Reproductive rights: laws and access to abortion - Interview with Ruby Lai

The current situation in East Asia constitutes a differential spectrum of legal rights and practice. In Japan, Taiwan and South Korea, females still have to obtain spousal authorisation before getting an abortion legally. In Hong Kong the laws allow females aged 16-18 to have sexual activities, but they need parental consent for abortions. Gestational (pregnancy duration) limits exist for abortions almost everywhere, usually ranging from 10 to 24 weeks. Access to safe medical care at ease depends on social class and ethnicities, and sometimes young girls find medical care workers in public or religious institutions giving them judgemental and traumatic experiences. Females in need of abortions sometimes would rather choose to undergo across the border to get the surgery they need, adding uncertainties to post-abortion care and recovery. Dr Ruby Lai, who has researched the topic extensively, spoke to us about her viewpoints on Hong Kong’s situation as compared to East Asia, and her policy recommendations.

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For women eligible for legal abortion in Hong Kong, access to medical services may be hindered by gestational duration, waiting time in public sector, costs in private sector, and judgemental attitudes from conservative healthcare workers.

Q: Is abortion a cultural taboo, how do communities in HK / neighbouring regions react to females seeking abortions?

Unfortunately, abortion is still taboo in Hong Kong. Under the strong influence of Christianity and other religious doctrines such as Buddhism, abortion is equated to killing, which is a sinful and immoral deed. Conservative gender ideologies still place a high value on women’s sexual conduct; women who have had an abortion are often stigmatized as irresponsible and morally improper or even described derogatorily as “broken shoes,” damaged by abortion. Given the heavy stigma attached to abortion, it is common for women to face condemnation and judgmental attitudes when seeking abortion services. Most women who have had an abortion will conceal their experiences to avoid blame from their social circle and society.

Q: What are the current Hong Kong laws on reproductive rights? Under what circumstances can a female decide to continue / terminate her pregnancy?

A: Abortion was legalised in Hong Kong in 1976. According to Section 47A of the Offences Against the Person Ordinance (Cap. 212), if the pregnancy threatens the physical or mental health of the pregnant woman, such as rape and incest, or if it may result in foetal impairment, an individual may undergo abortion surgery at a designated hospital or clinic with the consent of two registered medical practitioners. However, the procedure cannot be performed after 24 weeks of pregnancy unless it is a necessary procedure to save the pregnant woman's life. Parental consent is required for women under the age of 18.

The abortion law in Hong Kong is relatively flexible compared to some of its East Asian counterparts. For example, spousal authorization is not required in Hong Kong, but it is mandatory in Japan, Taiwan, and South Korea. Among the East Asian countries, China and Singapore have the most lenient abortion policy, which permits abortion on request based on various gestational limits. In Singapore, the limit is 24 weeks; in China, the gestational limit varies across different provinces.

Q: What factors impact access to medical care? (Public vs. private medical services, social class, marriage status, age, race)

A: The first factor is the institutional context, which refers to the differential access to abortion services. In Hong Kong, there are currently 19 public and private hospitals and clinics providing legal abortions. While the clinics operated by the Family Planning Association (FPA) do offer abortion services, their services are only available for pregnancies up to 10 weeks. Therefore, pregnant women cannot obtain an abortion at the FPAHK's clinics if they have exceeded the time limit. Apart from FPA's clinics, public hospitals also provide abortion, but the access is extremely limited, and women often have to wait for a few months before obtaining the procedures, which would exert a heavier physical and mental burden on the pregnant women. In contrast, private hospitals provide timely abortions, but they are unaffordable for younger women or those with limited financial resources.

Besides, access to quality abortion care is often stratified along the division of class, race, and age. Individuals' social position will significantly affect her access to a safe and timely abortion. For example, those who are financially capable can afford private abortion services and avoid lengthy waiting times, while those with limited financial resources may have to wait for two to three months when obtaining public abortion services. Once the pregnancy exceeds the 14th week, doctors may need to induce labour to terminate a pregnancy, which may increase the amount of physical and psychological burden on the women. Currently, abortion services in private hospitals cost about HK$20,000-30,000 (USD 2,580K-3,870), which is considerably higher than in public hospitals and FPA clinics, which cost a few hundred dollars (USD 100-500), respectively. Some women have to borrow money from their friends and relatives for obtaining the procedures; others even travel to Mainland China for a cheap and timely abortion. That may be risky because they are not familiar with the healthcare system on the mainland, and it can complicate the process of post-abortion recovery.

Apart from financial factors, the age and marital status of the pregnant women may also play a role. Some teenagers or young people in their early 20s often faced judgement from healthcare workers when obtaining an abortion. This stigma often increases the young women's psychological pressure or even traumatizes them.

Moreover, ethnic minorities in Hong Kong may encounter more obstacles when obtaining abortion due to language barriers, insufficient information, and the lack of cultural sensitivity of the healthcare workers.

Q: How does the Covid situation in 2020-21 influence the above scenarios?

A: Local media reported that the number of abortions has increased during the Covid-19 pandemic because many people have lost their jobs and are worried about future uncertainties. Unfortunately, Covid-19 has significantly hampered access to affordable and timely abortion. During the pandemic, the Hospital Authority had adjusted the non-emergency services provided by public hospitals to combat the epidemic, and therefore abortion services were suspended. Pregnant women were forced to seek abortions in private hospitals, which significantly increased their financial burden. Worse still, pregnant women can no longer obtain an abortion in mainland China due to the quarantine requirements and other health regulations. Some women have to seek backstreet services or resort to self-induced abortion. Some social workers expressed their worries that young girls who cannot obtain timely abortions may be forced to carry an unwanted pregnancy to term.

Q: What is your opinion on current laws and access to services? How are they perceived by civil society?

A: Even though abortion is legal in Hong Kong, access to patient-centred abortion services is still limited. The government has always emphasized that abortion service is widely available in public hospitals but some women's rights groups reflected that, in practice, only two or three public hospitals actually provide abortion services. These NGOs have asked the government to shorten wait times for abortion and to provide more support to facilitate effective access to timely and affordable abortion.

Q: What reform would you recommend to make the above more inclusive / progressive?

A: It is the responsibility of the government to guarantee safe, timely, and affordable access to abortion as it is essential for women's physical and psychological well-being. The government should maintain abortion services during the epidemic because abortion should be conducted in a timely manner. Access to abortion in public hospitals should be expanded to shorten the waiting time. Hospital authorities should provide more information regarding different types of abortion services and translate them into different languages to cater to the needs of people with different cultural and ethnic backgrounds.

Related articles:

India: A flawed right to safe abortion in India: What more can we do?

ASEAN: Women’s Bodies, Women’s Choice? Reproductive Rights in Southeast Asia

This Interview was first published by the Böll Office in Hong Kong.