The Mainland Menace
By Shirley Zhao and Time Out staff. Illustrations by escape.hk
Only one thing is certain: Hong Kong’s future is tied to China’s future. Over these past 15 years, the borders have opened, the rail tracks interlinked and the bridges built to form a seamless superhighway with the Pearl River Delta. But curiously, although convenient cross-border transport has brought about better communication, the much ballyhooed ‘integration’ of Hong Kong and Mainland China has failed to materialise. Physically, Hong Kong is closer than ever to China; psychologically, we are chasms apart.
On February 1, a group of Hongkongers sponsored a full-page advertisement in the popularist Apple Daily newspaper, vehemently protesting against Mainland mothers who cross the border to give birth here, and requesting Mainland tourists to ‘respect local cultures’. ‘Hong Kong people have had enough!’ ran the tagline. The sensational advert also showed a giant locust looming over the HK skyline. As we all know, Hong Kong citizens have been calling Mainland resource-drainers ‘locusts’ for a long while. But this time the plague seems to be a very definite reality.
The shocking locust advertisement brought the integration row back to a scorching boil, along with heated quarrels and nationalistic finger pointing. Behind the chaos, however, it was obvious that Hong Kong was feeling ever more insecure and anxious about the ‘one country, two systems’ set-up. Indeed, the very fabric of Hong Kong’s culture now feels at stake. People’s helplessness, even powerlessness, is palpable everywhere.
Of course, Hong Kong jealously guards its key values – the rule of law, the free market, the importance of freedom of speech and the pursuit of universal suffrage. But the Mainland’s way of doing things, in Hong Kong’s eyes, goes against everything we believe to be self-evident. Many of the Hong Kong’s older generation are early immigrants, fleeing the Communist Party rule to make a new home on the fragrant harbour. The younger generation, under the influence of these elders, still has fresh memories of the 1989 Tiananmen Square massacre.
These are the foundation blocks of our modern thinking, and it is an unspoken fact that Hong Kong simply doesn’t trust the Mainland government, and that the Politburo is to be feared and hated.
To ease the uncertainty about the Handover, the central government promised Hong Kong a high degree of autonomy, independent judicial and economic systems, and a way of life that ‘shall remain unchanged for 50 years’. With cautious expectation, the city reunited with their Mainland cousins. People thought they would have the power to decide their own future but, from where the city stands today, Beijing’s influence is stronger than ever before and the promise of universal suffrage appears more like a dream than a reality.
Economically, Hong Kong has been more and more dependent on the Mainland since 1997. When Hong Kong was suffering during the downturn in 2003, a free trade agreement allowed HK goods free access to the Mainland’s growing market, and various Mainland industries also opened up to our city. Growing tourism from the Mainland has been energising many local industries ever since, and more Mainland companies are listed on Hong Kong’s stock market. Today, we are no longer independent from China. That dream, as we said, is over. But has a new nightmare begun?
Look at our commercial situation. With no law to regulate the property market monopoly, the development of local small and medium-sized businesses is highly limited. An unequal distribution of wealth further widens the gap between the rich and the poor, causing serious social problems. These problems have become especially unbearable when an overwhelming tide of Mainland lower and middle-class people rush in and compete for our already limited resources and overcrowded social welfare. And all the while, the Hong Kong government has strangely (and suspiciously) remained inactive. Naturally, Hong Kong people are infuriated.
The major concern, of course, is the ‘delay’ in universal suffrage. Our common Hong Kong people, facing inflation and a widening wealth gap every year, had hoped they could one day elect their own Chief Executive to form an administration for the people, so that the citizens of Hong Kong could decide their own future. Not a chance of it. The ‘intangible hand’ of Beijing manipulated last month’s result, and even though the media reported that the Liaison Office of the central government called the election committee members asking them to vote for one candidate, the hoplessness of the situation has now deepened to uncharted depths.
So how does all this fear and paranoia and loathing and hopelessness manifest itself on a social level? Simple – we need to lash out. We need someone to blame. Step forward the Mainland individual, specifically the Mainland mother-to-be. She’s the one to blame. But really, any Mainlander will do.
Just look at them – cutting lines, speaking loudly, spitting, shouting, letting their kiddies shit in the street, crowding the MTR, acting rudely. How uncouth, how uncivilised they are. This is what many Hongkongers are saying today. You, dear reader, may be thinking the same thing. You may feel disrespected in your own home, your own city. You may feel outraged when the government tries to push the Putonghua language on our TV shows, on our radio and in our schools. Do we feel we have had enough? Or is there an element of over-reaction to it all? Let’s start by taking a look at those dastardly mothers-to-be…
Attack Of The Mainland Mothers
According to media reports, they are rude, unreasonable and uncivilised. They buy or lie or cheat their way into our hospital beds just to make sure that Hong Kong’s taxpayers tend to their children for the rest of their lives. They are parasites. They are invading our beautiful city and they need to be stopped.
Meet the Mainland mothers-to-be: scourge of Hong Kong, enemies of the SAR.
According to statistics from the Hospital Authority, last year there were 41,846 babies born to Mainland mothers here, almost 44 percent of all newborns in Hong Kong, and over four times more than in 2003. Over 85 percent of the babies were born to Mainland couples (17 times more than in 2003), the rest were Mainland mothers with Hong Kong husbands. A 2001 case in the Court of Final Appeal affirmed that Chinese citizens born in Hong Kong enjoy the right of abode regardless of the Hong Kong immigration status of their parents. Since a 2003 Hong Kong-Mainland agreement enabled free trade and individual Mainland tourists to visit Hong Kong, the number of Mainland mothers rushing into the SAR has been growing so fast, and in such a short time, that the government, known to be frugal on public spending, has been left bewildered and unprepared. It could be argued that the government’s inability to address the situation has further deepened an already sensitive social problem on the city’s collective conscious.But what has been the real impact of Mainland mothers in Hong Kong? How have they stretched our so-called ‘fragile system’? Why do they come here in the first place? And what will be their children’s, and Hong Kong’s, future?
The Pressured Public Hospital System
In 2011, over 10,000 babies born to Mainland mothers were delivered in our public hospitals, or 32 percent of the public hospital total. Around 4,000 were born to Mainland couples. According to Anthony Wu Ting-yuk, chairman of the Hospital Authority, the public hospital system can generally handle around 45,000 childbirth cases each year. The capacity should have been enough for the 42,000 babies born in the system last year, if all Mainland mothers had followed a proper booking-to-birth-giving procedure. Yet when public hospitals stopped accepting booking applications by Mainland mothers from last April through the rest of the year, it prompted many Mainland mothers to rush into public emergency wards just as they were about to give birth. Last year, there were 1,657 Mainland mothers giving birth in emergency wards – 75 percent did so without booking – twice more than in 2010. Meanwhile, immigration officials also successfully blocked 1,930 Mainland mothers without booking from crossing the border.
Hong Kong’s public emergency wards are known for their staff shortages, and non-urgent patients usually need to wait over 90 minutes to get treated. Without a booking, Mainland women who have been pregnant for 28 weeks or longer are not allowed to cross the border to Hong Kong. But some of those who managed to get through came under a tourist visa when their pregnancy was still not visibly obvious, normally a few months before their pregnancy due date. They took accommodation in small hotels here, overstayed till the due day, then rushed into the emergency wards. Others drastically chose to go to the border and cry for help as their labour pains set in, thereby forcing immigration officials to send them to the nearest hospital.
North District Hospital, a public hospital without departments of obstetrics and gynaecology, paediatrics and neonatal intensive care unit (NICU), saw 180 cases of Mainland mothers attempting to use its emergency ward to give birth, solely for the fact that the hospital is close to the border.
Kitchell Abdul Karim Bin, manager of the emergency department of North District Hospital, says they try to transfer most cases to the nearby public Prince of Wales Hospital, but in urgent cases they have to take the Mainlanders themselves, which not only soaks up staff numbers and time, but is dangerous to both mother and baby as well. “These mothers are risking their lives,” Bin says, “but it’s also unfair to other patients waiting in the emergency ward. If a mother comes in the evening, we could employ up to 40 percent of staff in our department to help her give birth.”
Most Mainland mothers who choose to give birth in emergency wards have never had a prenatal examination, thus adding many unknown dangers of childbirth, and many of their newborns often suffer from various health problems and need to be tended to in public hospitals’ NICUs, which have a total of only 100 beds. At the same time, private hospitals also keep transferring babies to public hospitals’ NICUs (there were 354 in 2010). According to Anthony Wu Ting-yuk, the public hospitals’ NICUs have been consistently overloaded. Currently, the charge for using emergency wards to give birth is $48,000 per woman. In order to reduce such cases, the government is considering raising the price to at least $70,000.
Who Gets The Profits?
Last year, over 90 percent of babies born to Mainland parents were delivered in private hospitals, where the quota for Mainland mothers was 31,000. With public hospitals fully booked, richer Mainland parents had no problem choosing private ones that charge much more, ranging from tens of thousands of dollars to hundreds of thousands; and private hospitals, eyeing huge profits, were more than happy to provide their beds.
According to a report released in December last year by Hong Kong Consumer Council, in 2011, 90 percent of private hospitals raised the prices of their ‘delivery service sets’. Precious Blood Hospital raised theirs nearly 50 percent, the highest of all. Meanwhile, complaints about the private hospitals’ delivery services also increased from three cases in 2010 to 26 in the first 11 months of last year. Most of these complaints were about additional and unexplained charging. The Consumer Council believes the huge demand from Mainland couples pushed up the prices.
Ambrose Ho Pui-him, vice-chairman of the Consumer Council, urges all the private hospitals in Hong Kong to list out the prices of everyservice included in the service packages. “It’s their responsibility to be more transparent to the public, so that it’ll be easier to supervise and cause fewer arguments,” says Ho.
However Alan Lau Kwok-lam, chairman of the Hong Kong Private Hospitals Association, says the delivery process is complicated and unpredictable. “The prices of the sets can only cover the basics,” says Lau. “Any additional services provided during delivery will be charged independently.” The increasing profits in the private market also attract experienced gynaecologists and nurses from the public hospitals to cross sides. Since 2007, the public hospitals have been losing about five percent of staff related to childbirth each year.
Destination Hong Kong
Why are so many Mainland couples willing to spend so much money, and so much risk, to have their babies born in Hong Kong? For the middle classes living in neighbouring Guangdong province, giving their children Hong Kong’s permanent residency could mean free and better education, government-subsidised medication, and better social welfare. For the nouveau riche coming from Shanghai, Beijing or even Dalian, permanent residency and its related benefits may not be as important as being able to have a second child.
Waiting outside the maternity ward in the public Tuen Mun Hospital, Mr Wang tells Time Out that he and his wife have travelled between Shanghai and Hong Kong four times, after they decided to give their second child a Hong Kong identity. “We’ve spent about $80,000 on this,” says Wang, who would not give his full name. “Because I’m still in Hong Kong, you know how intense the situation is these days.”
The couple already has a girl, but Wang says his mother wants to have a grandson. “Based on my income, having a second child in Shanghai would mean a fine of almost 300,000 yuan,” says Wang. And if the Shanghai government find out they have a second child, they will certainly be fined. “Of course I’m nervous about being found out,” he says, “but what can I do? My mum’s not in good health. I want to do something to please her.”
Wang also worries about the costs of raising a ‘foreign child’ in Shanghai. “Indeed, my child will have rights to all social welfare in Hong Kong, but he’s got to live in Shanghai, at least before college. We can only send him to private or international schools there, which requires a lot of tuition fees.” Wang wants his children to go to college and then work in Hong Kong. “I have very good impressions of this city,” he says. “Everything is effective, convenient and in order. People are more civilised, although sometimes I do feel the city is too small.”
Living in Lo Wu, Shenzhen, Xuan Lidan gave birth to her son in the private Hong Kong Baptist Hospital in 2009. “I want him [her son] to have schooling in Hong Kong,” says Xuan. “Hong Kong’s education is better than in the Mainland. He will have a better future. And we live close to the border so it’ll be convenient for him to cross the border for school.”
Last year, Xuan took her son to a public hospital in Hong Kong three times. “The medical service in Hong Kong is also better,” she says. “Every time I went to the hospital, I always found some parents around me speaking in Putonghua, and some were quite rude. Although we Mainland mothers feel for each other, we don’t like those [other mothers] who behave badly either.”
Speaking of Hong Kong citizens’ general disapproval of Mainland mothers, Xuan looks uneasy. “As a parent, I don’t think it wrong to want to give my son a better future,” she says finally. “I didn’t go to give birth illegally. I went because the government allowed me.”
Mainlanders’ Hong Kong children
Although not every Mainland mother’s Hong Kong child is currently enjoying the city’s social welfare services, the numbers have been steadily increasing, which is what worries local parents.
According to research conducted by the Hospital Authority, between January 6 to January 19 this year, a total of 1,624 children were transferred from emergency wards to paediatrics departments in 12 local public hospitals with these two departments. Among them were 104 with Mainland parents, and over 200 were with Hong Kong-Mainland parents. In other words, Mainland mothers’ children accounted for approximately 20 percent. The authority says when their Hong Kong children suffer from serious problems, Mainland parents tend to have them treated in local public hospitals. These children further challenge the already troubled local public hospital system, where staff and resources are shorted and unequally distributed. The authority estimates that the system needs at least 39 more paediatricians to maintain the current standard of services.
Chan Hin-biu, chief in service of the public United Christian Hospital’s paediatrics department, believes the Hong Kong government has not taken these children into consideration, nor are they prepared for the challenges. “We [the public hospital system] only got one more paediatrics surgeon over the past decade,” says Chan, “and there will be two paediatricians retiring soon. Our workload has doubled.”
For many schools in the New Territories, cross-border students counteracted the problem of under-enrolment, because of Hong Kong’s low local birth rate. Now, they have too many students waiting to be enrolled.
Too Siu-fung, principal of Sheung Shui Pui Yau Kindergarten, tells Time Out that about 80 percent of the kindergarten’s students are from Hong Kong-Mainland families, and another 15 percent are from Mainland families. “I remember when I first came to this kindergarten in 2001, there were only 40 students,” says Too. “It was on the edge of being closed down. To survive, we needed to actively recruit more cross-border students.”
According to the Education Bureau, there were 12,865 cross-border students in 2011/12, almost three times more than in 2006/07. The quota of Primary 1 students for schools in North District is 2,616 in 2012/13, but there are 3,700 applications, meaning there could be 1,084 students forced to go to schools in other districts relatively far from home – which is bad news for both local and Mainland parents.
“I think it’s unfair to us,” says Liu Wai-king, whose daughter is one of the applicants. “We live here. We work here. How come our children need to compete with the children of those who don’t [live and work here] for school vacancies?”
Vilas Chiu Ching-wai, the Education Bureau’s senior school development officer for North District, says the government is planning to increase the quota for primary schools in this district, but it may take a longer time because the bureau needs to discuss changing the approved use of land with the Lands Department.
Yet Cheung Shuk-kuen, chairman of the Federation of Parent-Teacher Associations of the Northern District, says that the government departments are constantly ‘passing the bucket’ to each other. “The government has been ignoring this issue for years,” she says. “If they [the government] had been more active, problems would have been solved a long time ago.”
The Lucrative ‘Grey Zone’
In February, a Mainland ‘intermediary’ who helped Mainland mothers, with or without booking, to give birth in Hong Kong was convicted in Sha Tin Magistracy for breaching the conditions of stay (doing business under a tourist visa) and lying to an investigating official, and sentenced to 10 months in prison. Last month, another woman was convicted of the same charge and sentenced to nine weeks in prison.
According to the Immigration Department, the department is investigating a further 58 similar Mainland intermediaries and agencies, as well as 20 local fixers.
In the Mainland, the business of making arrangements for mothers to give birth in Hong Kong is booming. There are agencies set up in many first tier cities in the Mainland providing an arrangement of services, including booking hospitals, transportation, prenatal examinations, accommodation, delivery services, postnatal care, birth registering and retrieving different certificates and visas. Some of the agencies even provide ‘illegal help’ to mothers without booking to get through the border.
So far this year, all local hospitals have no vacancies for Mainland mothers until October, but one agency in Shenzhen, Hong Kong Maternity Services Limited, tells Time Out that it can still arrange to help mothers with due dates before September. “Bring along $150,000 to $250,000 to Hong Kong, and our staff there will get you in hospital,” says a consultant of the agency over the phone. “But you will need to get through the border yourself. The check is becoming more and more strict, both here in Shenzhen and in Hong Kong.”
According to the consultant, normally the prices of their delivery-travel-sets range from $60,000 to $140,000, but in urgent cases where mothers need to give birth without booking, the prices will be higher.
Unwilling to give her real name, Ah Ping, an intermediary in Guangdong province, tells Time Out why her business is worth the risk. “The standard commission for us is $15,000 per person. For me doing this alone, two to three mothers a month is already a good profit,” she says. “But the hospitals, the doctors and nurses in Hong Kong are earning much more from this. What we get is just the leftovers.” Ping claims that she has never helped anyone to cross the border without a prior booking, and has now halted her business after the two court cases.
The Immediate Future
Hong Kong would not have the problem of Mainland mothers – Mainland couples, to be more exact – if the law had not allowed their babies born in the city to have permanent residency. So why is it allowed in the first place?
Pro-democracy lawyer Martin Lee Chu-ming was a member of the Basic Law Drafting Committee from 1985 to 1989, when many Hong Kong people, fearing the handover, emigrated overseas. Lee tells Time Out that back then Hong Kong, facing the loss of large amounts of talent, needed to attract those who moved away to come back. Hence Article 24 was included in the Basic Law, stating that all Chinese citizens born in Hong Kong before or after the handover, and their children born overseas, have the right of abode in Hong Kong. In other words, the article was meant for emigrants’ children born overseas.
“At that time the central government promised it would strictly control the number of people allowed to come to Hong Kong,” Lee recalls. “Who would have thought Hong Kong would open to individual Mainland tourists in the future?”
Currently there are four popular suggestions
to solve the Mainland mother problem –
1) administrative means, 2) seeking reinterpretation of the Article 24 by the Standing Committee of the National People’s Congress,
3) amending the Basic Law, and 4) letting the Court of Final Appeal overrule its 2001 decision.
Lee rules out the last three suggestions immediately. He says the reinterpretation will harm Hong Kong’s judicial independence; it will be nearly impossible to amend the Basic Law because no government would like to admit its fundamental law is wrong, and the process of amending the Basic Law is long and complicated; and, likewise, no highest court would like to admit its ruling is wrong.
The administrative route is preferred by Lee. “The government has cut the quota for public hospitals sharply this year, and promised it will prioritise local mothers’ demand,” he says. “And the immigration officials have also successfully blocked many Mainland mothers. As long as the government keeps actively enforcing the regulations, Hong Kong citizens’ benefits will be well protected.”
The quota of Mainland mothers for public and private hospitals this year is 34,400, a 20 percent cut from last year, while the quota for public hospitals has been cut over 65 percent from 9,800 last year down to 3,400 this year. But the quota is for Mainland couples as well as Mainland mothers with a Hong Kong husband, which has stirred protests among Hong Kong-Mainland families.
“This is such an unfair system,” says Chan Wai-hung, a social worker at the Mainland-Hong Kong Families Association. “Hong Kong mothers with Mainland husbands are treated as local mothers and prioritised, but Mainland mothers with Hong Kong husbands are not. This is ridiculous!”
According to government estimates, by 2030, a quarter of Hong Kong’s population is expected to reach age 65 and older. Another government research shows that around 60 percent of Mainland mothers’ children could come back to study or work before the age of 21.
If they come, when will they come? What will be their levels of education? Will they need public housing or social security? What influence will they have on this ageing society? Perhaps it is these uncertainties that make Hongkongers stigmatise Mainland mothers.
The Doctor’s Perspective
One of Hong Kong’s top specialists in women’s health discusses the Mainland maternity scare...
The ‘maternity vacancy’ controversy seems to be in overdrive at the moment. A so-called lack of hospital beds for Hong Kong’s pregnant women has prompted many to book a place for delivery on the very first day they are confirmed pregnant, even though we have one of the lowest birth rates in the region. Of course, this scare started because of the rush of pregnant women from the Mainland, and although there has never been a situation where a woman ends up with having nowhere to give birth, the increasing need for maternity care has poised significant implications to the Hong Kong health system.
The number of pregnant Mainland women has surged from 8,173 in 2000 to 40,648 in 2010, a fivefold increase. Of these women, those whose spouses are not a Hong Kong resident has vastly increased from 709 to 32,653. The majority (over 70 percent) of Mainland women give birth in the private sector. This has caused obvious worries for local women who feel their ‘spaces’ for delivery are being taken up. But before we cast aspersions, let’s have a look at why women from the Mainland rush down to Hong Kong to deliver. There are three main reasons:
1) The medical system in Hong Kong is trustworthy and of international standard. This is clearly the major attraction.
2) Couples in China get fined for having more than one child, based on the one child policy, which is not applicable in Hong Kong.
3) The child born can immediately enjoy the benefits of social welfare in Hong Kong. The baby has practically free or very low cost healthcare even if the parents are not a Hong Kong resident. Moreover, as they grow older, they can also benefit from the education here in Hong Kong.
But there are hidden problems. Similar to travel agencies, there are agents who make arrangements for women to come down to give birth in Hong Kong; they ‘bus’ them down. There are a certain percentage of women who can only afford to pay the agent fee and, upon discharge, leave for China without paying the hospital, the costs having to be absorbed by the hospital in question. For taxpayers and Hong Kong residents this is obviously unacceptable.
Public hospitals have now set a fee and stricter rules. There is an existing ‘maternity package’ of $39,000 which includes a ‘three days, two nights’ stay. If a woman needs to be hospitalised for longer there is an additional fee of $3,300 per day. If there are complications, and the baby needs further medical care, they need only pay $100 per night (as the baby is now a Hong Kong born resident). For private hospitals there is a range of fees and each hospital takes a set percentage off Mainland women. Some private hospitals heavily rely on this income whereas others are more financially stable and have lowered the numbers.
Maternity mortality in Hong Kong has improved over the years due to better prenatal check-ups. Problems are spotted early and monitored. However, many Mainland women do not attend prenatal care. To address this issue, some private hospitals issue women with a ‘care card’ to encourage prenatal check-ups in China after registering in Hong Kong for a planned delivery, but it’s mostly in vain. Women may not be compliant and the reasons are either due to cost issues or that they do not want to be found out to have a second child. Hence there will be many ‘high risk’ deliveries, including breech deliveries, pre-eclampsia, placenta praevia and haemorrhage.
Indeed, if a women turns up to an A&E with an imminent life-threatening problem as a result of her pregnancy, our health system does not allow us to reject them (and ethically, doctors would never do this). This has prompted agents to teach women to attend the A&E room at ‘just at the right time’. Moreover with the ‘three days, two nights’ package, to save costs, one may notice pregnant Mainland women lurking outside a public hospital just before midnight so that, at midnight exactly, they can walk into the hospital for admission and save a day’s cost.
Now, two types of specialists are necessary for a safe delivery. One is the obstetrician staff and the second is the neonatal paediatrician staff. The lack of paediatric intensive care specialists (and beds) is now a major issue, as not all hospitals provide such services. So this rush of Mainland mothers is a very serious concern.
What’s more, seven years ago there was a ‘freeze’ in trainees due to a population calculation that there would be a drop in delivery numbers. Therefore, the manpower calculation found that Hong Kong needed fewer obstetricians. Training of a specialist takes at least six years, which coincides with the gap we are seeing now; with the Mainland rush, the stress to staff is now all too obvious.
The matter gets more complicated when Mainland women married to Hong Kong men demand more priorities. Interestingly, the government quickly shifted this problem to the private sector and suggested there should be no such priority in the public sector. In simple terms, three categories were suggested: women who are Hong Kong residents, Mainland women who are not married to a Hong Kong resident, and Mainland women who are married to a Hong Kong resident.
For myself and many doctors, this creates messy complications, as at present, without the third category, women can easily be distinguished by having or not having an HK identity card. The additional category overcomplicates matters; it will trigger off more demand in medical benefits and social welfare. One cannot imagine what a small suggestion may avalanche into.
Last but not least one needs to congratulate those who benefitted the most: the agents! With the higher demand, agents now teach a woman to ‘lie’ about her due date. They have learnt to falsely provide a ‘later due date’ which allows them to book a room and pretend that the woman is having a premature delivery. Their websites also claim to have special relationships with certain private hospitals to attract more business. They also claim they can choose better rooms, and often arrive at the hospital with a woman to help prepare and ‘inspect’ the facilities (usually pretending to be a relative). Of course, it is unlikely that there will not be enough beds for delivery. But that is not the issue. The lack of specialist care is the issue, especially if the number of Mainland mothers is not controlled. Time Out has refrained from naming the specialist doctor who wrote his article.