Illustration by Rose Wong

In Hong Kong, Accessing Abortion Is Difficult, Expensive, and Dangerous

Legal restrictions, overcrowded public hospitals, and steep private clinic prices often prevent young women in Hong Kong from terminating their pregnancies safely. For many, the only viable option is to cross the border into mainland China, where a...

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Nov 14 2016, 3:35pm

Illustration by Rose Wong

When Tina was 15 years old, she was on a break between classes at her high school in Hong Kong—just like any other day. As she sat with her friends at their desks, the skirt of her school uniform was suddenly drenched in blood. Her girlfriends pointed to the floor, where there was more blood under her seat. That morning, Tina had taken pills to terminate her second unwanted pregnancy—her boyfriend got them from an illegal clinic not far from her school. But no one told her what would happen next.

This story is an all too familiar one in Hong Kong, yet it's not widely talked about—nor often reported. In the city, there's frequently a long road ahead for women who want to terminate their unwanted pregnancies, with few places to turn.

Read more: Abortion Is Legal in Italy, but It's Almost Impossible to Get One

While a public hospital in Hong Kong will perform an abortion at up to 24 weeks of gestation, long waiting lists and the city's notorious medical staff shortages can make it nearly impossible to get an appointment, a problem that's exacerbated during periods of high demand, such as cold and flu season. But there are also basic legal barriers: Hong Kong's abortion law states that, for an abortion procedure, two doctors must sign off that the birth of the baby would cause a female patient severe mental or physical harm, or that the baby would be born seriously handicapped. Private hospitals offer abortions without nearly as much red tape, and appointments are more immediate, but advocates say the procedure there can run as much as $2,000 and up. In 2012, the most affordable private hospital in the city—Hong Kong Central Hospital—closed. According to a South China Morning Post article from that year, it had provided a large percentage of the abortions in the city.

"The government doesn't have an official reason to oppose abortion. But they don't support it, so what they do is ignore it," said Bowie Lam, who runs Teen's Key, an organization dedicated to supporting young women in vulnerable situations. "If four out of eight doctors oppose abortion at a hospital, for example, the hospital will just shut down services, and the government leaves it."

When I reached out the Hospital Authority—the government department that runs public hospitals—for information on how it planned to reduce the waiting list for abortions, the spokesperson declined to answer. Instead, the spokesperson noted that in Hong Kong, abortion is not allowed simply by a woman's personal choice.

An office of the Family Planning Association of Hong Kong. Photo via Wikimedia Commons

The Family Planning Association of Hong Kong, an independent NGO, exists to help women get easier access to abortions and pick up the slack for the city's overloaded hospitals. While women seeking the procedure still have to go through the same legal channels and receive two doctors' signatures, the FPA will perform on-site abortions for women who are up to 10 weeks pregnant. It also runs centers that offer specialized counseling for unmarried women under 26.

"We will not be judgmental and say, 'You're only a teenager—why are you having sex?'" Dr. Susan Fan, the FPA's executive director, told me in a conference room at the facility. The building is clean and comfortable, and it looks much more like offices than a hospital. But while the FPA is a good solution for some women, they offer limited support to those with more complicated situations. "We are sort of selective. So the client comes to us and if her gestation is already advanced, or if she already has other medical problems...then we need to refer her to a hospital," Fan said.

If an unmarried woman under 26 comes to the FPA in the early weeks of pregnancy, Fan says, she will move through mandatory counseling with a social worker before the abortion, which can be done medically—through pills—or surgically, through dilation and curettage (D&C). According to a spokesperson for the organization, the FPA performed 3,155 abortions last year.

"Abortion is a tricky thing; it's something we don't really want to keep doing more of," Fan told me. "Because obviously if people are practicing contraception well, they wouldn't need to come to [get an] abortion." While the association facilitates abortions, that's not its focus—preventing unplanned pregnancies is.

In Hong Kong, it's not abortion on demand. We cannot just say, 'OK, do you want an abortion? Fine. Which date?'

In Hong Kong, discussions about basic sexual education are still shrouded in stigma and shame—and for the many young women who find themselves with accidental pregnancies, the city is a far cry from pro-choice.

Carla, whom I met at Teen's Key, never had an illegal abortion—both of the procedures she underwent were legal, yet still difficult. She grew up in a wealthy family that sent her to an international school where she was never taught sex education. A counselor at the FPA tried to tell Carla about contraceptives after her first abortion, but Carla and the counselor didn't connect. Two years later, Carla found herself with another unwanted pregnancy.

"I ignored her suggestions—I don't think the counselor was effective," Carla said. "It wasn't counseling—she just came in and gave me information about contraception." When, working as a youth counselor at a local church, Carla found herself with an unwanted pregnancy again, she hadn't even considered using contraception with her sexual partners.

Tina had similar experiences with social workers in Hong Kong. "I was exposed to a lot of social workers growing up," she told me. "Girls like me are afraid of them—sometimes, we know they're nice, but they act more like parents and have the assumption that we're bad."

Tina says she's heard from her friends that counselors at the FPA are more likely to scold girls for getting pregnant than to counsel them. The FPA denied my request to interview any of its counselors working with unmarried women under 26.

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Meanwhile, some liberal, fully pro-choice support—while sparse—is out there. Lam's NGO, Teen's Key, has a new program supporting girls with unwanted pregnancies and new young mothers. She introduced me to Tina at her tiny office—a converted studio apartment in a gritty walk-up building across the harbor from Hong Kong's central financial district, in Kowloon.

Tina never approached the FPA because, at the time of her first pregnancy, when she was 15, her boyfriend was 21—she feared they'd have him arrested for statutory rape. When she got pregnant, she heard through word of mouth that the black market for abortion—clinics that open, close, and constantly move—operated in Kowloon's Mong Kok neighborhood, famous for its thriving red-light district and neon-soaked shopping streets. Her friends told her to search the streets for flyers stuck to office buildings that read "GYN." Tina would find them, and then send a text message to the listed number on the flyer. On her seventh try, a doctor replied that he'd perform a surgical abortion for her.

She met the doctor at the clinic the next day, and the surroundings seemed normal to her—the office was clean and located upstairs in a commercial office building. The doctor admonished her boyfriend, who had accompanied her, for getting Tina pregnant so young. Tina remembers that the doctor was kind and professional, and others in the waiting room were also there for black market abortions. "I met a domestic helper from the Philippines trying to negotiate a price—she had unsafe sex with a foreigner," Tina recalled. The procedure cost just under $400—similar to what an abortion through the FPA costs—and her boyfriend paid.

The government doesn't have an official reason to oppose abortion. But they don't support it, so what they do is ignore it.

The next time, though—a year later—Tina wasn't so lucky. Although she started taking birth control, she still got pregnant. Her boyfriend refused to pay $400 for a surgical abortion again, and he went to another illegal clinic to find pills to abort the fetus. They cost about $200. After Tina took them the morning before school, she found herself not only a social pariah—where "gossip spread to every corner," she says—but afraid of the law, since she had undergone an abortion illegally, which in Hong Kong can result in fines or imprisonment. "After school, I had to convince the doctor that I had a heavy period, and that this was normal," she said.

As is the case in countries where abortion is illegal or heavily restricted, other young women in Hong Kong buy misoprostol, a drug used to prevent stomach ulcers, to induce a miscarriage; in a clinical setting, misoprostol is administered with mifepristone for a medical abortion. But although misoprostol is widely available in pharmacies around the world, it still carries risks, particularly when taken incorrectly. One of the girls Lam worked with took so many pills that she overdosed and had to be hospitalized. Her parents brought her to a private hospital, where they played it off as a suicide attempt to avoid legal troubles.

Hong Kong's Mong Kok neighborhood. Photo via Wikimedia Commons

For many other girls who find themselves in Tina's situation—both unable to approach the FPA because they're either over 10 weeks pregnant or afraid of being punished, and unable get an appointment at a public hospital or afford a private hospital—crossing the border into mainland China becomes one of the next options. It's a dangerous one: About two hours away by train from Hong Kong's central financial district, Shenzhen is home to many dark, dirty hospitals and unlicensed clinics that offer cheap abortions. Abortions there can cost as little as $50 and rarely exceed $250.

The mainland—which has a different legal system from Hong Kong—makes abortion easy. In fact, according to data from 2015, China performs about 13 million abortions per year, and that number does not include abortions performed at unlicensed clinics.

Decades of the one-child policy—which ended in 2015 but still has demonstrative effects—made abortion acceptable and common on the mainland, such that it never became stigmatized the way it is in Hong Kong. (The government also engaged in forced abortions during the 35 years the policy was in effect.) Also, China, unlike Hong Kong, is a communist state—which means it doesn't have the same Christian values as the semi-autonomous city. Although only 5 percent of the city's population is Catholic, many of Hong Kong's hospitals, schools, and charities are funded by the church.

Read more: What Women Do When They Can't Afford an Abortion

Women in Hong Kong began to cross the border into mainland China for cheap and quick abortions started in the late 1980s. Lam says she worked with one young woman who needed an abortion in February—peak flu season—and couldn't afford the $2,320 bill an available private hospital would charge her. She was past 10 weeks and she couldn't go to the FPA, so Teen's Key suggested she go to a clinic in Shenzhen, and they accompanied her to ensure her safety. Lam remembers the walls and the beds were covered in stains, and that the doctor refused to explain anything about the procedure. The clinic was tucked away in a commercial building; girls as young as 14 sat in the waiting area.

"This clinic was the only option for her," says Lam. The abortion was a success, without complications.

Lam worked with another girl who was turned down by the FPA because, although her pregnancy was under 10 weeks, she was a meth user—presenting a medical complication. Her mother escorted her to a large public hospital in Shenzhen, where she paid $250 for a successful abortion.

While these procedures ended successfully, clinics in Shenzhen can be terrifying. Tales of girls coming back bleeding, infected, and still pregnant abound today. It's not uncommon to search for abortion clinics in Chinese, and find a clinic that looks nothing like the way it was advertised online. One 17-year-old girl who worked with Lam found a clinic online and set out for Shenzhen. The doctor woke her up in the middle of her abortion and demanded she pay more money—or the doctor would leave her.

"In Hong Kong, it's not abortion on demand," the FPA's Dr. Fan said. "We cannot just say, 'OK, do you want an abortion? Fine. Which date?'"