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Following is a question by Hon Abraham SHEK and a written reply by the Chief Secretary for Administration, Mr Donald Tsang, in the Legislative Council today (May 21):

Question:

Regarding the low fertility rate in Hong Kong, will the Government inform this Council:

(a) as a local survey reveals that one in every six interviewees has fertility problems, whether the authorities have assessed the impact of the declining fertility rate caused by infertility on the population age structure, when projecting the future fertility rates for the formulation of the population policy; if they have, of the assessment results; if not, the reasons for that;

(b) as some medical practitioners do not consider infertility an illness and the cost of fertility treatment is relatively high, whether the authorities have assessed if the resources for fertility treatment in public hospitals are inadequate, thus discouraging those who are infertile from seeking early treatment; if they have, of the detailed results of the assessment; if the resources are assessed to be inadequate, the reasons for that; if the resources are assessed to be adequate, of the details; and

(c) as the authorities have indicated that it is not appropriate to adopt policies to promote childbirth and pointed out that the effectiveness of the pro-natalist policies to promote childbirth pursued by some countries whose fertility rates are low (but are still higher than that of Hong Kong) is not clear, whether it is the authorities' policy to not try to adjust it to improve the situation; if so, from the perspective of sustainable development, how the authorities cope with the pressures arising from the aging population in the future; if not, how the authorities will adjust the relevant policy ?

Reply:

Madam President,

(a) The population projections set out in the Report of the Task Force on Population Policy are made on the basis of certain assumptions regarding the future trends of fertility, mortality and migration. The assumptions on fertility are formulated on the basis of the trend of fertility rates of women of different ages. Although the effect of infertility has not been separately assessed, relevant factors including infertility, late marriage, preference for smaller family have been reflected in the assumptions.

(b) Infertility is a medical condition defined as the inability to conceive after 12 months of regular sexual intercourse in the absence of contraception. The causes of infertility include female factors, male factors and factors involving both partners. In a significant proportion of infertile cases, no known factor could be identified. Psychological problems are known to have ill effects on normal sex life and could lead to both female and male factors that result in infertility.

In Hong Kong, a full range of services are available in the public and private health care sectors to provide assistance and treatment to couples suffering from infertility.

At present, the 50 Maternal and Child Health Centres (MCHCs) and three Woman Health Centres (WHCs) of the Department of Health, and the Birth Control Clinics of the Family Planning Association of Hong Kong (FPAHK) provide primary care services in the form of counselling and consultation services for couples with infertility problems. These can be accessed largely on a walk-in basis. Where necessary, referral to secondary care services would be made.

In addition, all nine Obstetrics and Gynaecology (O&G) units of the Hospital Authority (HA) provide primary care in infertility on an outpatient consultation basis. Most of the units also provide secondary care services consisting of basic investigations, diagnostic tests and therapeutic treatments such as ovulation induction and gynaecological operations. The average waiting time for the first appointment is around 7 weeks. Secondary care services are also available at selected Clinics of the FPAHK with a waiting time between 2 to 12 weeks.

As such, easy and affordable access to primary and secondary care services in the public and subvented sectors should not discourage couples with infertility problems to seek treatment.

HA also provides limited tertiary and quaternary services, such as artificial insemination, microsurgery, in-vitro fertilization and intracytoplasmic sperm injection at the three Assisted Reproductive Centres located at Queen Mary Hospital, Prince of Wales Hospital and Kwong Wah Hospital.

Apart from the above, the two medical schools in the University of Hong Kong and the Chinese University of Hong Kong provide comprehensive infertility services for those who can afford to pay higher fees.

(c) We believe it is not appropriate for the Administration to promote childbirth which is a matter of individual choice. We have, however, reviewed our current policies to see if they discourage childbirth.

The Family Planning Association of Hong Kong (FPAHK) focused on birth control as its promotional theme in its early days against a background of population influx and baby boom during the 1950s and 60s. However, in view of changing economic and social circumstances and the declining fertility rate, since 1986, FPAHK has departed from that theme and introduced new services like pre-marital check up, pre-pregnancy preparation, youth healthcare etc. Our assessment is that the present activities of FPAHK are not intended to discourage childbirth.

As to Hong Kong's health care system, it can be said to have a positive effect on childbirth. Maternal mortality rate has been extremely low and ante-natal, childbirth and post-natal services are available from the Hospital Authority and the Department of Health at very low costs. The Maternal and Child Health Service of the Department of Health also provides a comprehensive range of promotional and preventive health services for women of child-bearing age and children from birth to five years old.

We have also looked at our tax system. While the differential treatment for child allowance between the first two children and the third to ninth child is unlikely to have a significant impact on the decision of a couple regarding the size of their family, the differential may not be appropriate in the light of our very low fertility rate and has been removed as from the current financial year.

In order to ensure the sustainability of our long-term development, apart from the above, we have made a number of recommendations in the Report of the Task Force on Population Policy to address our problem of low fertility and aging population.

Apart from local births, immigration from the Mainland under the One Way Permit Scheme is a major source of population growth for Hong Kong. Of the daily quota of 150, there is a sub-quota of 60 strictly for children holding Certificate of Entitlement who, though born in the Mainland, are children of Hong Kong Permanent Residents. This sub-quota will be strictly enforced.

The conditions for admitting professionals and talents from the Mainland will be relaxed and aligned with that for the admission of overseas professionals to make it more attractive to Mainland professionals. Furthermore, a new category of investment immigrants will be introduced to attract people who have the financial means to invest in Hong Kong but do not wish to run the business themselves.

Apart from measures to address the problem in terms of quantity, we have also recommended measures to improve the quality of our population: both local and new arrivals. We have invested heavily in education and training. We shall continue to pursue upgrading the general level of education for all and to promote and facilitate skills upgrading and life-long education.

On the issue of how to cope with the pressure arising from an aging population in future, we shall revisit and redefine the notion of retirement and old age and continue to develop programmes that promote active and healthy aging. We shall also develop a sustainable financial support system for the needy elderly.

End/Wednesday, May 21, 2003

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