By Francesca Chiu
On April 19, the United Nations Population Fund (UNFPA) issued its latest report on trends in world population, ranking Hong Kong as having the lowest fertility rate in the world at 0.8. That meant that, on average, every woman in Hong Kong gave birth to 0.8 children – a lower rate than both South Korea (0.9) and Singapore (1).
The Hong Kong government is well aware of the city’s falling fertility rate. Based on the government’s own demographic data, the fertility rate fell from 1.2 to about 0.8 from 2011 to 2021.
It has implemented various policies to boost fertility rate. For instance, in order to enhance the city’s fertility rate, Financial Secretary Paul Chan declared in his most recent budget that the city’s child allowance would be increased by HK$10,000. However, Hong Kong’s primary policy – a tax incentive – has done little to stop the fertility rate from falling in recent years.
One major reason for this failure is that Hong Kong’s fertility policies simply do not provide enough support to people who want to have children. There are of course societal factors, such as economic pressures, changing social structures and political stability, which directly affect people’s decisions on whether to have children.
But, for the sake of those who need help here and now, we need to pay much more attention to the medical causes of infertility and focus on providing more medical help to those who need fertility assistance in order to realize their right to reproductive health care.
Infertility is a medical condition defined as failing to conceive after 12 months or more of regular unprotected sex. The World Health Organization estimates that around one in six people globally has experienced infertility. Assisted reproduction technologies, such as artificial insemination and in vitro fertilization (IVF) are key to supporting couples who are seeking fertility assistance.
Yet such fertility services are by no means high on Hong Kong’s public health agenda. While the government does provide some subsidized fertility treatments at a few public hospitals, eligibility is restricted to married couples in which the wife must be a Hong Kong resident under the age of 40 at the time of receiving the first treatment.
And although a woman’s fertility declines with age, public patients must wait one to two years before they can even start their first treatment. In contrast, private patients can pay for immediate treatment at multiple hospitals and clinics in Hong Kong, but the obvious advantage of the public route is that IVF and other reproductive procedures are significantly subsidized.
For example, where a public patient might pay between HK$20,000 and HK$30,000 for a single IVF treatment at Queen Mary Hospital, a private patient can easily pay four or more times that amount.
This means that couples with limited financial means are faced with a painful choice between the high – and as treatments continue, increasingly unaffordable – cost of private treatment, or growing older and becoming less fertile while waiting for treatment under the public option.
But it doesn’t have to be like this, and there are a few very straightforward changes that can help minimise the needless pain and angst endured by Hongkongers who are struggling to conceive.
First, the government should revise its IVF policies to provide more than just three subsidised treatments to eligible couples, mainly because it is very common for women to need multiple rounds of IVF before they can successfully become pregnant. For example, the Japanese government provides up to six subsidised IVF treatments to eligible women under 40, and three treatments to those aged 40 to 42. Hong Kong should consider doing the same so that more women have access to the additional IVF treatments that are often necessary for success.
Furthermore, the Hong Kong government should provide subsidies to women who want to freeze their eggs to preserve their fertility for later in life. In South Korea, the government of Seoul is planning to subsidise women in their 30s who wish to freeze their eggs – on top of also providing more subsidies to couple seeking IVF and other fertility treatments.
Aside from providing more fertility services to those in need, it is also critical to teach the public about the factors that can affect fertility. An programme that educated younger women and men about how to best retain their fertility in later life would clearly be beneficial. This could include understanding how age and lifestyle choices – such as avoiding smoking or excessive alcohol consumption, and maintaining a healthy weight – can have lasting impacts on their chance of conception.
Additionally, and vitally for a city as patriarchal as Hong Kong, it is important to understand that infertility is not solely a women’s issue and to work to end the stigmas attached to the issue regardless of gender. This is another area where education programmes can help address longstanding social issues and encourage people to seek support and treatment early on when it is most effective. With greater awareness and access to resources, hopeful parents can take control of their reproductive health and increase their chances of having children.
Even though the Hong Kong government is well aware of the city’s chronically low fertility rate and its contribution to our aging society, the available support for couples who want to have children falls far short of addressing demand. And, as outlined above, this problem is compounded when would-be parents seeking subsidised aid are forced to wait for treatment.
And while it is true that IVF and other fertility treatments are time-consuming and costly on a personal level, countries around the region show how governments can afford to boost funding for the medical aid that is needed to help couples trying to conceive successfully.
In short, the Hong Kong government should expand its support to people seeking fertility treatments and deliver on its promise to tackle the city’s low birth rate.
Francesca Chiu is a PhD researcher focused on urban marginality and citizenship at the University of East Anglia and the University of Copenhagen. She is a former researcher at the Centre for Civil Society and Governance at the University of Hong Kong. Follow her on Twitter.
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