KLE Hon, AKC Leung

Dear Editor,

January 23, 2012 marks the Chinese New year of the Dragon. The Dragon is one of the 12-year cycle of animals which appear in the Chinese zodiac related to the Chinese calendar. It is a mythical creature and the only animal that is legendary. The dragon is also a symbol of power, strength, and good luck, and traditionally symbolizes potent and auspicious powers, particularly over water, rainfall, hurricane, and floods. With these beliefs, it is expected that the childbirth rates will dramatically surge among Chinese populations.

On January 17, 2012, a paediatric doctor was accidentally smacked by a "neither nor" parent in an attempt to separate a quarrel between the "neither nor" father and a Hong Kong father at a public hospital neonatal unit in Hong Kong (http://orientaldaily.on.cc/cnt/news/20120118/00176_040.html). The police was called for to settle the dispute. "Neither nor" is a peculiar colloquial term which refers to the scenario that a baby is born in Hong Kong by Mainland parents that neither the father nor the mother is a Hong Kong citizen.^1-3

Like many Asian cities, Hong Kong is facing the millennial problem of declining population growth due to inadequate childbirths to replace the aging population.^1,3 Since 2003 when the 'visa-free' policy for tourists from Mainland China was implemented to boost the Hong Kong economy, there has been an escalating trend in the number of "neither nor" parents from different provinces of China entering Hong Kong to deliver babies that will automatically be granted Hong Kong permanent residency and entitled to the inexpensive public health coverage. This influx leads to a major surge of obstetric and neonatal workload in Hong Kong public hospitals, creating a peculiar phenomenon that the Hong Kong birthrates have nearly doubled but the actual population growth remains low.

A key consequence is that pregnant women who are permanent Hong Kong residents or Hong Kong citizens have major difficulty in getting a bed to deliver their own babies in Hong Kong.^1-3 On January 15, 2012, about 400 mothers-to-be, young couples and parents wheeling their infants in prams marched to the Hong Kong government headquarters to protest against the shortage of maternity beds and abuse of local public resources by "neither nor" parents. In response, the Hong Kong Hospital Authority will consider admitting fewer expectant women from the mainland during the Year of the Dragon. Some public hospitals have already stopped accepting advance bookings by mainlanders.

With limited resources, every health system should take care of its citizens first. It seems reasonable to stop or reduce the influx of Mainland expectant mothers so that more obstetric beds are reserved for Hong Kong mothers.^1-3 Nevertheless, the government wants to booster birth-rates. Doctors in the private sector also welcome parents from Mainland China, some of whom can afford very expensive medical expenditures. The problem seems to be inadequate facilities for Hong Kong to handle this sudden baby boom. It is debated that even if the government begins to build more hospitals and increase obstetric and neonatal facilities, the problem could not be resolved as there would be inadequate medical and nursing staff to man the facilities.

What could Hong Kong do to rectify the current desperate situation of the Year of the Dragon if immediate escalation of obstetric and neonatal supports is neither planned nor achievable? The government has been blamed for its incompetence in formulating a long-term population policy and ineffective administrative measures which have resulted in the continuing abuse of the Hong Kong medical system by mainland mothers. Mainland mothers giving birth in public hospitals have to pay about HK$40,000 for the privilege. Local women pay just HK$100 a day. The policy takes a populist stance against the practice of expectant Mainland women coming over the border to give birth. Subject to a quota, they could still pay private hospitals for obstetric services to have their babies delivered in Hong Kong. It is argued that these Mainland women do not help solve the problem of our ageing population but use medical and other social resources without making sufficient contributions in return. While their babies have permanent right of abode, it is not known when they will come to live in Hong Kong, adding a great uncertainty to planning and quality assurance for such social services as education, housing and health care in Hong Kong.

Another phenomenon is that the number of emergency births involving mothers from Mainland China almost tripled in 2011, because they had not made prior bookings and would not have been admitted to hospitals otherwise.^1-3 The Hospital Authority has warned that such births place an enormous strain on public hospital resources, and capped bookings for Mainland women to give birth at public and private hospitals at 34,400 a year and has asked Chinese authorities in Mainland China to help stop pregnant women without hospital bookings from entering Hong Kong (http://topics.scmp.com/news/hk-news-watch/article/C-Y-Leung-wants-mainland-mum-ban). Putting these plans into action has not been easy. Border baby patrols (a one doctor, one nurse team stationed at the border crossings) have been set up to physically examine women suspected of harboring a post-28 week fetus.

An expectant mother was admitted on New Year day of the Dragon and gave birth to a "neither nor" 33-week gestation 1.98-kg premature baby with respiratory distress and indeterminate genitalia, who was also found to have difficult airway and major cardiac anomalies. The cardiologist, otolaryngologist, cardiothoracic surgeon and radiologist were summoned. A team of more than 10 neonatal and nursing staff were held up in stabilising the critically ill baby in a busy neonatal ICU already occupied with many babies born of "neither nor" parents.

It is arguably if any of these policies are effective in monitoring the number of "dragon sons" and "dragon daughters" to be born. Meanwhile, Macau, a prosperous city 40-mile away and with very similar background as Hong Kong, does not seem to have this problem with the Year of the Dragon. The policy in Macau is that babies born of "neither nor" parents do not instantaneously become Macau citizens. Hong Kong may learn from her many Asian neighbours such as Singapore, Taiwan, Malaysia, Korea and Japan, where right of abode or citizenship is not instantaneous or spontaneous at birth. Any civilised city should have the responsibility and obligation to regulate immigrations. Non-citizens are welcome to apply for citizenship following birth, which may take several weeks or months. Meanwhile, any irresponsible acts of unscheduled or emergency births in Hong Kong will mean spontaneous sacrifice of this right of application.

References

1. Cheng MH. Hong Kong attempts to reduce influx of pregnant Chinese. Lancet 2007;369:981-2.

2. Juk JY, Wong S. Obstetrical Outcomes among Non-local Chinese Pregnant Women in Hong Kong. Hong Kong J Gynaecol Obstet Midwifery 2009;9:9-15.

3. Yam B. Cross-border Childbirth between Mainland China and Hong Kong: Social Pressures and Policy Outcomes. PORTAL J Multidisciplinary International Studies 2011;8:1-13.