.

'It is a dangerous sign, because [young people] are more open-minded about sex and, yes, more sexually active than before,' says Ng. 'They have more sexual partners than before, they start their sex life earlier than before, but their sexual knowledge is not better than before.'

More than half of the respondents to the Zi Teng survey said they learned about the existence of condoms through the media and only 37 per cent learned about them at school. Not surprisingly, the internet has become a trove for information about sex but, online, teenagers run the risk of being exposed to unreliable sources.

'They don't know what is reliable, so they are influenced in a very confused manner by the media,' says Ng.

Ultimately, parents must be the primary sex educator, says Grace Lee. 'Most parents in Hong Kong are very busy and they are kind of conservative. They mistakenly believe that if they talk more on this subject, they're going to encourage their children to experiment with sex. They still cling onto this kind of myth,' she says.

In every case of a teen mother killing her newborn reported last year, parents and elder siblings said they were not aware of the pregnancies. And yet, the buttoned-up conservatism that dictates Hong Kong's sexual mores all but disappears in the face of a scandal. When news broke of the 'handbag baby', television cameras and photographers swarmed to the scene, filming as the teen was wheeled into the hospital. Newspapers published comic strip-style illustrations depicting the tragedy.

Ng is not surprised by the deaths of so many newborns last year. He does not see it as an anomaly, rather an indication of the increasing promiscuity of young people, coupled with a lack of knowledge about sex.

'We can expect these things to happen more and more frequently.'