Are illegal abortions in Hong Kong related to ‘class problem’?
High costs for private hospitals and stretched public health services blamed for women turning to black market or mainland to seek help over unwanted pregnancies
Increasing numbers of Hong Kong women are risking their lives by seeking illegal abortions at makeshift clinics in the city or on the mainland, an issue which a local lawmaker has condemned as a huge “class problem”.
Speaking to City Weekend after two women were jailed for carrying out illegal abortions in Hong Kong, Shiu Ka-chun, who represents the social welfare sector in the Legislative Council, said Hong Kong’s overburdened public hospitals meant not all pregnant women could get an abortion even if they were eligible. This forced them to resort to dangerous means out of desperation, he added.
In Hong Kong, abortions are legally performed in public and private hospitals, if two doctors agree that the pregnancy endangers the life of the mother. Women under 18 years of age generally require parental consent for the procedure.
Since 2011, Hong Kong has seen a 17 per cent drop in abortion rates, although the figure only applies to legal procedures. According to a Legco document, the number of cases dropped from 11,864 in 2011 to 9,890 in 2015. Most were women aged between 25 and 34.
The most significant drop during this four-year period was between 2012 – the year of Central Hospital’s closure – and 2013, when there were 645 fewer cases. The private hospital was the city’s largest provider of abortions – up to 60 per cent of total cases – and had operated for 46 years, offering low-cost services to patients who could not afford private care elsewhere.
A 2012 study by the non-profit Family Planning Association of Hong Kong showed more than 40 per cent of the 61 women polled had previously had abortions, and among them, 37 per cent terminated their pregnancies in mainland China, while another 23 per cent did so illegally in the city.
Shiu suggested the numbers reflected that more young women were opting for illegal procedures in the city, or went across the border to do so.
He did not comment on whether this trend could also be explained by women taking greater precautions to prevent pregnancies.
Abortion is legal in mainland China where the government has adopted a “don't-ask policy”, which has allowed hospitals and unregulated clinics to capitalise on desperate women who are out of options.
In Hong Kong, Shiu said some public hospitals did not prioritise abortions because of stretched resources.
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“If you ask me why pregnant women in Hong Kong choose to risk their lives and go to public housing flats for abortions, I would say: it all comes down to money, and it’s a class problem,” he said.
His comments came after two women – Li Shuk-fan, 75, and Lo Wun-yi, 65 – were last week jailed at the High Court for carrying out illegal abortions in a 300 sq ft public housing flat in Lam Tin in 2014.
Li, who claimed to have 30 years of experience as an “obstetrician” in mainland China, used a pressure cooker to sterilise surgical instruments and was sentenced to 17 months’ jail. Lo, a registered Chinese medicine practitioner who referred patients to Li, was jailed for 10 months.
Shiu said the shocking case further shed light on the hidden trend of illegal abortions, where women would rather turn to the black market than wait for up to 10 days to obtain a legal procedure from a public hospital, with private hospital fees being too high for most to afford.
Lam Po-yee, executive director of Teen’s Key, a non-profit organisation in Hong Kong, agreed with Shiu that Central Hospital’s closure had driven low-income pregnant women to clinics in mainland China as well as the local black market.
She said her organisation, which receives at least 20 inquiries related to unplanned pregnancies each month, was concerned about the difficulties in accessing services for legal abortions in Hong Kong.
“The way the regulations are implemented in Hong Kong very much depends on the doctors’ perspectives and assessments,” she said.
“We understand some doctors have declined to offer abortions because of their religious views.”
Dr Joseph Chan Woon-tong, a specialist in obstetrics and gynaecology at the Hong Kong Sanatorium and Hospital, said he was aware of such cases.
But Chan, who is Christian, said patients could always be referred to other doctors who would be willing to carry out the procedure. He added he had gone ahead with most of the abortion cases he had received as long as they were eligible.
In Hong Kong, public hospitals that provide obstetrics and gynaecology services, three private hospitals and Family Planning Association clinics can perform abortions.
Inquiries by City Weekend with four private clinics and hospitals in Hong Kong showed that there were pre-procedure costs of between HK$800 and HK$1,200. For women who are under 18 years of age, consent from a parent or guardian is required.
One private hospital said that a referral letter from the Family Planning Association of Hong Kong was required for a discounted rate of HK$22,000 for the procedure. The full fee was between HK$30,000 and HK$40,000.
Another check with three hospitals in Shenzhen showed that two could perform the abortion without parental consent for women under 18. Only one required approval.
Costs ranged from 980 yuan (HK$1,200) to 2,880 yuan, according to the hospitals. One even offered a discount of up to 800 yuan for a 2,000 yuan procedure, including free shuttle bus service, to holders of student ID cards.
The costs cited from such hospitals in mainland China are significantly lower than those in private Hong Kong institutions. Local public hospitals also charge a HK$75 admission fee and HK$120 inpatient fee per day.
Booking an appointment for an abortion could be done within minutes with any of the three mainland hospitals through their websites or by Whatsapp and WeChat.
Lam from Teen’s Key said the convenience and low costs of getting an abortion in mainland China were “extremely tempting” to many young Hong Kong women with unwanted pregnancies.
But Family Planning Association executive director Dr Susan Fan Yun-sun questioned why local women would want to risk their lives with illegal abortions when her organisation could provide legal and relatively affordable services for HK$3,500.
Fan insisted her association was ethically neutral on abortion, so consultants would not put pressure on pregnant women to change their minds.
But she said consultants would ask women to “consider seriously” before making a decision.
“We are responsible to explain all risks,” she said.
In response to suggestions that it was increasingly difficult for local women to obtain abortions at public hospitals, a Hospital Authority spokesman said public hospitals which provide obstetrics and gynaecology services could perform abortions in accordance with the law on any women who were less than 24 weeks’ pregnant.
Additional Reporting by Rachel Blundy
How other Asian countries deal with abortion:
Abortions are permitted for citizens who want the option and are 24 weeks pregnant. Beyond this mark, the procedure is allowed only if the pregnancy endangers the mother’s life.
There is no minimum age requirement for women to be eligible for an abortion, and obtaining parental consent is not a legal requirement.
A foreigner is eligible if she has been residing in Singapore for at least four months or is married to a Singaporean.
After a consultation with a doctor, women who want to have an abortion must have counselling.
Patients must also sign a declaration giving marital status, educational level, and number of living children. They will normally undergo post-abortion counselling.
Abortions cost between S$800 (HK$4,600) to S$5,000 depending on whether a public or private hospital is used.
The number of abortions in Singapore fell from 12,318 in 2009 to 10,624 in 2012, according to latest available government figures.
Abortion is only legal if a doctor decides a pregnant woman has mental health issues, has been raped or became pregnant through an incestuous relationship or if there is a risk of significant negative psychological impact to the mother if the baby is born.
The pregnant woman must also obtain the permission of her husband, unless he is not considered to be mentally fit enough to give his consent.
Unmarried pregnant women aged under 20 must seek the permission of their parents.
Women who seek an illegal abortion face up to six months in prison, while those assisting her for monetary gain may face up to five years’ imprisonment.
The mifepristone “abortion” pill (also known as RU486 ), which can be taken 49 days after a woman’s last menstruation, is legally available.
Doctors estimate as many as 400,000 women took the pill in 2015, out of the 500,000 abortions that year. Most of these abortions were second pregnancies.
Abortion is only legal if it is considered necessary for the sake of the woman’s health or if she becomes pregnant as a result of a criminal offence.
Women are not permitted to have an abortion for economic or social reasons or if the child is likely to be born with a disability.
But according to the UN, the country’s abortion law is not rigorously enforced. Illegal abortions are common, even though women in such cases face up to three years in prison, while those helping can be jailed for five years.
There have been thousands of cases in which an aborted fetus is dumped on the premises of a Buddhist temple by an illegal abortion clinic.
Doctors estimate as many as 300,000 illegal abortions are carried out each year.