Bloomberg News

Dragon Babies Escaping One-Child Policy Overrun Hong Kong Wards

October 19, 2011

Oct. 19 (Bloomberg) -- Hong Kong resident Renee James wanted to keep news of her pregnancy quiet for a few months. Her doctor urged her to book a hospital immediately. By the time James started calling at 10 weeks, it was too late.

Every private hospital with a maternity ward in Hong Kong, where Australian James and her husband have lived for two years, was full at the time of her due date. The reason: Mainland mothers-to-be are filling the slots to avoid China’s one-child policy and win residency rights for their children.

“Back home, you rarely tell people that you’re pregnant before 12 weeks,” said James, an engineer. I was calling hospitals “even before I told all my friends.”

The number of babies born in the city almost doubled in the decade to 2010, thanks to 232,536 babies born to mainland mothers, according to the city’s Census and Statistics Department. The influx is pushing the city’s neonatal intensive care units to beyond designed capacity and forcing some mothers to resort to emergency wards for childbirth, doctors say.

“In the coming few months it’s going to be chaotic,” said Cheung Tak Hong, who runs the obstetrics and gynecology department at the public Prince of Wales Hospital. “The number of deliveries in 2011 will outnumber the ones in 2010.”

York Chow, Hong Kong’s food and health secretary, agreed in June to cap the number of non-residents allowed to give birth in the city next year at 34,000. Mainlanders delivered 40,648 babies there in 2010. “Hong Kong cannot accept that we have a deterioration of our standard of care simply because we are overwhelmed by unexpected workload,” he said in an interview.

ER Switch

That may not solve the issue as some mainlanders who fail to get a place turn to emergency rooms, affecting care for residents, said Cheung. The number of births from non-local women in public emergency wards almost doubled to 156 in August, from 86 in April, according to the city’s Hospital Authority.

A 2000 Court of Final Appeal decision ensures that all children of mainland Chinese parents born in Hong Kong are entitled to residency, said Richard Cullen, a University of Hong Kong law professor. The U.S. is among few developed nations that grant automatic citizenship to children born within its borders.

Hong Kong’s maternity hospitals may also come under more strain next year because it is the year of the dragon in the 12- year Chinese zodiac, said Bill Chan, spokesman for the Neonatal Service Concern Group, set up in April by the city’s eight public neonatal intensive care units or NICUs. About 5 percent more babies are born in a dragon year as the symbol of China’s emperors is considered to impart power and wealth, said Cheung.

Dragon Baby

Shenzhen resident Ling, who declined to provide her last name for fear of repercussions from Chinese authorities, applied for a place at Hong Kong’s Baptist Hospital to have her own dragon baby in April. The 34-year-old owner of a garment factory has a 7-year-old daughter, and wants to circumvent China’s one- child policy, instituted in 1979 to constrain population growth.

“I can afford the fees, so why not?” she said in a phone interview. “I want my baby to be a Hong Kong citizen.”

In Hong Kong, a pregnant woman usually books a private hospital slot through her gynecologist. If the baby arrives early and the department is full at that time, she may have to go to another hospital. Meanwhile, mainlanders have pushed up the rate of cesarean sections, often to ensure the baby is born at a convenient or auspicious time, said Kun Ka Yan, a private obstetrician and gynecologist.


C-section rates in private hospitals were about 60 percent in 2010, according to the government, compared with 24 percent at public hospitals. The highest recorded rate for the operation in the U.S., in 2007, was 32 percent, according to the U.S. Department of Health and Human Services.

The rise in deliveries has boosted revenues of private hospitals, most of which are run as non-profit businesses.

Deliveries at Union Hospital, owned by Henderson Land chairman Lee Shau-Kee, rose almost nine fold, to 4,816 in 2010, from 556 in 2005. Occupancy at the hospital, which uses 78 of its 300 beds for obstetrics and gynecology, went “uncontrollably up” after the 2000 court ruling, said Ares Leung, the deputy medical director.

Union will introduce in 2012 a minimum charge of HK$58,000 ($7,400) for a three-night stay in a standard room with a vaginal delivery. That can rise to HK$130,000 for a four-night stay in a private room with a cesarean.

After phoning the private hospitals, James contacted the public wards to discover that she was too late to enroll there also. Her doctor said she may have to go back to Australia to give birth. At 13 weeks, a private hospital had a cancellation. She is still on the waiting list for her preferred hospital.

Book Early

By contrast, local resident Alice Tang booked a hospital spot immediately after taking a home pregnancy test. “I knew from my friends I had to book very early on,” she said.

The influx of Chinese from across the border has affected more than just hospital places. Mainland buying helped drive up home prices and contributed to a consumer sales boom from nearly 3 million visitors in August, government figures show. The city’s education bureau said that 9,899 children crossed the border from China to attend school in the 2010-2011 school year.

At the hospitals, deliveries outpaced staffing, causing departments to “scream for help” last year, said Cheung, the obstetrician. Recruitment from public wards left a deficit of 240 nurses in public NICUs in April, said Chan, a neonatologist at the government-run United Christian Hospital.

Lives at Stake

“Neonatal care is an even bigger issue,” said Chan. “Those are the urgent ones, the ones where lives are at stake.” The city’s 100 NICU beds have been operating above official capacity for several years now, said Chan.

At the Prince of Wales Hospital, nearest to the Chinese border, the NICU typically has at least three patients more than its designated 21 beds, increasing the risk of infection and error, said pediatrician P.C. Ng, who runs the department.

While mainland mothers must pay private-patient prices for a delivery in Hong Kong, the newborn baby is entitled to the city’s 97 percent subsidy for health care. A day’s supply of oxygen to a baby at a private NICU is about HK$30,000. Public hospitals charge HK$50 a day inclusive of medical services.

Cheung said border patrols to stop pregnant women entering Hong Kong without a hospital booking are hampered by mainland travel agents that sell all-inclusive maternity packages.

“They can still easily go through,” said Cheung, who urged the government to raise the fee and punishment for non- residents who show up at emergency departments. “With the agents, everything becomes so easy.”

Clare Green, whose husband works at an international bank in Hong Kong, had to wait until she was almost 37 weeks pregnant to get a place at Matilda Hospital.

“It was stressful,” she said. “I was worried in case I delivered early -- what would the process be?”

--With Assistance by Sophie Leung in Hong Kong. Editors: Adam Majendie, Jason Gale

To contact the reporter on this story: Natasha Khan in Hong Kong at

To contact the editor responsible for this story: Jason Gale in Singapore at

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