Press Releases

Family Planning Knowledge, Attitude and Practice in Hong Kong Survey 2022: As couples’ average parity hits record low yet women’s childbearing intention improves, enhanced fertility related services and policies called for

Childless couples more than doubled in proportion to overtake one-child families as the majority as the average parity plunged to a new record low of 0.9 despite more women desired to have children in Hong Kong, according to the latest findings of The Family Planning Knowledge, Attitude and Practice (KAP) in Hong Kong Survey 2022 (the Survey) released by The Family Planning Association of Hong Kong (FPAHK) today. FPAHK calls for enhanced fertility related services and policies. 

Professor Paul Yip, FPAHK’s Honorary Adviser cum Chairman of Research Sub-committee, Dr. Mona Lam, FPAHK’s Executive Director and Mr. Sun Chan, FPAHK’s Statistics and Information Technology Manager presented the results of this latest territory-wide survey in a press conference today. The Survey has been conducted every 5 years since 1967 to monitor trends in family planning and related issues, including parity, fertility, contraception, induced abortion and marital and sexual life among married and cohabiting couples in Hong Kong. The 2022 Survey, the twelfth in the series, surveyed 1,502 married or cohabiting women aged 15 to 49, and 1,052 of their spouses or partners, during September to December 2022. 

Family Planning and Fertility

According to the Survey, childless women more than doubled to 43.2% while those with one child and two children both fell by approximately 10 percentage points to about one quarter (27.4% and 25.2% respectively) of all women respondents in 2022, compared with 5 years earlier. Following a continuous downward trend over previous decades, the average parity among women rose back slightly from the previous lowest point of 1.2 in 2012 to 1.3 in 2017, before plummeting again to 0.9 in 2022. 

In comparison, women’s average ideal parity in 2022 dropped only slightly to 1.5 after remaining constant at 1.6 over the 2 decades from 2002, resulting in a widening gap with the rapidly declining average actual parity. Nearly half of the respondents (49.7% women; 46.5% men) regarded “two children” as ideal. Those preferring to be childless surged by about 1.5 times to about one fifth (22.7% women; 20.1% men) in 2022 from about 8% for both sexes in 2017. Conversely, following a continuing upward trend over several decades up to 2017, those favouring only one child plummeted from the highest point of about 32% for both sexes to 18.6% of women and 25% of men in 2022. 

Those women desiring a child or another child rose back significantly to 22% in 2022 from 15.3% in 2017. 55.2% desired no (more) children, down from 67.4% in 2017. 6.4% were undecided and 16.4% said they “don’t know”, compared with 14.6% and 2.7% respectively in 2017. “Attained ideal parity”, “heavy responsibilities” and “dislike children” were the 3 major reasons in descending order for favouring only one child, and in reverse order for choosing to be childless. 

Regarding possible public policies to encourage childbirth, more women in this Survey compared with five years earlier indicated that various financial incentives, strengthened parental support from employers and society and improvement in the quality of education (in that order), etc., might incentivize them to have more children, particularly among women with only one child, followed by those without children. 

12% of the women had sought subfertility service. About half of them had sought service with western medicine clinics (private) and hospitals and 35% with Chinese medicine clinics. Among those who hadn’t sought medical advice for subfertility, apart from the majority with no such need or no pregnancy plans, the reasons cited included “insufficient knowledge about such services”, “hoping to conceive naturally”, “can’t afford the costs” and “no idea where it is available”. Concerns about assisted reproductive services among all women respondents included “high costs”, “possible side-effects of treatment”, “low success rate”, etc. 

Contraception

The male condom remained the most common principal contraceptive method used by 75.1% of women in 2022, slightly down from 79.8% in 2017. Those on intrauterine contraceptive devices (IUCD) showed a declining trend since 2007, from the highest point at 11.7% to 6.2% in 2017 to 3.9% in 2022. Oral contraceptive pills and injectable contraceptives were used by 6.7% and 1.6% respectively. Worth concern is that 8.5% relied on withdrawal, significantly up from 1.6% in 2017. 

The proportion of women who practised contraception every time they had sex was on the decline, from 74.8% in 2012 to 66.7% in 2017 to 57.3% in 2022. Those who “sometimes do, sometimes don’t practise contraception” were on the increase, from 10.1% in 2012 to 13.2% in 2017 to 17.8% in 2022. Major reasons for not practicing contraception were “I don’t care” and “I think I won’t get pregnant” . Only 4.9% of women used emergency contraceptive pills in the previous year, 65.3% of whom had obtained it from pharmacies, which is illegal without doctor’s prescription. 

Both women and men showed poor contraceptive knowledge with only 2.8 and 3.1 questions on average respectively correctly answered out of 10, down from 3.4 and 3.2 respectively in 2017. 

Induced Abortion

Continuing the steady decline in women who have had induced abortions, the proportion decreased from 11.5% in 2017 to 8.3% in 2022, with “not psychologically prepared” (52.9%), “not the right timing” (36.4%) and “financial constraints (31.4%)” given as the major reasons. Concerning the location of their last abortion, 61.2% had it performed legally at FPAHK or hospitals in Hong Kong and 29.8% in Mainland China. It is of concern that 5% had illegal abortion in Hong Kong or purchased drugs for self-induced abortion.

Marriage and Sex

Couples had sex for an average of 3.1 times per month, down from 3.7 times in 2017 and further from 4.3 in 2012. Those who were satisfied or highly satisfied with their sex life dropped significantly to barely over half in 2022 from about 70% in 2017 whereas those unsatisfied or highly unsatisfied rose to about 11% from about 2%. Similarly, those who were satisfied or highly satisfied with their marriage fell more than 10 percentage points to about 70% in 2022 from about 80% in 2017 among both wives and husbands whereas those unsatisfied or highly unsatisfied rose to 5.9% among wives and 3.3% among husbands in 2022 from 1.7% and 0.9% respectively in 2017. “Work stresses”, “sharing the same room with children” and “crowded living space” were the top detrimental factors to their sex life. 

Conclusions and Recommendations

The survey showed a widening gap between the average ideal parity and average actual parity, more women wishing to have a/another child and significantly higher proportions of women supporting various public policies and financial incentives to encourage births compared with 2017. More than 20% did not know or had not decided on their fertility plan. Other than calling for the concerted efforts from all sectors of the community to further promote a family-friendly environment, FPAHK also recommends to strengthen pre-pregnancy, subfertility, other sexual and reproductive health and fertility related healthcare to support couples hoping to have (more) children with accessible and affordable services. Delayed marriage and childbearing are important factors for unattained fertility goals, FPAHK encourages couples intending to have children to plan early in order to pursue their fertility aspirations. 

In view of the general decrease in their consistent practice of contraception, with a growing reliance on withdrawal and poor contraceptive knowledge among both women and men, FPAHK reminds couples of the importance of persistent and correct use of reliable contraceptive methods every time they have sex and encourage them to make the most of FPAHK’s comprehensive birth control services. FPAHK recommends couples to subscribe to its “Tak and Kar” Facebook Page and Instagram Account, a comic illustration series about a young couple to debunk common misconceptions about contraception and convey sexual and reproductive health messages, which has been gaining popularity since its launch in 2018. 

Professor Paul Yip (middle), Dr. Mona Lam (right) and Mr. Sun Chan (left)

Professor Paul Yip

Dr. Mona Lam

Note: PowerPoint file of graphs of the Survey findings (available in Chinese only) is available in the Press Release Section on the FPAHK Website (www.famplan.org.hk/en)