Hong Kong health care and hospitals

Hong Kong couples who lose their baby by miscarriage face an uphill struggle in an uncaring system

Miscarriages affect as many as half of all pregnancies, yet as parents grieve, many are concerned by the apparent indifference of Hong Kong’s institutions

PUBLISHED : Saturday, 14 July, 2018, 8:32am
UPDATED : Saturday, 14 July, 2018, 1:58pm

With children’s laughter ringing in the background, Mr and Mrs Chan take a deep breath as they walk hand in hand past the playground.

The stroll through the neighbourhood park has never been more painful for the couple, who recently lost their child, Wilson, to a miscarriage.

Looking back, the nightmare the pair went through in June contrasts bitterly with the elation they felt when they saw the two telltale lines appear on the pregnancy kit they used in February.

Losing their child, however, was just the first chapter of a protracted ordeal for the Chans, who declined to give their full names. Their struggle illustrates the many pitfalls awaiting bereaved couples.

As many as half of all Hong Kong pregnancies end in miscarriage, according to a study by the Hong Kong College of Family Physicians. The trend towards marrying later in life, stressful lifestyles and environmental pollution have only exacerbated the problem.

And as they navigate the emotional turmoil, these Hongkongers also have to deal with a bureaucratic health care system, outdated legislation and social stigma surrounding the issue.

Mrs Chan was 12 weeks’ pregnant when her fetus showed signs of a fatal genetic disorder, Edwards syndrome, which led to a termination.

Closure at last for couple who fought to bury fetus

After their tearful decision, the couple soon realised they were facing an uphill battle against an uncaring and outdated social system which provides little to no support for couples like the Chans.

Women whose pregnancies are terminated before 28 weeks are not entitled to maternity leave despite the pain many experience from a miscarriage. Worse still, the remains of a fetus under 24 weeks are disposed of as medical waste by public hospitals instead of released to the parents for burial. And amid the trauma, there is a dearth of support services for couples dealing with the psychological toll of losing a child.

‘My son should not be dumped as waste’

Mrs Chan recalled the moments following the procedure to end her pregnancy.

“The nurses were very friendly. They let us spend time with our little Wilson ... we were able to meet him and hold him one last time,” she said, referring to staff at Princess Margaret Hospital in Kwai Chung.

“But after that, I was told we would not be able to lay him to rest and that my son would be dumped in a rubbish bin,” Chan, in her mid-30s, said.

Their 18-week-old son was terminated six weeks shy of the 24-week mark, meaning his remains could not be released for burial under the policy followed by Hong Kong’s Hospital Authority. Exceptions are only made if the authority is satisfied parents have made adequate alternative arrangements for disposal.

The stillborn was therefore classified as clinical waste and was due to be dumped in the same way as a tumour or body tissue.

Hope for couple stuck in bureaucratic battle over attempt to bury baby

So the couple turned to a drastic option: they approached a pet crematorium, which they hoped would agree to handle their unborn child’s remains and satisfy Hospital Authority criteria.

“Having to cremate my child like this is a disgrace, but we had no other option,” Mr Chan said. “It was the best arrangement we could make.”

Mrs Chan added: “It’s not what we imagined, but we were relieved to be able to give our baby some level of dignity and respect.”

Facing the same plight were Jerry and his wife Maggie, who also declined to give their full names. The couple found themselves in search of closure following the death of their unborn son, Chi Chun, who died earlier this month at 17 weeks. They wanted a proper funeral for the boy.

“I went through sleepless nights wondering what to do. I felt I couldn’t cry because I needed to be strong for my family, so the negative emotions just bottled up inside me for weeks,” Jerry said.

Unable to find a cemetery to accept him, the pair sought help from Hong Kong’s Catholic diocese, which made an exception to the rule barring fetuses under 24 weeks by laying Chi Chun to rest at Angel Garden, a Catholic cemetery in Chai Wan.

“Just imagine: hours after the miscarriage, you’re told that the child you longed to come into the world will be thrown into a landfill,” said Maggie, a Roman Catholic.

“The process of scrambling all over town trying to find someone to agree to cremate your deceased son is so dreadful that you’re not even thinking about the physical pain you just went through.”

Frustrated couple finally get go-ahead to bury their miscarried son

At least 20 Catholic parents have turned to the church for help in the past year, and now the diocese is leading a battle against public hospitals to allow couples to reclaim their fetuses.

“To us, a baby is a living being from the moment it is conceived,” Vicar General Dominic Chan Chi-ming said.

He called for burial services to be made available for all fetuses.

“What we are asking for is a process that allows the doctors to make the call on whether the body of the unborn child can be considered for cremation. In our opinion, we think that once the embryo becomes a fetus, parents should be granted the option of burying their child,” Chan said.

He revealed that the diocese had been in touch with the Hospital Authority to discuss relaxing the rules to allow for formal cremations of miscarried babies. The two organisations are scheduled to meet next month.

No room to mourn

Still grieving and in pain, both Maggie and Mrs Chan were back at work within weeks of their ordeals.

“As much as I wish I could have stayed home to rest a bit longer, I had to go back to work because all my leave had been used up,” Mrs Chan said.

Under Hong Kong labour laws, women whose pregnancies are terminated before 28 weeks are not entitled to maternity leave.

That is unacceptable, said lawmaker Fernando Cheung Chiu-hung.

“Are pregnancies that end before 28 weeks not considered pregnancies? Having just gone through this traumatic time, mothers are only able to resort to sick leave or unpaid leave to allow them to deal with the loss of their child,” Cheung said.

“Those who don’t reach 28 weeks don’t go through any less of a painful procedure than those who miscarry when they reach their second trimester,” said the legislator, who has intervened in at least six such cases in the past.

Cecci Chan Lai-wan, an adviser with concern group Once a Mama, Always a Mama, said not allowing these women the time and room to grieve and cope with the trauma could leave mental scars or disorders such as depression.

Possible miscarriage gene is found, spurring hopes for diagnosis and remedy

It also did not help that Hong Kong society still considered miscarriage a taboo, which forced many parents to hide their emotions, she said.

“Women who suffer miscarriages are discouraged from expressing their pain because of social taboos surrounding death and human reproduction in Hong Kong,” Chan said.

“People feel giving birth is a very private issue, but it’s a common experience that should be discussed in public.”

Therapist Ava Chiu Wai-fan said expressing sadness was important.

“When these women come to me, very often they won’t even mention they lost a baby,” Chiu said. “They’ve been telling themselves, ‘miscarriage is not a big deal’, and at some point they start to believe it.”

Pain experienced by the father was also often neglected, and some turned to substance abuse, she said. As a result, miscarriages could profoundly affect marital relationships.

Hong Kong study reveals devastating impact of miscarriages

These consequences are reflected in the data. Studies from Hong Kong, Europe and the United States all indicate losing a child in pregnancy can lead to significant anxiety and depression among women and their families.

“There’s the struggle of explaining to my nine-year-old daughter why her younger sibling hasn’t come home, and also the need to take care of our parents to make sure they’re coping emotionally,” Maggie said.

“It is pain my whole family goes through.”