Shenzhen abortions hold high risks for Hong Kong women
Hong Kong women head to the mainland for quick, cheap and anonymous termination of pregnancy, while mainland mums come here to give birth
The many economical and ecological benefits to using human excrement and urine as fertiliser are not to be sniffed at. Fred Pearce gets to grips with a sorely underused resource.
While pregnant women from the mainland have flocked to Hong Kong to give birth at the city's top-notch hospitals, thousands of pregnant Hongkongers are making the reverse journey - for a rather different reason.
They are women who want an abortion but have slipped through the net of the Hong Kong system. They are forced to turn to substandard facilities across the border because of public hospitals' reluctance to provide abortions, sky-high prices in the private sector, and the fact that the Family Planning Association can only perform abortions in the first 10 weeks of pregnancy. Poor knowledge about sex and contraception worsen the problem.
The number of women affected remains unclear, but surveys have suggested that more than a third of Hong Kong women who have an abortion each year do so on the mainland. The problem could worsen with the forced closure in September of the non-profit Hong Kong Central Hospital, which performed 40 per cent of abortions in the city .
Those crossing the border are often the most vulnerable: poor, young women who cannot afford an abortion in Hong Kong or who seek the anonymity of an operation across the border to hide their pregnancies from their parents - girls as young as 12 or 14, taken over the border for the cheap price and ease of obtaining an operation.
But in exchange for that ease, that anonymity, that price, they take on the risk of infection, infertility and trauma, with non-existent psychological support for dealing with post-abortion blues. Conditions in the best hospitals over the border are below those of even the most burdened public hospitals in Hong Kong.
The South China Morning Post found poor conditions even in hospitals with ties to well-known Hong Kong institutions. At the Peking University Hospital Shenzhen, the in-patient obstetrics and gynaecology wards were overcrowded, dark and dank.
Several women shared each room, with no curtains separating them. The walls of the ward were coated with grey, dark stains and looked in need of a paint job. There was no smell of antiseptic in the air. Patient beds spilled out of the rooms into the hallways. A woman who looked as though she had come out of major surgery lay hooked up to a machine monitoring her vital signs that any of the children running helter-skelter around the circular hallway could easily knock over.
"Everywhere in Shenzhen is busy and crowded, there is no quiet place to get an abortion," said an older woman doctor in the hospital's out-patient Ob-Gyn. In the 20 minutes the Post had waited to see her, the doctor had been through four rounds of patients. One patient's companion had come out of her room and spat in the hallway.
This is a hospital currently collaborating in medical research with the Hong Kong University of Science and Technology, and considered one of the best medical facilities in Shenzhen.
"We do around 20 abortions a day at our facility," said the nurse in charge of the reception desk for the hospital's abortion clinic, which conducts abortions for women less than 10 weeks pregnant.
Women further into their term have to be admitted to the inpatient department. At the clinic, the fee for abortions is around 800 yuan (HK$1,000). The price can go up to about 3,000 yuan if patients are admitted.
The price, the nurse said, was set by the government and was the same at any public hospital in Guangdong province.
While the operating theatre at the clinic looked well-maintained and clean, there was little privacy afforded during the procedure: two beds were almost side by side with no barrier in sight.
The Post visited two other facilities. One, the Luohu hospital, offered a medical abortion for 3,500 to 4,000 yuan. There, a woman would need to stay for four to five days in a crowded, dark and dirty ward, taking pills for three days to gradually bleed out the fetus. This was the safest way, the nurse said.
At another facility, the private Taihe Women's Hospital, the facilities from the outside looked clean, and the waiting area resembled a massage parlour, but the abortion would only take "two minutes", according to the doctor, who would not quote a price. The benefit here would be that the whole procedure would be done under anaesthesia.
The Peking University hospital doctor said her hospital would not provide such a service, though a nurse later said it would be possible for an extra 500 yuan.
The conditions were better and more sanitary even at Hong Kong's most strained hospitals, such as Tuen Mun Hospital, where the waiting list for some other medical procedures stretches to 2017.
The comments of the doctors also alarmed family planning professionals in Hong Kong.
"I guess that price is what accounts for the standard of what you're seeing - or lack of standard," said Susan Fan, director of the Family Planning Association, adding that a typical operation for an early-term abortion in Hong Kong would take around 15 minutes.
Fan and her colleague, Professor Paul Yip, said they understood one of the reasons young women went to Shenzhen was the anonymity. But they stressed that Hong Kong's policy of requiring approval for an abortion from two doctors was a necessary safeguard. It is a way for young women to be more informed about the choice she is about to make, a way to protect a girl from making a decision she will regret. "To have sex is not something wrong or right," Yip said.
It is difficult to say how many Hong Kong women are going over the border to get an abortion. An unmarried woman less than 14 weeks pregnant need not show any identification to get an abortion on the mainland, let alone be required say where she is from. But the number of Hong Kong women seeking abortions on the mainland is not small, if statistics and estimates last year by the consultancy Bain and Company for the organisation Mother's Choice are anything to go by.
Based on data provided by Mother's Choice and health care providers, an estimated 7,000 women each year faced crisis pregnancies.
"That [going across the border] happens a lot, especially among the population we serve," says Alia Marwah-Eyres, chief executive of Mother's Choice, which supports young women who go through crisis pregnancies. "All I can tell is that the number of phone calls we are getting is going up, certainly not abating. I can't imagine the number of abortions for Hong Kong is going down."
Marwah-Eyres says unlike in the West, abortion is considered the best and often only option for a pregnant young girl.
It is a trend supported by data from sexuality surveys conducted by the Family Planning Association, says Professor Yip who has been conducting such surveys for more than a decade.
Though the sample is small, with fewer than 100 young women saying they have had an abortion, 37 per cent of young women who had an abortion in last year's Youth Sexuality Survey said they had gone to the mainland for the procedure, up from 24 per cent in 2006. More than four in 10 of the 311 women interviewed in a 2007 household survey by the association said they had had a termination on the mainland.
The number of legal terminations recorded in Hong Kong has gone down from more than 20,000 in 2001, to around 11,000 in 2010.
Yip considers this an indication the trade has moved across the border, though some of the decrease is attributed to better awareness of contraception.
But more still needs to be done. "Parents aren't talking about it at home, teachers are very embarrassed and nobody's ever taught them, so they don't know how to deal with it, so sex education is maybe limited to one hour of a student's whole secondary schooling and we talk about purely scientific terms, and so they get their information from their friends or the internet, and the things that they think would just boggle your mind," said Marwah-Eyres.
"You would be shocked at the things we found out through this Bain and Company study.
"There were many misconceptions - like you can't get pregnant the first time you have sex. I can tell you we have huge numbers of girls who've only had sex once, and lo and behold, they come to us. They're 13 and they're pregnant."
There are also a number of misconceptions about abortions in Hong Kong that can lead to women seeking abortions across the border.
Some women are unaware abortions are legal in Hong Kong and others think lines at the Family Planning Association are too long to wait in.
Some are not aware that obtaining two doctors' approval should not be difficult, with financial and mental stress considered sufficient grounds. They are also unaware that costs at a Hong Kong public hospital can be lower than those over the border.
Here, women pay a HK$50 admission fee and then HK$100 for each day they spend in hospital. But there is a downside: patients must meet "strict criteria" that can be difficult to prove, a spokeswoman for the Hospital Authority said earlier this year.
Fan, of the Family Planning Association, says it is likely to be a case of strained resources. "I can understand hospitals saying, 'We'd rather treat a cancer patient than perform abortions.'"
For the past five years, public hospitals have only performed 500 or so abortions each year. There are other barriers, with the Family Planning Association only carrying out early-term abortions and charging HK$3,000 for Hong Kong residents, while abortions at the four private hospitals that provide the service cost at least HK$14,000.
The closure of the non-profit Hong Kong Central Hospital in September has further complicated the issue, as the city lost a hospital which carried out about 5,000 abortions yearly, or roughly 40 per cent of all abortions in the city. The price that hospital charged was HK$8,000.
"I'd like to know what's happening to our patients," said Wendy Tam, the former executive manager at Central Hospital.
She said former staff were looking to media reports for answers.
It is something the government is also unaware of, despite the Post and women's groups pointing out in July that the controversial closure, which came about when the Anglican diocese ended the hospital's lease, might force women to turn to illegal clinics or substandard facilities.
While the government is required to keep abortion statistics, a Department of Health spokesman said it had more important things to do than track numbers.
He did not know if those who would have used the Central Hospital had migrated to other private hospitals or to the public system.
To be fair, the public health system is pushed.
But even without knowing the exact numbers it is possible for the health system to aid these women and understand what it is that makes them cross the border.
Fan encourages public hospitals, which perform around 500 operations a year, to accept more patients, but acknowledges many of them are strained for resources and time.