LCQ5: Assisted reproductive services
17.5.2023

Following is a question by the Hon Elizabeth Quat and a reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (May 17): Question: It is learnt that the birth rate in Hong Kong continues to drop, with the total fertility rate falling to 0.77 in 2021, which is among the lowest in the world. There are views pointing out that assisted reproductive services may increase the aspirations of members of the public for childbearing. In this connection, will the Government inform this Council: (1) whether it will consider afresh introducing measures to boost the fertility rate within a short time, such as directly providing subsidies for child-rearing, increasing child-minding services and strengthening family-friendly working arrangements; (2) given that the median age of women at first childbirth in Hong Kong increased from 29.4 in 2001 to 32.6 in 2021, whether the Government will study the provision of centralised oocyte cryopreservation service for women in Hong Kong, so that patients and women marrying late can have their eggs frozen and preserved as early as possible for future use, thereby increasing their chances of childbearing; if so, of the details; if not, the reasons for that; and (3) given that Queen Mary Hospital, Prince of Wales Hospital and Kwong Wah Hospital currently offer in-vitro fertilisation (IVF) clinic or subfertility assessment clinic services, and they also provide IVF treatment services, but it is learnt that the longest waiting time for such services is 10-odd months, while the waiting time for the relevant private healthcare services is extremely long and the fees charged are often more than $100,000, whether the Government will introduce measures, such as increasing the quotas for the relevant public healthcare services or providing subsidies to those who use private healthcare services; if so, of the details; if not, the reasons for that? Reply: President, Birthrate and wish for child-bearing are part of population policy issues, specific initiatives of which concern a wide range of policy aspects and bureaux, including the Labour and Welfare Bureau (LWB), the Home and Youth Affairs Bureau (HYAB), the Education Bureau (EDB), the Civil Service Bureau, the Financial Services and the Treasury Bureau, the Health Bureau and other relevant departments. In response to the Hon Elizabeth Quat's question, my co-ordinated response in consultation with relevant bureaux is as follows: (1) People's decision to bear a child is dependent on various factors, including personal preference, lifestyle, economic and social situations at the time, etc. While childbearing is a major family decision for which direct government intervention is not appropriate, the Government has implemented various family-friendly measures to foster a supportive environment for childbearing. The Government has all along been encouraging employers to implement family-friendly employment practices, including flexible work arrangements, additional leave benefit to cater for family needs and offering living support, etc., to help employees balance their work and daily needs. In addition, subsequent to the Government's lead to implement relevant arrangements for its eligible employees, the paternity leave and maternity leave under the Employment Ordinance were increased to five days and 14 weeks respectively in 2019 and 2020, enabling eligible employees to have more time to spend with and take care of their newborn babies. To assist parents who cannot take care of their children temporarily because of work or other reasons, the Social Welfare Department (SWD) subsidises non-governmental organisations to provide a variety of child care services to meet the different needs of parents and their children. To enhance the long-term planning of child care services, the Government has formulated and incorporated a population-based planning ratio for aided child care centre (CCC) places, i.e. 100 places per 25 000 population, into the Hong Kong Planning Standards and Guidelines in March 2020. The SWD is committed to increasing aided CCC places with provision of long-term full-day child care service for children under the age of three through various means. At the same time, with the implementation of the Kindergarten Education Scheme by the EDB since the 2017/18 school year, about 90 per cent of half-day kindergartens are currently free of charge while the school fees for whole-day kindergartens are maintained at a low level. Families with financial needs may apply for fee remission under the Kindergarten and Child Care Centre Fee Remission Scheme. Besides, the EDB has regularised the provision of student grant starting from the 2020/21 school year. All students studying in secondary day-schools, primary schools and special schools as well as kindergartens will receive a student grant of $2,500 every school year to alleviate parents' burden in education expenses. In addition, the HYAB will continue to support the work of the Family Council in promoting and encouraging the wider adoption of more diversified and flexible family-friendly employment practices in the community. To this end, the Family Council will launch a set of new promotional videos and radio programme in 2023-24. (2) and (3) Childbearing is a personal choice. Generally speaking, healthcare service is not a key factor when citizens consider whether to bear a child or not. While the proportion of couples with birth plan but in need of assisted reproductive services is relatively not very high, there are in fact a series of assisted reproductive services offered by public and private healthcare institutions to support the couples in need, including in-vitro fertilisation (IVF), storage of oocytes, etc. As at May 1 this year, a total of four public and 11 private healthcare institutions in Hong Kong have been licensed by the Council on Human Reproductive Technology to provide services on the storage of oocytes. Licensed reproductive technology institutions under the Human Reproductive Technology Ordinance (Cap 561) may provide services on storage of oocytes to their clients, including singletons. However, for singletons who had their oocytes preserved, their preserved oocytes may only be used for other reproductive technology procedures after they become married. According to the relevant regulation, the preservation period of oocytes for reproductive technology procedures on one's self is up to 10 years. From the healthcare services policy perspective, there are two major reasons for the provision of assisted reproductive services in the public service system. One of them is to serve as an opportunity for specialist training, while another is to offer a certain number of options to the public. In terms of resource allocation prioritisation in the public service system, a proper balance needs to be struck with due regard to trade-offs in the provision of assisted reproductive services vis-&agrave;-vis other life-saving medical services, especially for life-saving medical services which are not available or are charged at a higher rate in the private healthcare sector. The Government and the Hospital Authority are all along closely monitoring the demand for assisted reproductive treatment and other related medical services as well as the service development of public assisted reproductive services. At present, the overall service capacity can largely meet the service demand. At this stage, we do not have the plan to pursue public-private partnership for assisted reproductive services.