Ariana #05 Reproductive Rights by Ariana Life

C O N T E N T S 目錄

05 Spring 春

2020 HK$50 | MOP50

Shedding light on social issues in Asia 揭示亞洲社會問題

“Reproductive freedom is not a privilege – it’s a fundamental human right.” 「生育自由並非特權，而是基本權利。」 – Bowie Lam, Teen's Key 林寶儀，青躍 arianalife.com | REPRODUCTIVE RIGHTS

C O N T E N T S 目錄

生育權 | arianalife.com

C O N T E N T S 目錄

ON THE COVER Eggs, a symbol of fertility, demonstrate how girls and women can thrive when granted fundamental reproductive rights. But without such rights, they can fall through the cracks in a messy, broken system. 雞蛋是生育的象徵，代表女性被賦予基本的生育權利後如何繁衍生息。如果這種權利被剝奪，她們便會陷入混亂破碎的局面。

SHORT 短篇

under 5 minutes

12. T H E

MEDIUM 中篇五分鐘內

I N I T I AT I V E 環球倡議

World of Change 變革世界 Explore social projects around the globe, from a dragon boat team formed by breast cancer survivors to a school training women to be solar engineers.

under 10 minutes 10分鐘內

20. T H E

PITCH 變革攻略

Dogged Pursuits 不懈追求 Sai Kung Stray Friends Foundation founder, Narelle Pamuk, learns to pitch Hong Kong Round Table. 西貢流浪狗協會創辦人 Narelle Pamuk向香港圓

訓練貧困女性成為太陽能工程

42. C U LT U R E

26. I N

NEWS 文化資訊

Live and Learn 學無止境 Documentaries, books and podcasts recommended by the Ariana team. Ariana推介發人深省的紀錄片、書籍和 podcast節目。

Right at Home 有你就是家

澳門希望之源協會透過寄養照顧

32. T H E

A Macao photographer and Hong Kong poet team up to share meditations on everyday life.

VOICES 本地之聲

Breaking The Cycle 打破宿命 Doctors, lawyers, professors and teens weigh in on reproductive rights in Hong Kong and Macao. 醫生、律師、教授和青年分享對港澳兩地生育權的看法。 144. L A S T

FA C T S 事實數據

Reproductive Health 生殖健康 A deep dive into reproductive rights and health issues around the world.

THE LENS 眾鏡透視

Under the Sky 同一天空下

定如何改變她的世界觀。

幫助弱勢兒童。

深入探討全球的生育權及健康問題。 136. T H R O U G H

Tanja Wessels writes about her decision not to have children and how it’s affected her worldview. Tanja Wessels親述選擇不生育的原因以及這個決

128. L O C A L FOCUS 聚焦

How Cradle of Hope supports Macao’s most vulnerable children.

師的學院。

E S S AY 個人陳述

My Child-Free Choice 無孩人生

桌會請教申請資助的技巧。

介紹世界各地的社會項目，從乳癌康復者組成的龍舟隊，到

112. P E R S O N A L

WORD 流芳之語

Hong Kong’s Daughter 香港女兒 Remembering the late Dr Joanna Tse Yuen-man, a respiratory specialist who lost her life to SARS in 2003. 懷念在 2003 年因治療沙士病患而殉職的謝婉雯醫生。

44. H E R

VOICE 女聲

Equal Opportunities 機會均等

澳門攝影師與香港詩人攜手分

SENsational Consultancy’s Faride Shroff shares her journey from teacher to inclusivity advocate. SENsational Consultancy創辦人 Faride Shroff分享

享眼中的人生百態。

她從教師轉變成平等共融倡導者的歷程。

arianalife.com | REPRODUCTIVE RIGHTS

C O N T E N T S 目錄

LONG

長篇

under 20 minutes 20分鐘內

52. Let’s

Talk About Sex 談性可以嗎？

Many students in Macao seek more progressive sexuality education but religious institutions are blocking the path forward. 澳門許多學生期望得到更開明的性教育，但宗教的影響力阻止了前進的道路。 62. Invisible

Tolls 自主之難

Long waits, high costs and judgmental medical staff make it difficult for some women in Hong Kong to access safe abortion services. 冗長的輪候、高昂的費用及帶有偏見的醫護人員，阻礙了部分香港女性得到適切的人工流產服務。 76. Out

of Step 不一致的步調

How Hong Kong’s sexual and reproductive health care provisions are failing the city’s transgender patients. 香港的性與生殖保健對跨性別社群的支援存在許多不足之處。 86. The

Surrogates 借腹生子

Commercial surrogacy in India has led to financial empowerment for some women. This year, a controversial new law could ban the practice. 印度的商業代孕服務讓一些當地婦女得以改善生活，卻可能因為新法案而畫上休止符。 102. Tomorrow’s

Harvest 希望在明天

In today’s ever-demanding world, egg-freezing offers women a liberating choice, but it may come at a cost. 女性可透過凍卵擺脫生育年齡的限制，但必須付出相當代價。 118. Life

Studies 生命何去

Experts in religion, biology and psychology ruminate on complex ethical issues. 宗教、道德倫理、生物科技和心理學等領域的專家反思複雜的道德問題。

生育權 | arianalife.com

118

C O N T E N T S 目錄

arianalife.com | REPRODUCTIVE RIGHTS

C O N T E N T S 目錄

生育權 | arianalife.com

M A S T H E A D 出版頁

Publisher 出版商 i-CABLE Communications Limited

Cover Photographer 封面攝影師 Yankov Wong

Executive Director 行政總監 Andrew Chiu

Illustrators 插畫師 Mandy Chan, Vincy Chan, Gonçalo Viana, Lauren Crow

Production 製作 Ariana Life

Social Media Manager 社交媒體經理 Tina Chu

Editor-in-Chief 總編輯 Mariana César de Sá

Partnership & Distribution Manager 合作企劃及發行經理 Sabina Wong Sutch

Managing Editor 管理編輯 Kate Springer

Printing 印刷 Asia One Printing Ltd

Editor-at-Large 特約編輯 Gonçalo César de Sá

Distribution 物流 One Logistics

Deputy Editor 副編輯 Cathy Lai Features Editor 專題故事編輯 Samuel Miller Writers 作者 Rafelle Allego, Vincy Chan, Gayathri Durairaj, Ruby Lai, Kary Lam, Chermaine Lee, Andrea Lo, Rhea Mogul, Anna Simpson, Crystal Tai, Tanja Wessels Translators 翻譯員 Rosa Chen, Kary Lam, Ng Mei Kwan, Yam Yim-lan Proofreaders 校對員 Anna O’Connor, Yoko Siu Designers 設計師 Fernando Chan, Inês de Campos Alves, Pierre Pang, Sandra Norte Photographers 攝影師 Deepti Asthana, Krollfilm, Eduardo Leal, William Liu, Karma Lo, Alex Macro, António Sanmarful

Get in touch 聯絡我們 Story ideas and feedback

歡迎將意見或報導題材分享至

editorial@arianalife.com

Partnership inquiries 查詢合作，請電郵至

partners@arianalife.com

Facebook | Instagram @ arianamag.hk Twitter @ arianamag_hk Room 802, 8/F, Far East Consortium Building 121 Des Voeux Road Central, Central, Hong Kong 香港中環德輔道中121號遠東發展大廈8樓802室

arianalife.com | REPRODUCTIVE RIGHTS

C O N T E N T S 目錄

生育權 | arianalife.com

C O N T E N T S 目錄

arianalife.com | REPRODUCTIVE RIGHTS

27.7 BILLION RMB

Annual operating income in 2018 2018年度的營業收入

43.8 BILLION RMB Total assets 公司總資產

INNOVATION DRIVES PROGRESS

科技創新引領進步作為全球消費電子產品功能視窗及外觀防護零部件行業的領導者，藍思科技集團相信真正的領導力植根於創新思維。

這就是我們每年在研發上投入12-15億元人民幣的原因。目前，我們還擁有超過1,500項國內專利、13項國際專利、1,100項授權專利，專利數量在同行中遙遙領先。

此外，我們還不斷研發新興科技，例如3D玻璃、藍寶石、精密金

屬及陶瓷面板、生物識別、自動化生產等，致力將世界級的產品

帶到消費者手中。

As a believer in the‘Made in China 2025’strategy, we’re 「藍思科技積極響應『中國製造2025』戰略，我們很榮 “proud 幸能夠透過生產尖端消費電子零件，彰顯中國製造商的 to produce cutting-edge consumer electronics parts that 魄力與創造力。」 show the drive and ingenuity of Chinese manufacturers. ” 創始人周群飛 Founder Chau Kwanfai

1,500

Number of national patents 國內專利數量

40 BILLION RMB

Investment in Hunan Province 在湖南省的投資總額

100,000

Employees in Hunan Province 在湖南省的員工數目

CHARTERHOUSE SCHOOL AD

生育權 | arianalife.com

EDITOR'S LETTER 主編語

eproductive rights are about much more than abortion or access to contraception. It’s a human rights discussion that affects everyone. As the late American civil rights activist Audre Lorde said: “There is no such thing as a single-issue struggle because we do not live single-issue lives.” In her 1982 address at Harvard University, Lorde was reflecting on the 1960s civil rights movement by black Americans. But this intersectionality, she said, is true for “all the disenfranchised peoples,” including women. Women don’t live in vacuums, isolated from society. Outdated education, underage pregnancies, maternal mortality, insufficient care, access to assisted reproductive technologies, social stigmas... every so-called “women’s issue” has a ripple effect on the local and international community. While adopting the UN Millennium Development Goals in 2000, world leaders agreed that addressing women’s reproductive health is key to development. A woman’s right to decide when to marry, as well as to control the timing and number of children, is critical for a family’s security and welfare. What’s more, women’s reproductive rights directly correlate with economic development. If just 10 per cent more adolescent girls attended secondary school instead of dropping out to raise children, a country’s GDP would increase by an average of 3 per cent, according to US Agency for International Development. And yet, 200 million girls in the developing world lack access to contraception. In our own city of Hong Kong, young adults rarely receive comprehensive sexuality education, while women face restrictions on timely abortions and assisted reproductive services. Many of us are hesitant about having open, honest conversations about reproductive issues for fear of castigation. That is precisely why we need to push the conversation forward. In this edition of Ariana, we interview teenage girls driven to black-market abortion clinics in Hong Kong (pg 62), women who have tried to silence their biological clocks with egg freezing (pg 102), and surrogates in India who will no longer be able to give the gift of life to infertile couples once new legislation passes this year (pg 86). We also investigate how many religiously affiliated schools in Macao urge students to safeguard their virginities and choose not to discuss teenage sexual activity or non-binary identities. In doing so, these schools fail to fully prepare students to make informed choices about their sexual and reproductive health (pg 52). Also left out of the conversation is the trans community, who often encounter prejudiced and misinformed doctors during obgyn appointments (pg 76). Until reproductive rights are deemed ‘fundamental’, we will remain miles behind as a society. So, I encourage you to read these pages, come to your own conclusions and share your thoughts with us. We want to hear your suggestions, criticism and encouragement, so we can build a healthier, more inclusive future together. Echoing Lorde’s Harvard address: “Our struggles are particular, but we are not alone.” Editor-in-Chief

Mariana César de Sá

生

育權遠遠不止於墮胎或避孕需求的爭議。這是一場影響全人類的人權討論。正如已故美國民權運動家奧瑞德 · 洛德在 1982 年於哈佛大學發表的演講中所言：「世上從來沒有單一議題的鬥爭，因為我們的生命不是只有單一議題。」在這場演講中，洛德回顧了 1960年代美國黑人民權運動的歷史。她提到多元交織性這個概念，同樣適用於「所有被剝奪權利的人」，包括婦女。女性並非活在與社會隔絕的真空之中。過時的教育、未成年懷孕、孕產婦死亡、醫療服務不足、對輔助生殖技術的需求、社會污名……每個所謂的「女性議題」在本地和國際社會均會產生漣漪效應。聯合國「千禧年發展目標」於 2000年獲通過時，世界各國領導人一致認同，解決女性的生殖健康問題是促進發展的關鍵。女性有權決定何時結婚、何時生育，以及生育子女的數量，這對維持家庭的福祉至為重要。此外，女性的生育權與經濟發展更是密切相關。美國國際開發總署指出，一個國家如果能夠讓多百分之十的少女就學，而非輟學撫養子女，該國的國內生產總值將平均增長百分之三。不過，時至今日，全球發展中國家仍有超過兩億女性無法獲得避孕用品。在我們的城市香港，年輕人缺乏全面的性教育，而女性往往在尋求適時的終止懷孕服務及輔助生殖服務時面臨阻滯。然而，為免受到譴責，許多人都不願就生育議題作出開誠相見的對話。正因如此，我們更需要推動相關討論。在今期 Ariana中，我們採訪了逼於無奈而在香港非法診所終止懷孕的少女（第 62頁）、嘗試以凍卵戰勝生理時鐘的女性（第 102頁），以及將受到新法例影響而無法為不孕夫婦擔任代母的印度婦女（第 86頁）。我們還探討了澳門許多教會學校如何督促學生維護童貞，同時禁絕對青少年性行為或非二元性別身分的討論，以致學生們未能做好充分準備，就性與生殖健康作出知情的選擇（第 52頁）。被排除在對話之外的，還包括跨性別群體，他們在尋求坊間的婦產科服務時，往往要面對帶有偏見，甚至對他們的健康需求一知半解的醫護人員（第 76頁）。在生育權被定義為「基本」權利之前，我們的社會還要走過漫漫長路。因此，我邀請您閱讀這些故事，綜合得出自己的結論，並與我們分享您的想法。我們希望聽到您的意見、批評和鼓勵，讓我們得以共同建立一個更健康、更包容的未來。誠如洛德在哈佛大學所說：「我們的鬥爭特殊，但我們並不孤單。」總編輯

沙欣賢 arianalife.com | REPRODUCTIVE RIGHTS

WORLD OF CHANGE 變革世界 Words 文 Rafelle Allego

Philippines

Cebu Pink Paddlers Established in 2017, the Cebu Pink Paddlers have scooped up several awards at competitions around Asia. But that’s not the only reason it’s notable: As the first dragon boat team formed by cancer survivors in the Philippines, the Pink Paddlers provides an important source of strength, support and physical therapy. The teammates not only take care of each other but also promote early detection and diagnosis in order to save lives. “They are not just breast cancer survivors,” Christian Ian Sy, Cebu Pink Paddlers’ head coach, told Rappler. “They are now athletes who are inspiring the world, teaching us that despite the scenarios that may happen in someone’s life, one should keep moving forward as life must go on.”

菲律賓

宿霧粉槳自2017年成立以來，宿霧粉槳龍舟隊在亞洲各地的比賽中獲得了多個獎項。然而，這並非她們成名的唯一原因。宿霧粉槳是菲律賓第一支由乳癌康復者組成的龍舟隊伍，粉紅色的船槳給她們帶來了復康所需要的力量及支持，以至物理上的治療。龍舟隊的隊友們不僅互相照顧，還合力推廣癌症早期篩查和診斷，以挽救生命。龍舟隊主教練Christian Ian Sy接受菲律賓新聞網Rappler訪問時表示：「她們不僅僅是乳癌的倖存者，更是鼓舞世界的運動員。她們令世人明白到，無論生活中發生任何事都要不斷前進，讓生活得以繼續下去。」

Learn more 詳情請看: facebook.com/cebupinkpaddlersdbt17

Cebu Pink Paddlers

India

Barefoot College Founded in Rajasthan, India, in 1972, Barefoot College sets out to alleviate poverty and promote sustainable energy in rural communities around the world. At no cost to participants, the school invites women to take part in five-month-long Women Prosper vocational training programmes where they learn to be solar engineers. Throughout the curriculum, “Solar Mamas,” as they’re nicknamed, build a toolkit of practical skills. Not only can they install and maintain solar power for their communities, but they also learn to become entrepreneurs and educators. Nearly 50 years on, Barefoot College now operates in 1,300 villages across 92 countries and has impacted more than 2 million people.

印度

赤腳學院位於印度拉賈斯坦邦的赤腳學院成立於1972年，其宗旨是在世界各地的農村社區緩解貧困，並促進可持續能源。該校通過招募女性參與為期五個月的免費職業培訓課程，讓她們學習到如何成為太陽能工程師。被暱稱為「太陽能媽媽」的學員們會在課程中學習到一系列實用技能：她們不僅可以為社區安裝和維修太陽能電力系統，還可以學習成為企業家和教育家。過去 50年間，赤腳學院已將服務拓展至92個國家、1,300個村莊，受惠人數超過200萬人。

Learn more 詳情請看: barefootcollege.org

生育權 | arianalife.com

Barefoot College

T H E I N I T I AT I V E 環球倡議

16 Julia Gunther

WORLD OF CHANGE 變革世界

Rwanda

盧旺達

Maternity Ward

產科病房

German photojournalist Julia Gunther explores themes of social justice and gender issues in her work, which takes her across sub-Saharan Africa. On one of her trips to Rwanda, Gunther learned about the challenges facing women when it comes to reproductive rights. In the Central Africa nation, at least 30 per cent of births are unplanned due to a combination of strict local traditions and little sexual education, according to a study by the Guttmacher Institute. Of those pregnancies, roughly 22 per cent end in abortion – often in an unsafe or illegal environment, which can cause grave health risks. To raise awareness about these issues, Gunther started documenting daily interactions at Kigali’s Kanombe Military Hospital, one of the country’s major maternity wards, in 2013. “To be allowed to witness the intense joy and pain of childbirth is always humbling,” says Gunther. “New life is precious anywhere, but in a country like Rwanda, with its dark past still well within living memory, watching a child being welcomed into this world, is something very special.”

德國攝影記者Julia Gunther穿越撒哈拉以南的非洲，透過攝影探討社會公義和性別議題。在走訪盧旺達期間，她了解到婦女在生育權利方面所面臨的挑戰。紐約伽麥切爾研究所的研究報告指，由於當地嚴格的傳統加上性教育不足，盧旺達超過三分之一的新生兒都是來自意外懷孕的。而在意外懷孕的婦女當中，約 22%的人最終選擇墮胎，而且通常是在不安全或非法的環境中進行，給母親帶來嚴重的健康風險。為了提高意識，Gunther自2013年開始在基加利的卡諾比軍醫院記錄人們的日常互動。Gunther表示：「被允許目睹分娩的強烈喜悅和痛苦總是讓人感到自身微不足道。新生命在任何地方都是寶貴的，但在盧旺達這樣的國家，黑暗的過去仍然在人們的腦海裡揮之不去，在這裡看著一個孩子出生，感覺非常特別。」

Learn more 詳情請看: juliagunther.com/marternity-ward

arianalife.com | REPRODUCTIVE RIGHTS

Nemo’s Garden/Ocean Reef Group

Italy

Nemo’s Garden A chemical engineer, professional scuba diver and avid gardener, Sergio Gamberini combined his passions to create Nemo’s Garden. Located about 20 feet below the surface of the Ligurian Sea in northwestern Italy, the collection of ‘biospheres’ (which resemble balloon-like greenhouses) serves as an alternative way to grow produce such as basil, strawberries, beans and lettuce. The futuristic underwater system is not only used for botanical research but also as a way to repopulate marine life and teach the next generation about self-sustainable agricultural solutions. Gamberini believes that bold, outof-the-box ideas will be necessary in the face of extreme environmental conditions, which could make traditional farming more difficult in the future.

意大利

尼莫花園 Sergio Gamberini既是一名化學工程師，也是一名專業的水肺潛水員和園藝工作者。他把這些技能與愛好結合在一起，從而創造了尼莫花園。尼莫花園位於意大利西北部的利古里亞海裡約六米深的位置，由多個氣球狀的溫室「生態球」組成，為種植羅勒、草莓、豆類和萵苣等農產品提供了另類方式。這個充滿未來主義風格的水下系統不僅可用於植物學研究，還可以用來繁殖海洋生物，並向下一代傳授可自給自足的農業技術。Gamberini認為，在極端的環境條件下，傳統農業可能會變得越來越困難，因此必須以大膽創新的想法來應對。

Learn more 詳情請看: nemosgarden.com

DOGGED PURSUITS 不懈追求

Sai Kung Stray Friends Foundation’s founder Narelle Pamuk learns how to pitch sponsors from Hong Kong Round Table’s Jonathan Benarr. 西貢流浪狗協會創辦人 Narelle Pamuk向香港圓桌會成員 Jonathan Benarr請教申請資助所需要的技巧。

Words 文 Rhea Mogul | Photography 攝影 Karma Lo

生育權 | arianalife.com

DOGGED PURSUITS 不懈追求

ai Kung Stray Friends Foundation (SKSFF), located near Tai Lam Wu village in the New Territories, houses more than 100 stray dogs, many of which have been rescued from cramped, unhygienic breeding factories Australian Narelle Pamuk founded the animal charity in 2014 after noticing the high volume of abandoned, sick and unwanted dogs in Hong Kong. According to the Agriculture, Fisheries and Conservation Department (AFCD), the department caught or received about 2,300 stray dogs and 1,200 cats from 2015-2016. Since then, that number has decreased by half: 1,187 stray dogs and 508 stray cats were “reclaimed, rehomed or euthanised,” between 2018 and 2019. At SKSFF, Pamuk relies heavily on public donations to pay for the animals’ shelter, food and medical costs. Last year, she spent close to HK$1 million on veterinary bills. Pamuk also has big plans for expansion: She wants to rescue more dogs as well as build a not-for-profit clinic that covers animals’ medical needs and offers free neutering services to villages with high stray populations. Last year, Pamuk pitched Hong Kong Round Table (HKRT), a social club and philanthropic organisation that supports local charities, in hopes of raising money to bring these goals to life but was unsuccessful. For guidance on her fundraising journey, we invited Pamuk to sit down with Jonathan Benarr, a team member of HKRT. NARELLE PAMUK

Thank you for the chance to present to your team last year. What kept you from saying yes?

JONATHAN BENARR

During your pitch, we came to understand the dayto-day operations of the charity and saw obstacles that prevented us from funding SKSFF. For instance, the animal shelter is not selfsustaining and the request was heavily weighted towards operational costs, which is not something our charity pays towards. There was also a lack of clear strategy overall, which created some uncertainty.

西

貢流浪狗協會（SKSFF）位於新界大藍湖附近，收容了100多隻流浪狗，其中很多是從擁擠和不衛生的養殖場中拯救回來的。澳洲人 Narelle Pa mu k 注意到香港有大量被遺棄和生病的狗，遂於2014年創立了這個動物慈善機構。據漁農自然護理署年度報告， 2015年至 2016年間，漁護署捕獲和接收了近2,300隻流浪狗和1,200隻貓。而2018年至2019年間的數字則下降將近一半，共有1,187隻流浪狗和508 隻流浪貓被「捕捉、接收或處理」，683隻動物透過夥伴動物福利機構由市民領養。 SKSFF十分依靠公眾捐款來支付動物收容所、食物和醫療的費用。單是過去一年，該會就在獸醫費上花了近 100萬港元。 Pamuk還有擴充大計，她不僅想拯救更多流浪狗，還希望建立一所非牟利動物診所，以滿足這些動物的醫療需求，並在流浪動物較多的村落免費為動物絕育。香港圓桌會是一個支持本地慈善機構的社交團體和慈善組織，去年 Pamuk曾向該會申請資助，可惜未能成功。為了給她的籌款之路提供指引，我們邀請 Pamuk與香港圓桌會成員 Jon at h a n B e n a r r 坐下詳談。

NARELLE PAMUK

感謝您給我機會向你的團隊提出議案。是甚麼原因讓你拒絕了呢？

JONATHAN BENARR

我們透過遊說的過程，深入了解你慈善機構的日常運作，從中看到了一些問題，令我們對資助SKSFF有所卻步。比如說，動物收容所不能自給自足，而你要求的資金大部分用於營運成本，但我們通常不會提供這方面的資助。而且你也沒有提出清晰的整體策略，這一點亦令我們有所顧慮。診所是否能長期經營，是否有足夠理由令我們提供資助？這也是我們考慮的因素之一。例如，你是否會向其他使用診所的人收費，從而獲得營運資金？這樣我們才可以看到你能夠持續地獲得收入。為了保持聲譽，我們必須對自己捐贈的每一分錢負責，所以我們非常挑剔。

arianalife.com | REPRODUCTIVE RIGHTS

THE PITCH 變革攻略

生育權 | arianalife.com

DOGGED PURSUITS 不懈追求

Will the clinic be in business for long enough to justify us funding it? For instance, would you be charging other people to use the clinic, and thereby become sustainable? In that case, we can see there’s money being generated, and it’s going to continue. We are accountable to ourselves for every dime that we donate, because we want to maintain our reputation, so we are very particular. NP

Any advice on how to improve the initial pitch?

No one is going to get a donation signed off after that first pitch. Treat that meeting as an opportunity for us to meet and learn whether our values align. For that opening dialogue, tell your story: Who are you? Why did you start it? What is your passion? When presenting your pitch, keep it as simple as possible. The easier it is for us to digest the information, the easier it is to understand what you need. But it’s also important to get the balance between compassion and business just right. We buy into emotional engagement, and that plays an important role. In short, communicate your story and vision for what you wish to achieve, then outline measurable goals on how you plan to get there.

對於起初的計劃方案，你建議如何修改呢？

沒有人會在第一次申請就得到資助。第一次會面當作一個互相認識的機會，並從中理解我們的價值觀是否一致。你可以在開場對話中介紹一下你自己是誰、為甚麼創立這個機構，及你的推動力是甚麼？在表達你的想法時，表述得愈簡單愈好。資訊愈容易消化，我們就愈容易理解你的需要。在同情心和商業之間取得平衡是很重要的，但我們相信，情感投入是很重要的一環。比如說，你可以告訴我們創辦這個慈善機構的原因，如果是與個人經歷有關的話，你就可以分享你的心路歷程，但同時也要表達出對自己的目標抱持清晰的願景。你心裡必須要有一個清晰可行的緩解方案，來處理你慈善機構面對的問題。

POPULATION CONTROL 動物數量控制

Currently, the AFCD and The Society for the Prevention of Cruelty to Animals (SPCA) both practice the often-criticised “catch and kill” method to control stray populations, if homing is not possible. In 2015, however, the SPCA obtained approval from the government to conduct a three-year “trap-neuter-return” trial in Cheung Chau and Tai Tong. During the trials, which ended in 2018, dogs were captured by the organisation, de-sexed, and released back into their habitat. Analysis of the trials’ effectiveness is still underway. 雖然漁護署和香港愛護動物協會均會試圖為動物安排領養，但最終都會以「先捕後殺」的方法來控制流浪動物的數量。

2 0 1 5 年，香港愛護動物協會獲得政府批准，在長洲和大棠進行為期三年的流浪狗「捕捉、絕育、放回」試驗計劃，期間，該組織為被捕獲的流浪狗進行絕育手術，然後把牠們放回原來的棲息地。計劃於 2018 年結束，其成效尚在分析中。

THE PITCH 變革攻略

Which charities have you said yes to?

We are sector agnostic; however, we do like to help humanitarian-focused charities. For example, ImpactHK helps the homeless, LoveXpress helps families with autistic children and Tagsibol Foundation helps women who have been victims of violence. Recently, we gave money to a charity called Sailability. It’s a charity that teaches adults and children with learning difficulties how to sail. They needed sails, replacement dinghies and life vests – and we funded these items for them. We overwhelmingly prefer to invest in tangible needs as we can directly see where the money goes. For example, we donated money to Tai O Village after Typhoon Hato hit in 2017, as it wiped out home appliances like refrigerators, ovens and washing machines. We don’t pay, for example, electricity and water bills, because that’s an operational expenditure, and they vary.

你曾經批准哪些慈善機構的申請？

其實並沒有固定對象，不過我們的確喜歡幫助以人道主義為中心的慈善機構，例如幫助露宿者的 ImpactHK、服務自閉症家庭的LoveXpress，以及協助家暴受害人的Tagsibol基金會。最近，我們撥款給一個名為「 Sailability」、專門教導有學習障礙的成人和兒童駕駛帆船的慈善機構，以資助他們構買帆船、更換橡皮艇和救生衣。我們傾向資助慈善機構在物質上的需要，因為我們可以直接看到資金的用途。例如 2017 年颱風「天鴿」吹襲大澳村，幾乎摧毀了村內所有的家用電器，如冰箱、烤爐和洗衣機等，我們當時亦有捐款救助。不過，我們不會承擔如電費和水費等開

生育權 | arianalife.com

Who should we approach for funding? Should we be going to banks, wealth management organisations or hedge funds?

You have groups like the Hong Kong Jockey Club, which is a major charitable group, as well as the Rotary Club and Ladies Circle. Ladies Circle is our sister charity. Personally, I think if you go too big, you will be disappointed, as there are so many layers to go through with a big company. The chain of communication is more difficult, and many other charities will be targeting them too. Keep the focus on small- to medium-sized enterprises because you can access the right people faster. For example, Midland Realty, a property company in Hong Kong, has 20 to 30 branches internationally – you could approach them for fundraising. Some of the food and beverage groups like Pirata Group or Black Sheep Restaurants might also

支，因為這些屬於營運支出，而且種類繁多。 NP

我們應該向甚麼機構尋求贊助？應該選擇銀行、財富管理機構還是對沖基金？

香港賽馬會是一個重要的慈善團體，還有扶輪社和我們的姐妹慈善機構Ladies Circle。我個人認為，如果你找非常大型的機構，你可能會失望而回，因為在大公司你需要通過層層關卡，溝通上更加困難，而且許多慈善機構也會以他們為目標。你可以把焦點放在中小型企業，因為他們的層級較少，你可更快接觸到相關人士。例如，美聯物業在國際上有20至30家分支機構，你可以嘗試向他們提出資助申請。一些飲食集團，如Pirata Group或

DOGGED PURSUITS 不懈追求

be interested. These are companies that are very plugged in when it comes to social issues. Corporate social responsibility is very zeitgeist at the moment, as companies – and their consumers – do look at the impact they have on society. NP

Would HKRT consider funding a veterinary clinic for stray dogs? If we had our own clinic, we would save so much.

That’s a much bigger concept but something we could get behind. To make something like that work, we need to see a business plan. The plan has to be viable – we don’t want to invest in a project that will be abandoned down the line, so we need to know that you have thought about the long-run. 

Black Sheep Restaurants，也可能感興趣。這些公司通常都熱衷於社會議題。目前，企業社會責任正大行其道，因為企業和消費者們都確實會關注企業對社會的貢獻。 NP

你們會否考慮資助獸醫診所以幫助流浪狗？如果我們有自己的診所，我們可以省下很多錢。

這是一個更大的想法，但我們亦可以考慮。要令這個想法行得通，就必須要有一個可行的商業計劃，因為我們不想投資一個最終會半途而廢的項目，我們需要知道這個計劃是經過周詳考慮的。 

Learn more 詳情請看: saikungstrayfriends.org; roundtablehongkong.org

arianalife.com | REPRODUCTIVE RIGHTS

IN FOCUS 聚焦

生育權 | arianalife.com

RIGHT AT HOME 有你就是家

Cradle of Hope provides shelter and developmental support to vulnerable children in Macao. 「希望之源」為澳門的弱勢兒童提供庇護和支持。

Words 文 Rafelle Allego | Photography 攝影 Eduardo Leal

ne morning in 1993, Marjory Vendramini picked up her daily newspaper. On the front page, she read a heart-breaking story: A passer-by discovered a newborn boy inside a trash bin in Macao wrapped in plastic and covered in mice bites. The baby was taken to the hospital where he quickly recovered, but since Macao did not yet have any foster homes for infants, the child could not be discharged until Macao’s Social Welfare Bureau (IAS) found adoptive parents. Vendramini leapt into action. A missionary from Brazil, she had been living in Macao since 1990 and volunteering at a Christian missionary and outreach group called Youth with a Mission. Together with her husband Jorge, Vendramini offered to foster the boy while IAS searched for a permanent home. Considering the couple’s enthusiasm and extensive social work experience, the IAS agreed that fostering would be the best move for the child.

993年一個清晨， Marjory Vendramini 如常拿起報紙，赫然

看到頭版刊登了一則令人難過的新聞：澳門有市民在垃圾桶裡發現一名被遺棄的新生男嬰，當時他被膠袋包裹著，身上多處被老鼠咬傷。男嬰被送往醫院後很快就康復了，但由於當時澳門並沒有收容嬰兒的寄養機構，因此男嬰必須繼續留在醫院，等待澳門社會工作局（社工局）為他尋找收養者。 Vendramini決定採取行動。這位來自巴西的傳教士，從 1990 年起定居澳門，並在基督教宣教組織「青年使命團」擔任義工。她和丈夫Jorge向社工局表示願意在男嬰覓得收養家庭前暫時照顧他。考慮到二人對社會工作充滿熱忱，且富有經驗，社工局亦同意寄養是最好的安排。

arianalife.com | REPRODUCTIVE RIGHTS

IN FOCUS 聚焦

The bureau delivered the then 2-month-old had more than doubled to nine cases. Reports of baby to Vendramini’s home, where he remained for child abuse have also been on the rise: The Against four months until a family in Sweden adopted him. Child Abuse (Macau) Association recorded 41 cases Having proven that they could provide a safe, loving of child abuse in 2016, compared to nine in 2014. “I environment for vulnerable youth, the IAS began wish that Cradle of Hope Association did not need to trusting the couple to shelter more orphaned children exist,” says Vendramini. “Unfortunately, many kids under 3 years old. are deprived, for one reason or another, from living A year later, Vendramini and her husband with their families.” officially established their not-for-profit foster More than 300 children have lived in COHA’s organisation, Cradle of Hope Association (COHA). two homes since that first baby boy in 1993. Before “I’ve always loved being arriving at COHA, children around children and looking have often been passed from after them,” says Vendramini. caregiver to caregiver with no “But I’m also aware of the sense of safety or stability. hardships many of them “If children don’t build face. Founding COHA was secure attachments in their my way of creating a place early years, they’re likely for them to heal.” to have a delay in learning, Initially, the couple rented and possibly problems in an apartment in Taipa, one adulthood,” says Vendramini. of Macao's islands, with In addition, children who've enough space to care for up been traumatised are more to eight orphaned children at likely to suffer from depression, a time. But within just a few anxiety, trust issues, or physical years, the association grew in health problems. “These are size and scope. wounds that time won't heal In 1997, Cradle of Hope unless they get help as soon as – Marjory Vendramini moved into a much larger possible,” says Vendramini. space, and three years later To help children heal, they opened Fountain of Hope the COHA team includes on the Macao Peninsula. They dedicated this second home teachers, psychologists, therapists, counsellors and to caring for older children from 3 to 14 years old who nurses who offer essential social, educational and moral have been rescued from dangerous situations, such as support to children and young adults. They also integrate domestic abuse and serious neglect. various types of therapy, including art and play, which “We started extending our mission to those who Vendramini says can be effective tools to enhance didn’t have a home to go back to,” says Vendramini. children’s emotional and cognitive development. “For those who grew up with us, COHA is a safe place. “Play is the way children express themselves,” It’s a bridge for them to reach into their future.” says Vendramini. “By letting them play and playing COHA’s expansions came at the right time. with them, we can come to understand their needs According to IAS, there were 69 cases of abandoned and really connect. Drawing has the same effect. Kids children in Macao from 1999 to 30 June 2019. In share a lot of their emotional thoughts when they’re 2008, there were four cases – by 2018, that figure given a pencil and paper.”

“Forgiveness is one of the most powerful keys for healing.” 「寬恕是治癒心靈創傷最有效的方法之一。」

生育權 | arianalife.com

R I G H T AT H O M E

Vendramini把當時只有兩個月大的男嬰抱回家中照顧，直至男嬰在四個月後被一個瑞典家庭收養。看到這對夫婦能夠為弱勢兒童提供一個安全而充滿愛心的環境，社工局開始放心讓他們收容更多三歲以下的孤兒。一年後，Vendramini和丈夫正式成立非牟利寄養組織「希望之源協會」，「我很喜歡小孩子，也樂於照顧他們，同時我亦看到許多兒童的生活很艱難，所以我創立希望之源協會，為他們提供一個療癒的空間。」最初，這對夫婦在氹仔租了一個單位，足夠容納八名年幼孤兒。隨著組織的規模和服務範圍在短短幾年內逐漸擴大，二人遂於1997年將院舍遷至更大的空間，

三年後再於澳門半島開設第二個院舍「希望之泉」，專門照顧遭受家暴或被嚴重疏忽照顧的3至14歲的兒童與青少年。 Vendramini說：「我們開始將服務擴展至無家可歸者。對那些在我們照顧下成長的人來說，希望之源協會是一個安全的地方，是讓他們邁向未來的橋樑。」協會的擴充恰逢其時。根據社會工作局的數據， 1999年至 2019年 6月 30日期間，澳門共有 69宗遺棄兒童個案。 2008 年有四名兒童被遺棄，在 2018 年增加至九名。虐待兒童個案也有上升趨勢，根據澳門防止虐待兒童會（ ACAM ）的紀錄，2014年有九宗虐兒案件，2016年增加至41宗。 Vendramini說：「我寧願希望之源沒有

有你就是家

存在的必要。遺憾的是，許多兒童因為不同的原因被剝奪了與家人同住的權利。」自從 1993年收容第一個嬰兒至今，希望之源協會的兩個院舍已為 300多名兒童提供安身之所。來到院舍之前，這些兒童總是不斷更換照顧者，這讓他們既沒有安全感，生活也不穩定。 Vendramini說：「如果兒童沒有在發育早期建立起穩定的依附關係，他們很可能會有學習遲緩等問題，甚至在成年後還會出現精神困擾。」更嚴重的是，曾經受過創傷的兒童，極可能會產生抑鬱、焦慮、不信任他人等心理困擾，或生理健康問題。Vendramini說：「有些傷口不會因為時間而痊癒，因此必須盡快得到適當治療。」

arianalife.com | REPRODUCTIVE RIGHTS

IN FOCUS 聚焦

ADOPTION IN MACAO 澳門的領養制度 In cases of abuse or neglect, many children eventually return to their parents once IAS deems it safe. Vendramini says the resilience of children never fails to amaze her as, many times, they are able to return home with a forgiving attitude and a better understanding of their family’s problems. “They don't have any anger [towards] their parents when reuniting,” says Vendramini. “Forgiveness is one of the most powerful keys for healing.” The relationships that Vendramini and her team forge with children can last a lifetime. Many children return to visit, including Susan Wang*, a 20-year-old university student who grew up within COHA’s foster care system. “Marjory has been an essential guide to so many of us,” says Wang, who moved into COHA at 2 years old. “She has given us homes filled with love... COHA has the power of changing lives. It did with mine.”  *Name changed at the request of the subject.

At least 39 children have been adopted in Macao over the past 20 years. Here’s how adoption works: • Applicants should be between 25 and 60 years old - Foreign applicants are allowed • Adoptive parents can be: - Single (over 28 years old) - Married (over 25 years old, min 3 years together; no history of separation) - Domestic partners (min 3 years if adopting partner’s child; min five years if adopting together) • A mother can only agree to the adoption of her children six weeks after delivery • Children older than 12 must provide “consent” before a judge

為了幫助孩子們治癒創傷，希望之源協會找來老師、心理學家、治療師、顧問和護士組成支援團隊，為兒童和青少年提供社交、教育和道德等方面的協助。他們還整合各種療法，例如藝術和遊戲等， Vendramini深信這些療法能夠讓兒童加強情感和認知發展。 Vendramini說：「遊戲是兒童表達自我的方式。透過陪伴他們玩耍，我們可以了解他們的需要，跟他們建立起真正的連繫。繪畫也有同樣的作用。給孩子一支鉛筆和一張紙，他們就會分享很多個人的情緒和心思。」在一些受虐或疏於照顧的個案中，兒童通常會在社工局認為安全的情況下回到父母身邊。 Vendramini說，孩子們往往擁有驚人的復原能力，因為很多時他們回家之後，都會以寬容的態度原諒父母，而且更能體諒家裡的問題。 Vendramini說：「與家人團聚後，他們並沒有記恨父母。寬恕是治癒心靈創傷最有效的方法之一。」 Vendramini和她的團隊與孩子們建立的關係可以維持一輩子，許多孩子會在長大後回來探望他們。現年 20 歲的大學生 Susan*就是在希望之源協會的庇護下成長的孩子，她在兩歲時住進協會的院舍。「Marjory為我們很多人照亮了前路，她為我們提供了一個充滿愛的家……希望之源具有改變生命的力量。我在這裡重獲新生。」她說。

• Age difference between the adopter and adoptee should be 18-50 years

*已按受訪者要求更改名字。

• • 收養人和待被收養人之間的年齡差距應介於 18至 50年之間

過去20年來，澳門至少有39名兒童被領養。以下是澳門的領養條件： • • 收養申請人的年齡應介於 25歲至 60歲 -外國人也可申請領養 • • 養父母可以是： -單身（必須是 28歲以上） -已婚（至少三年，且無事實分居，二人均超過 25歲） -同居伴侶（如果是個人收養，而收養對象是伴侶的子女，雙方必須共同生活逾三年；若是共同收養，則必須共同生活逾五年） • • 生母只能在子女出生六個星期之後方可同意收養

•• 1 2 歲以上的兒童必須親自向法官提出「同意」

Learn more 詳情請看: cradleofhope-association.org

生育權 | arianalife.com

R I G H T AT H O M E

有你就是家

7 SPACE AD

arianalife.com | REPRODUCTIVE RIGHTS

FAMILY PLANNING 計劃生育

63%

of women* globally in 2017 used some form of contraception. 2017年女性使用不同避孕方法的百分比。 Here’s the breakdown by region: 以下為各地區比例： *Married or in a union; 15-49 years old 已婚或有伴侶；年齡介乎15至49歲

生殖健康

REPRODUCTIVE HEALTH

T H E FA C T S 事實數據

生育權 | arianalife.com

70%

75%

65%

36%

75%

• North America 北美洲 • Latin America and Caribbean 拉丁美洲與加勒比海地區 • Europe 歐洲 • Africa 非洲 • Asia 亞洲 Oceania 大洋洲 •

SITUATION IN THE SARS

特區狀況

HONG KONG 香港

Sexual and reproductive health services provided by the Family Planning Association in 2018: 香港家庭計劃指導會（家計會）於2018年提供的性與生殖健康服務數字：

104,910 Birth control services for men and women 男女節育指導服務

25,516

33%

of health issues for women between 15 and 44 are caused by sexual and reproductive problems. The most common examples include: 在15至44歲的女性當中，由性和生殖問題引起的健康問題比例。其中最常見的問題包括：

FAMILY PLANNING AND CONTRACEPTION 計劃生育和避孕

58%

 Emergency contraception 緊急避孕  Adolescent pregnancy 未成年懷孕  Unsafe abortion 不安全墮胎  Maternal mortality 孕婦死亡

Women’s health services, including hormone replacement therapy 女性健康服務，包括荷爾蒙補充療法

4,856 Sub-fertility services 生育指導服務

5,547 Men’s health services, including erectile dysfunction treatments 男性健康服務，包括陽痿治療

2,037 Surgical services, including vasectomy, male circumcision and surgical abortion 手術服務，包括輸精管結紮手術、包皮環切手術及終止懷孕手術

SEXUALLY TRANSMITTED INFECTIONS 性傳播疾病

 HIV/AIDS 人類免疫缺乏病毒/愛滋病  Human papillomavirus (HPV) 人類乳突病毒  Cervical cancer 子宮頸癌 Sources 來源: World Health Organization, United Nations

MACAO 澳門

Macao does not track sexual and reproductive services beyond basic census data. 除了基本的人口普查數據外，澳門並未有性與生殖服務相關的數據紀錄。

arianalife.com | REPRODUCTIVE RIGHTS

T H E FA C T S 事實數據

MATERNAL MORTALITY 產婦死亡率

In developing countries, maternal mortality is an all-too-common reality. 發展中國家的產婦死亡率高得令人難以接受。

94% 38% decrease in maternal mortality rate, from

342 deaths per 100,000 live births in 2000 to 211 deaths in 2017

of maternal deaths occur in low

產婦死亡率降幅。按每10萬名活產嬰兒計

and lower-middle-income countries

算的孕婦死亡比率由2000年的342人下降至

產婦死亡發生在低收入和中低收入國家之比例

2017年的211人。

DEADLY BIRTHS 致命分娩

2017年，非洲國家的產婦死亡率是全球最高的。

*per 100,000 live births *每10萬活產

Sources 來源：WHO, UNICEF

生育權 | arianalife.com

MATERNAL MORTALITY* 產婦死亡率

As of 2017, African nations had the highest maternal mortality rates.*

South Sudan

Chad

Sierra Leone

南蘇丹

乍得

塞拉利昂

UNDERAGE PREGNANCY 未成年懷孕

2.5 million

women died every single day in 2017 from preventable causes related to pregnancy and childbirth

girls under 15 years old give birth annually 每年 15歲以下產婦人數

2017年，全球每天死於與懷孕和分娩有關的可預防疾病的女性人數

3.9 million

girls aged 15-19 undergo unsafe abortions every year

PREVENTABLE CAUSES: 可預防的死因:

每年進行不安全墮胎的15到19歲少女人數

33,000

child marriages every day 每日童婚個案宗數

 Severe bleeding 嚴重出血  Infection 感染

650 million

women and girls alive today married as children

 High blood pressure 高血壓  Complications from delivery 分娩併發症  Unsafe abortions 不安全墮胎

在兒童時代成婚並生存至今的少女和女性人數

140 million

girls will become child brides between 2011 and 2020 2011至2020年間有1.4億名女孩成為童婚新娘

150 million

more girls will become child brides by 2030 without accelerated progress 按目前增長速度，到2030年，全球將再有1.5億名少女成為童婚新娘

Nigeria 尼日利亞

Somalia & Central African Republic 索馬里和中非共和國

INFERTILITY 不孕 Between 50 and 80 million people globally are infertile, accounting for roughly 8-12% of couples. Many turn to assisted reproductive technologies, such as in vitro fertilisation (IVF), artificial insemination, intrafallopian transfer and surrogacy. 全球約有5,000至8,000萬人不能生育，約佔全球伴侶的8至12%。很多人因此尋求輔助生殖科技的協助，如體外受精（IVF)、人工授精、輸卵管內移植及代孕。

WHO USES IVF? 誰會使用體外受精？

23% > 40

BY AGE 年齡

12%

65% 30-39

< 30

BY MARITAL STATUS 婚姻狀況

100%

3% SINGLE

單身人士

90.7% in a heterosexual r e l at i o n s h i p

5.9%

處於異性關係的女性

in a same-sex r e l at i o n s h i p

處於同性關係或沒有伴侶的女性

Based on 2017 figures in the UK *根據英國2017年數據

生殖權 | arianalife.com

R E P R O D U C T I V E H E A LT H 生殖健康

EMERGING TRENDS 大勢所趨

EGG FREEZING

冷凍卵子

1,200%

IVF IN FOCUS

Increase in egg freezing procedures in the US, from 745 in 2009 to 6,207 in 2015

輔助生殖技術

美國進行冷凍卵子的上升比例 (由2009年745宗至2015年6,207宗）

NEARLY

11,000

American* women freeze their eggs annually 每年選擇冷凍卵子的美國*婦女數字

2.5 million

257%

in vitro cycles annually around the world

Increase in the UK, from 410 egg-freezing cycle in 2012 to 1,462 in 2017

全球每年體外受精次數

英國進行冷凍卵子的上升比例，卵子冷凍週期從2012年 410個到2017年增至1,462個

23.3% success rate for live births from IVF 體外受精活產成功率

500,000

BY AGE 年齡數據 The UK’s Human Fertilisation and Embryo Authority (HFEA) says the optimal time for egg-freezing is during a woman’s 20s and early 30s. However, 67% of patients are older than 35: 英國人類受精與胚胎學管理局(HFEA)表示，卵子冷凍的最佳時間是在 20歲到30歲初。然⽽，在選擇凍卵的⼥性當中，有65%超過35歲:

deliveries annually 每年生產次數 50%

> 8 million

25%

IVF children born to date 至今已出生的IVF嬰兒數字 0%

• • • • •

< 35: 33%

35-37: 29% 38-39: 21% 40-42: 13% > 43: 4%

*Global data is not available 暫未有全球數據。 Source 來源: IFFS Global Reproductive Health

Sources 來源: The Guardian, HFEA, The Economist

arianalife.com | REPRODUCTIVE RIGHTS

T H E FA C T S 事實數據

FEMALE GENITAL MUTILATION 女性割禮

Driven by entrenched cultural and religious beliefs, Female Genital Mutilation (FGM) causes injury to female genital organs for no medical purpose: 女性割禮是根深蒂固的宗教及文化傳統，毫無醫療益處，且對女性的生殖器官造成嚴重損傷：

< 15 The age when most FGM is carried out 進行割禮的主要年齡

> 3 million girls annually are estimated to be at risk of FGM 每年面臨割禮威脅的少女人數

> 200 million women and girls alive today have been subjected 當今世上受過割禮的少女和女性人數

30 countries in Africa, the Middle East and Asia practice FGM 仍奉行女性割禮的非洲、中東和亞洲國家數字

HEALTH RISKS 健康風險:  Infections 感染  Genital tissue swelling 生殖器組織腫脹  Urinary problems 尿道問題  HIV transmission HIV感染  Death 死亡 Sources 來源: UNICEF, WHO, UN

生育權 | arianalife.com

R E P R O D U C T I V E H E A LT H 生殖健康

MALE REPRODUCTIVE HEALTH PROBLEMS 男性生殖健康問題

MOST COMMON ISSUES 常見問題  Low sexual desire 性慾低下  Ejaculation disorders 射精障礙  Penile disorders 外生殖器異常  Impotence 性無能  Erectile dysfunction 勃起功能障礙  Testicular cancer 睪丸癌  Prostate disease 前列腺疾病 Source 來源: Australian Family Physician

ERECTILE DYSFUNCTION 勃起功能障礙 The inability to maintain an erection for sexual intercourse can be caused by psychological or physical reasons:

無法在性交時保持勃起可能是由心理或生理原因引起的:

PSYCHOLOGICAL • • • • • • • •

PHYSICAL

心理原因

Alcoholism 酗酒 Stress 壓力 Anxiety 焦慮 Depression 抑鬱 Fatigue 疲勞 Smoking 吸煙 Drug abuse 藥物濫用 Lack of communication between partners 與伴侶缺乏溝通

• • • • • • • • • •

生理原因

Injury to the penis 陰莖受損 Prostate cancer treatment 前列腺癌治療 Spinal cord injury 脊椎受損 Neurological diseases 神經性疾病 Heart, Peyronie's or kidney disease 心臟、佩羅尼氏或腎臟疾病 Diabetes, obesity or low testosterone 糖尿病、肥胖或睪酮不足 High cholesterol and lipid levels 高膽固醇和血脂水平 Hypertension (high blood pressure) 高血壓 Hormonal disorders 荷爾蒙失調 Certain medications 服用某種藥物

BY AGE 年齡數據

5% of men in their 40s have complete erectile dysfunction, compared with about 15% of men in their 70s 在年屆40歲的男性當中有5%完全無法勃起，而在年屆70歲的男性中比例約為15%。

arianalife.com | REPRODUCTIVE SPRINGRIGHTS 2020

T H E FA C T S 事實數據

ESSENTIAL TERMS 說文解字

   Abortion

The termination of pregnancy. Safe abortions usually refer to legal abortions performed by a registered medical professional in a medical clinic or hospital. Unsafe abortions usually refer to illegal abortions performed in an unhygienic environment by individuals who lack the necessary qualifications.

   Assisted Reproductive Technology

Assisted Reproductive Technology (ART) includes all forms of fertility treatments where both eggs and embryos are handled, including in vitro fertilisation (IVF), donor in vitro fertilisation (donor IVF), intrauterine insemination, intrafallopian transfer, and intracytoplasmic sperm injection (ICSI). In the case of IVF, doctors remove eggs 40

R E P R O D U C T I V E H E A LT H 生殖健康

from a woman’s ovaries, then fertilise them with the father’s sperm in a laboratory. Successfully fertilised eggs are then returned to the original woman’s body (IVF) or donated to another woman (donor IVF).

   墮胎

   Contraception

   輔助生殖技術

   Donor insemination

輔助生殖技術（ART）包括體外受精（IVF）、贈卵體外受精（donor IVF）、人工受精、輸卵管內植入術及胞漿精子注射（ICSI）等所有處理卵子和胚胎的生殖治療。在進行IVF時，醫生會從女性的卵巢內取出幾個卵子，然後在實驗室裡讓它們與男方的精子結合。成功受精的卵子隨後會被放回該名女性體內（即體外受精）或捐贈給另一名女性（即贈卵體外受精）。

Various methods used by women to prevent pregnancy, including the use of condoms, oral contraceptives, the morning after pill, intrauterine devices, contraceptive rings, contraceptive implants, contraceptive injections or sterilisation.

An assisted fertilisation procedure involving the use of a syringe to insert semen into a woman’s vagina.

   Egg Freezing

Also known as oocyte cryopreservation, egg freezing is an increasingly popular procedure intended to preserve a woman’s reproductive potential for professional or personal reasons. During the treatment, doctors extract a patient’s eggs, freeze them, then store them for several years until the woman is ready to try fertilising them.

   Family Planning

Planning by a family to determine the number and timing of their children.

   Maternal Mortality

即終止懷孕。安全墮胎通常是由註冊醫療專業人員在醫療診所或醫院合法進行。不安全墮胎則是由不合資格的人在不衛生的環境下進行的非法墮胎。

   避孕指女性使用的各種避孕方式，包括使用避孕套、口服避孕藥、事後避孕藥、宮內節育器、陰道避孕環、避孕植入管、避孕注射針或絕育。

   異配受精一種輔助受精技術，主要使用注射器將精液注入女性陰道。

   冷凍卵子也被稱為卵母細胞冷凍保存，是一種越來越流行的輔助生殖方法，目的是幫助出於職業或個人原因希望保存生育能力的女性。在過程中，醫生會提取女性的卵子，並加以冷凍保存，直到該名女性打算讓卵子受精。

When a woman dies while pregnant or within 42 days of terminating a pregnancy due to complications related to the pregnancy.

   計劃生育

   Reproductive Health

婦女在懷孕期間或在終止懷孕後42天內因妊娠相關的併發症而死亡。

Complete physical, mental and social well-being relating to the reproductive system and its functions. It implies that people have a satisfying and safe sex life, with the capacity to reproduce and have the freedom to decide when and how often this will be.

   Sexual Health

Closely tied to Reproductive Health, but focuses on the physical, mental and social well-being in relation to sexuality.

由一個家庭來計劃並決定他們生育子女的數量和時間。

   孕婦死亡

   生殖健康與生殖系統及其功能有關的完整的生理、心理和社會福利，這亦意味著擁有滿意和安全的性生活、生育能力，以及決定生育時間及間距的自由。

   性健康與生殖健康密切相關，但關注與性有關的生理、心理和社會福利。 41

C U LT U R E N E W S 文化資訊

LIVE AND LEARN 學無止境 A selection of thought-provoking documentaries, books and podcasts from the Ariana team. Ariana精心挑選一系列發人深省的紀錄片、書籍和 podcast節目。

DISPLACED

Hosted by Grant Gordon and Ravi Gurumurthy, Displaced is a podcast that tackles the world’s most pressing issues, such as climate change, displacement crises and the future of warfare. You’ll hear from some of the world’s most forward thinkers, including policymakers, activists and entrepreneurs, as well as moving personal stories from those who have been directly affected by humanitarian crises. Grant Gordon和 Ravi Gurumurthy主持的 podcast 節目《 Displaced 》，探討全球最迫切的問題，如氣候變化、流離失所危機，以及戰爭的未來。節目訪問最具前瞻遠見的思想家，包括政策制定者、社運人士及企業家，並且邀請遭受不人道對待的受害者親述自己的經歷。

生育權 | arianalife.com

THE HANDMAID’S TALE

EXPLAINED

《使女的故事》

《流行大百科》

Based on Margaret Atwood's 1985 novel of the same name, The Handmaid’s Tale TV series is returning this autumn for its fourth season. The story takes place in Gilead, a dystopian authoritarian republic where women are enslaved as surrogates for infertile couples on the pretense of preserving mankind.

As the name implies, Explained aims to unpack complicated issues in engaging, informative ways. This Netflix series covers a wide range of topics from cryptocurrency to the world of athleisure wear, the future of meat, pandemics, beauty, K-Pop, diamonds and much more.

改編自瑪格麗特・愛特伍於 1985 年出版的同名小說，《使女的故事》第四季將於今年秋季播映。故事以名為「基列國」的反烏托邦專制共和國為背景，該國以保存人類命脈為名義，逼迫女性成為不孕夫婦的生產工具。

從影片名稱不難猜出這套 Netflix原創作品旨在以深入淺出的方式來解開各種複雜問題的謎團。《流行大百科》內容涵蓋各種主題，從加密貨幣到運動休閒風、肉類的未來、流感疫症、美的定義、韓國流行音樂到鑽石等。

FROM THE ARCHIVES 檔案重溫

1987: Fourteen Days in May An award-winning BBC documentary by Paul Hamann, Fourteen Days in

May invoked widespread criticism of capital punishment when it aired in 1987. The film centres around the final days of Edward Earl Johnson, an African American man who was convicted of murder and sentenced to death by the US state of Mississippi. While on death row, Johnson continuously

professed

innocence,

asserting that police coerced him to sign a false confession. The state executed Johnson on 20 May 1987 when he was 26 years old. BBC得獎紀錄片《Fourteen Days in May》由Paul Hamann拍攝，於1987

MAID: HARD WORK, LOW PAY, AND A MOTHER'S WILL TO SURVIVE 《我只想讓我女兒有個家：一個單親女傭的求生之路》

Equal parts social exposé and memoir, Maid sheds light on the stigmas of poverty through the eyes of Stephanie Land, a single mum who works as a housekeeper while caring for her daughter and studying to become a writer. The New York Times bestseller reflects the experience of thousands of underpaid, overworked single mothers worldwide. 這本書既是作者史蒂芬妮・蘭德的回憶錄，也刻畫了窮苦低下階級的日常生活。作者在書中講述自己由一個單親鐘點女傭進修成為作家的經歷，其間靠微薄的收入撫養女兒。蘭德的作品真實反映了全球成千上萬低薪單親母親的苦況，上巿後即登上《紐約時報》的暢銷書榜。

A WOMAN IS NO MAN

年在電視台播映時引起社會大眾對死刑一致撻伐。影片記錄非裔美籍死刑犯Edward Earl Johnson走完人生最

Palestinian-American writer Etaf Rum’s debut novel tells a story of three generations of Palestinian-American women whose lives are dictated by religion, marriage and childrearing obligations. Relegated to second-class citizens, the women look for ways to escape the abuse and oppression experienced in their daily life.

後日子的過程。他因謀殺罪名成立，被密西西比州政府判處死刑，但是在死囚牢房時，他不斷宣稱清白，聲稱因警方脅迫才在捏造的供詞上簽字認罪。州政府於 1987年 5月 20日處決 Johnson，當年他26歲。

巴勒斯坦裔美籍作家伊塔芙・蘭姆的處女作《 A Woman Is No Man》，以一個移居美國的巴勒斯坦家庭為中心，講述了家族中三代女性的故事。她們把一生奉獻給宗教、婚姻和撫養子女等義務，卻在家族中淪為次等階級，因此想方設法逃避日常生活中經常發生的虐待和壓迫。 Watch 觀看： bbc.co.uk/programmes/p05m5xb9

arianalife.com | REPRODUCTIVE RIGHTS

HER VOICE 女聲

生育權 | arianalife.com

EQUAL OPPORTUNITIES 機會均等

Faride Shroff, the founder of SENsational Consultancy, explains why she’s working to cultivate a more inclusive workforce. SENsational Consultancy 創辦人 Faride Shroff 分享她為何致力推動更平等共融的工作環境。 Words 文 Rhea Mogul | Photography 攝影 Karma Lo

uring her nearly two-decade-long career as a special education teacher in Mumbai and Hong Kong, Faride Shroff came to the realisation that many of her students have struggled to find work after graduating. Without any income, some of her former students have had to rely on their family or the government for support, which left them feeling depressed and hopeless. Determined to change the situation, Shroff left teaching seven years ago to start SENsational Consultancy, a social enterprise in Hong Kong which dispels misconceptions about people with disabilities, provides corporate training on inclusivity, and offers pro-bono training for candidates with disabilities to help them thrive in a corporate setting. SENsational has worked with many industry leaders such as HSBC, Bank of America, Colliers International, AXA, BNP Paribas and Skadden, among others. We speak with Shroff about her work, and why she believes it’s crucial for society to cultivate more inclusive work environments.

過

去在孟買和香港從事特殊教育工作近 20年間， Faride Shroff發現很多學生在畢業後都難以就業，無法維持生計，只能依賴家人或政府支持，這讓他們感到沮喪且絕望。 Shroff 決心改變現狀，於是她在七年前毅然辭職，在香港創立了社會企業 SENsational Consultancy ，致力於消除人們對殘疾人士的誤解，教育並協助企業制定更具包容性的政策，並且為殘疾人士免費提供職業培訓，幫助他們更快適應工作環境。 SENsational 與許多龍頭企業合作，如匯豐銀行、美國銀行、高力國際、 AXA 安盛、法國巴黎銀行及世達國際律師事務所等。 Shroff 與我們暢談她的工作，以及為何締造更平等共融的工作環境至關重要。

arianalife.com | REPRODUCTIVE RIGHTS

HER VOICE 女聲

ARIANA

Did you always want to become a teacher?

FARIDE SHROFF

I actually always dreamt about becoming a teacher. When I was in secondary school, I started teaching young children in my neighbourhood and provided private tutoring sessions. At university in Mumbai, I studied education – that’s where I started training at a special-needs school on campus. I remember those days fondly: The children would sit beside me and we’d chat, read stories and play games. It was the highlight of my day and it did not take long for me to realise that I wanted to devote my career to working with students with disabilities.

ARIANA

them with pity and don’t have a lot of interaction. This is not what they want. People with disabilities want – and deserve – to be an integral part of our society with mutual respect and equal rights. ARIANA FS

What are a few highlights from your career? When I was teaching at Beacon Hill School in Hong Kong, I had the freedom to start new initiatives, which included early intervention programmes for infants and parents, and the inclusion of differently abled students in mainstream schools. I also trained some of my students to participate in the US Special Olympics, where they won gold and silver medals in long distance running. Being an athlete myself, I would take the students to run after school and on the weekends. Seeing their determination and perseverance has greatly enriched my life. I think that my work has also positively impacted my students, as I have helped them build selfconfidence and taught them to remain positive. I also often speak with parents to give them a chance to express their feelings freely and discuss the challenges they might be facing.

ARIANA

In Hong Kong, what have you observed about the attitude towards people with special needs?

There is certainly a lack of awareness in Hong Kong and Asia-Pacific, in general. Most of this stems from ignorance, fear, a lack of understanding, cultural bias, and not having the opportunity to interact closely with people with disabilities. Often, people are willing to make charitable donations for people with disabilities, but they look at

生育權 | arianalife.com

ARIANA

What led you to start SENsational Consultancy? I have always felt a deep connection with my students. Even after they have graduated, I try to maintain relationships with them and do what I can to help them succeed. When hearing from former students, I noticed that many were battling depression, in addition to their own physical and psychological challenges, because they couldn’t find work and contribute to society. At that time, about seven years ago, I realised that no one in Hong Kong was working to help people with disabilities enter the workforce and educate society about the importance of inclusion. I wanted to build those bridges – that’s why I founded SENsational Consultancy, “SEN” standing for “Special Employment Needs.” What does SENsational Consultancy do?

Our mission is to create an equal and inclusive working environment and society for all. By raising awareness and sensitising members of society, we hope that differently abled workers can better integrate into the workforce, showcase their unique talents and add value to the company. To fulfill this goal, we provide customised corporate training programmes and, in the future, we will work with corporates to hire people with disabilities. We will also offer pro-bono, one-on-one support for candidates with disabilities to ensure a smooth and successful transition into the corporate workforce.

ARIANA

What were the biggest obstacles when you first started in 2013?

First, I had to adapt to a new role. Having been a teacher for so many years, I had no idea how to run a business. Creating equal opportunities for everyone seemed like such a simple plan.

EQUAL OPPORTUNITIES 機會均等

At SENsational Consultancy's 'Showcasing Talent with Disabilities' event SENsational Consultancy舉辦的「Showcasing Talent with Disabilities」活動 From left 由左起： Pooja Vora; Faride Shroff; Jezrael Lucero (musician 音樂人)

ARIANA

你是否一直想成為一名老師？

FARIDE SHROFF

是的，從事教師工作一直是我的夢想。讀中學時，我開始在社區指導小朋友做功課，兼作私人補習。在孟買讀大學時，我主修教育，並開始在校園附設的特殊教育學校接受培訓。我對那段日子充滿感情，孩子們會圍在我身邊，大家一起聊天、讀故事書和玩遊戲。那是我人生中的美好時光，我很快就意識到自己未來的職業志向將是為殘疾學生服務。

ARIANA FS

你的職業生涯中有哪些精彩之處？當我在香港的畢架山小學任教時，學校允許我自行展開新項目，包括為嬰兒和父母而設的早期介入計劃，並且將能力有差異的學生納入主流學校。我還訓練了幾位學生參加美國特殊奧運會，他們捧回了長跑金牌和銀牌。我本身也是一名運動

員，經常在放學後和週末帶學生去跑步。看到他們的決心和毅力，我的生活也更加充實。我幫助學生建立自信，教他們保持積極的人生態度，因此我認為自己對學生有正面影響。此外，我經常與學生的父母溝通，讓他們有機會自由表達感受，也跟他們討論可能需要面對的挑戰。 ARIANA

你在香港看到一般人對有特殊需要的人態度如何？

一般來說，香港和亞太區對這方面缺乏一定的認知，主要是由於無知、恐懼、缺乏理解、文化偏見，以及沒有機會與殘疾人士實際互動等緣故造成的。人們通常都願意慷慨解囊捐助殘疾人士，但他們大多以可憐的眼光看待他們，彼此之間沒有太多互動。殘疾人士想要的不是這個。他們想要且有權成為我們社會必不可少的一分子，同樣受到尊重及擁有平等的權利。

arianalife.com | REPRODUCTIVE RIGHTS

SENsational Consultancy

HER VOICE 女聲

But it wasn’t that easy. To achieve this goal, I realised that I would have to change a deep-rooted unconscious bias in society, which is very difficult. It was hard at first – a lot of companies cancelled on us or had a dismissive attitude in those early days. It’s gotten easier, as many companies have started to see the overwhelmingly positive impact of an inclusive workforce. We are very pleased with the gradual shift in our society towards inclusivity and open dialogues regarding disabilities.

ARIANA

How do you work with corporations on inclusivity?

We are continuously working to change misconceptions about disabilities as well as help companies employ differently abled workers by providing simple yet effective solutions. The first and most important solution is to dispel misconceptions about hiring persons with disabilities through

生育權 | arianalife.com

practical workshops and training sessions, which we give to corporate employees and hiring managers. Other simple solutions include offering technological support – such as a larger display screen or special applications – to a person with visual impairment. Simple hearing aids and text messages could be used for people with hearing impairments. ARIANA

Why is it important to cultivate a more inclusive workforce?

I truly believe that it is important for all companies to gain a competitive edge by being more inclusive. People often focus more on the “dis” rather than the “abilities.” For example, many people are unaware that technology can help a visually impaired person read, or that a physically challenged person can drive a car, swim or take part in a marathon. We need to change our perceptions to advance society as a whole.

EQUAL OPPORTUNITIES 機會均等

ARIANA

甚麼原因促使你創立 SENsational Consultancy ？

我一直覺得跟學生心意相通，我真心關懷他們。即使他們畢業了，我也會嘗試與他們保持聯繫，並且盡力幫助他們成功。聽到一些舊生的近況時，我留意到許多人除了面對身體和心理上的挑戰，還受到抑鬱症的困擾，因為他們找不到工作，覺得自己對社會沒有貢獻。大約七年前，我發現香港沒有人幫助殘疾人士進入勞動力市場，從而讓大家明白多元共融的重要性。我想在殘疾人士與社會之間建立起溝通的橋樑，於是創立 SENsational Consultancy ， SEN 代表「 Special Employment Needs （特殊就業需要）」的意思。

ARIANA FS

一些公司甚至對我們嗤之以鼻。但隨著時間過去，許多公司開始看到多元共融的工作環境帶來的正面影響。社會逐漸朝更平等共融的方向發展，與殘疾人士展開更多溝通，這些轉變令人倍感欣慰。 ARIANA FS

SENsational Consultancy 的主要工作是甚麼？我們的使命是為所有人創造一個機會平等、多元共融的工作環境和社會。透過提高社會成員的意識和感知，我們希望協助能力有差異的人士融入工作團隊，一展所長，從而為企業作出貢獻。為了實現這個目標，我們為企業提供特別制定的培訓計劃，並且協助企業聘用殘疾人士。我們還為正在謀職的殘疾人士提供免費的一對一職業培訓，確保他們可以順利而成功地踏入職場。你在 2013 年創立公司時遭遇過甚麼主要障礙？首先，我必須適應新角色。多年來我一直擔任老師，對營商一竅不通，只想為每個人創造平等的機會，但做起來才明白知易行難。為了實現這個目標，我必須改變社會上對殘疾人士根深蒂固而不自覺的偏頗態度，而這一點非常困難。公司創立初期，我們遭到許多公司拒絕，

ARIANA FS

你如何與企業合作開創共融社會？我們一直努力改變社會對殘疾人士的誤解，以及提供簡單而有效的策略以協助企業聘用能力有差異的員工。第一個也是最重要的策略是消除對聘用殘疾人士的誤解，我們會為企業員工和招聘經理提供工作坊及培訓課程。其他的簡單方案包括提供技術支援，例如為視障員工設置更大型的顯示屏或特殊應用程式。至於有聽力障礙的員工，則可準備一些簡單的助聽器材和以短訊溝通。為何締造更平等共融的工作環境如此重要？我堅信所有公司均可透過更平等共融的策略獲得競爭優勢，這一點很重要。大家通常會把焦點放在「殘疾」而非「能力」上。例如，許多人不知道視障人士可以利用科技協助他們閱讀，或是身體有殘障的人亦能開車、游泳或參加馬拉松。我們必須改變先入為主的觀念，才能合眾人之力推動社會發展。可以分享一個成功個案嗎？有一次，我們幫一位求職多年的年輕女士找到一份適合她的工作。她在這家公司工作了快六年，現在她不僅對自己更有自信，更肯定自我價值，也因為對社會更有歸屬感而變得更快樂。她的家人、朋友和同事亦因此改變對她的看法。

arianalife.com | REPRODUCTIVE RIGHTS

HER VOICE 女聲

BY THE NUMBERS 看數說話 ARIANA FS

ARIANA FS

Can you share a success story? In one instance, we helped a young lady who was suffering from acute depression. She was unable to find a job despite all her efforts and felt like a burden on her parents. Through coaching, mentoring and training with SENsational, she felt empowered to continue her job search. After she found the right job, she worked at the company diligently for several years. Having this success in her life boosted her confidence and selfworth, and she became a much happier person because she felt included in society. It also changed the way her family, friends and co-workers viewed her. What’s next for SENsational? We want it to be a win-win situation for all stakeholders. In our 10-year plan, we would like to work with more companies in Asia-Pacific and represent Hong Kong as a leading specialist in disability inclusion globally. We would also like to work with the Hong Kong government to make our city more accessible for people with disabilities. Eventually, I would like to build a residential space for candidates with disabilities to be able to live and work independently. 

<0.02% The number of registered companies in Hong Kong that employ persons with disabilities, according to SENsational 據SENsational網頁，

香港聘用殘疾人士的註冊公司的比例

6% The official unemployment rate of persons with disabilities in 2013. Social welfare groups say it’s much higher in reality

2013年香港政府統計適齡工作殘疾人士的失業率，但社福團體認為實際比率高於此數據

48% of disabled individuals were jobless in 2017, according to a survey by six welfare groups 據六所社會服務機構的調查，

2017年失業或待業的殘疾人士比例

55% ARIANA FS

SENsational 接下來有何大計？我們希望為所有相關人士開創雙贏。我們希望在未來這10年與更多亞太地區的公司合作，並代表香港成為全球傷健共融領域的領導者。我們也希望與香港政府合作，使這個城市更適合殘疾人士生活。我的最終目的是為殘疾人士建立一個適合居住的空間，讓他們獨立生活和工作。 

Learn more 詳情請看: sensationalconsultancy.com

生育權 | arianalife.com

of employers said they wouldn’t hire disabled workers 沒有意願聘請殘疾人士的香港僱主比例

17% Of Hong Kong employers expressed an interest in hiring disabled workers, according to a 2016 survey by CareER 據CareER的2016年調查，有興趣聘請殘疾人士的香港僱主比例

their bodies. Very often, they are affected by their families, husbands and traditional cultures, which all undermine their autonomy,” says Joan, in Invisible Tolls (pg 60). “But after this experience, I understand that women should determine what happens to their bodies, and every woman should take control over her own life." 「女性對自己的身體一向沒有很大的自主權。很多時她們會受到家庭、丈夫和傳統文化的影響，令到她們不能自主。不過，這次經歷後，我明白到，女性的身體應該由自己主宰，她應該要自己決定她的生命。」

Joan 在《自主之難》中說( pg 62 )。

Let’s Talk About Sex 談性可以嗎？

Invisible Tolls 自主之難

Out of Step 不一致的步調

The Surrogates 借腹生子

Tomorrow’s Harvest 希望在明天

102

My Child-Free Choice 無孩人生

112

Life Studies 生命何去

118

F E AT UR ES 專題故事

“Women do not always have control over

LET’S TALK ABOUT SEX 談性可以嗎？ For many students in Macao, progressive sexuality education is still off the table. 對於澳門的許多學生而言，進步的性教育仍然遙不可及。

Words 文 Cathy Lai and Rafelle Allego | Illustrations 插圖 Mandy Chan

t Chan Sui Ki Perpetual Help College (PHC), a Catholic school in Macao, 17-year-old Enya* has learned the “proper way” to interact with the opposite sex: According to her teachers, dating is acceptable, but sex should be avoided until marriage. “Our Catholic teachers have told us that sex is a gift from God so we shouldn’t do it casually,” says Enya, noting that graphic descriptions of abortions have accompanied some abstinence lessons. “They told us how doctors insert forceps into the uterus, crush the fetus, then use a plastic tube to pull it out,” she recalls of a Form 5 class conducted by social workers from Macao Catholic Family Advisory Council. “When they explained the procedure, I was frightened and found it really cruel.” According to PHC Principal Sister Margaret Cheung, the school’s sexuality education curriculum covers topics like abortion, sex, consent, sexually transmitted diseases and contraception but does not address gender diversity or homosexuality. They also do not condone pre-marital sex. “We insist that sexual activities should be based on true love and commitment and [teenagers] should not reject the possibility of pregnancy,” Cheung explains. “If the students understand these concepts then they will know how to be good men or women by playing their gender roles appropriately throughout the different stages of their life.” PHC is just one example of how religiously affiliated schools in Macao – which comprise roughly half of the city’s 77 schools – approach sexuality education. These schools address many important topics, but often saturate lessons with religious beliefs and traditional gender conventions. “I would say that, in Catholic schools, [sex education] is taught indirectly,” says Father Rodrigo*, a former teacher who retired three years ago from a local school. Rodrigo says that the focus tends to be more on cultivating respect and love between partners, rather than having open conversations about sex. The relatively late introduction of a government-backed sexuality education curriculum in 1999 (about a decade after Hong Kong’s) also impacts teaching methods, as many schools are playing catch up when it comes to meeting the needs of youth in modern society.

就

讀陳瑞祺永援中學（永援中學）的澳門學生 Enya *，自小就被這家天主教學校教導與異性的「相處之道」：結織異性、約會男生是可以的，但要等到結婚之後，才可以發生性行為。「我們的天主教老師說，性是上帝的禮物，所以我們不可以隨意對待。」現年 17 歲的 Enya 說。她亦記得，在中五的一堂課中，學校專程請了社工向同學們講解墮胎如何進行。「他們描述醫生如何將鉗子伸進子宮裡，將胎兒打碎，之後用一條塑膠管將胎兒吸出。聽著他們解釋，我除了感到害怕，也覺得很殘忍。」永援中學校長張湧秀修女表示，該校的性教育課程包括墮胎、性、身體自主權、性病和避孕，但不會提及性別多元或同性戀，而且亦會教導學生拒絕婚前性行為。「我們堅持性應該是基於真愛和承諾，而且不能否定懷孕的可能性，」張修女解釋道。「如果學生明白這些概念，他們就會知道如何在人生的不同階段中，恰當地扮演他們的性別角色，從而成為一個好男人、好女人。」永援中學是其中一個例子，反映澳門的教會學校在進行性教育時，滲入了宗教的價值觀。而在 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

DESIGN YOUR OWN CURRICULUM Conceived by the Education and Youth Affairs Bureau of Macao, the curriculum covers lessons for kindergarten through secondary school. In 2011 and 2012, the Education Bureau of Macao, alongside experts from Taiwan, updated its curriculum, publishing its Sex Education Supplementary Teaching Materials – new lessons that address topics such as physiological health, relationships, privacy, bodily integrity, and respect for gender and sexual diversity. The materials are available to all schools in Macao at no cost. As of 2018, 85 per cent of Macao’s 77 local schools referred to some or all of the bureau’s materials. Though the curriculum is intended to be secular, religiously affiliated schools have had notable influence: Among the seven schools consulted by the Education Bureau, four had Christian backgrounds. This input can be seen in chapters such as “The Ideal

Kingdom of True Love”, which encourages students to "wait for true love, and refuse premarital sex.” Though the supplementary materials exist, it does not necessarily mean religiously affiliated schools will teach these lessons. Schools have the freedom to design their own curriculums – they can adapt, cut or add materials based on their values. Furthermore, schools often local NGOs to manage sexuality education lessons. Many participating associations – such as Caritas Macau, Macao Catholic Family Advisory Council, and Gabinete Coordenador dos Serviços Sociais, Sheng Kung Hui, Macau – have religious affiliations. The Macao Society of Sexuality Education (MSSE) is one of the few secular NGOs promoting and teaching sex education in the city. Established in 2013, the NGO hosts workshops and talks in partnership with several local schools and associations. But when working with religiously affiliated schools, General Director Fiona

澳門，宗教團體營辦的學校佔全澳 77 間學校的一半。 R o dr igo * 神父曾於澳門的學校任教，並於三年前退休。他觀察到，教會學校很少會直接教授性教育，「它們往往將性教育的焦點放在培養伴侶之間的尊重和愛，而不是就性本身展開坦率的對話。」

自己課程自己設計澳門政府於 1999 年才制定性教育課程大綱，涵蓋幼稚園到中學的學程。這個相對滯後的發展（比香港晚了大約 10 年），令很多學校至今仍未能開展全面而進步的性教育。在 2011 和 2012 年，澳門教育暨青年局（教青局）在台灣專家的協助下推出新的性教育教材《性教育輔助資源》，內容包括精神 54

生育權 | arianalife.com

L E T ’ S T A L K A B O U T S E X 談性可以嗎？

Chan says MSSE must take a tailormade approach. “When it comes to sensitive topics such as sexual activity, we need to have a discussion with the school first to understand what they can or cannot accept,” says Chan. “From there, we will adjust our teaching content accordingly. We understand that it’s their stance, and we respect that.”

COMING OF AGE Comprehensive, progressive sexuality education – covering the cognitive, emotional, physical and social aspects of sexuality – is an essential part of a child’s preparation for the world, enabling them to protect their health, make informed decisions, advance gender equality and navigate one of the most confusing, challenging times in life. For Vivek Nair, the director of School of the Nations (SON), an international school in Macao, educational institutions have a responsibility to evolve alongside society. SON tackles the issue by providing a safe environment for students to ask questions – not just about sex but also about relationships in general. In one of the school’s Language and Literature classes, for example, teachers use Kazuo Ishiguro’s Never Let Me Go, a dystopian science fiction novel published in 2005 that explores themes about relationships and the question of identity as a vehicle to discuss sexuality. “I don’t believe it’s our position to moralise or tell people, ‘You must do this,’” Nair says. “But we

KEY TAKEAWAYS 關鍵撮要 Macao introduced its sexuality education curriculum in 1999 澳門在1999年制定性教育課程大綱 Roughly half of Macao’s schools have religious affiliations, which emphasise abstinence 澳門的學校有大約一半具宗教背景，而宗教團體往往反對婚前性行為 Students say discussions about sex and relationships are rare 學生們表示關於性和關係的討論非常少 In a 2019 survey on sex and reproductive issues, students answered an average of 50 per cent of questions correctly 2019年一項關性知識的調查發現，受訪學生平均只能答對一半的問題 Discussions on LGBT+ issues and gender diversity are still absent from lessons 有關性小眾、性別多元的討論仍然未在課堂出現

健康、關係、私隱、身體完整性和尊重性別和性向多元，而且免費提供給澳門的所有學校。截至 2018 年，全澳 85% 以上的學校使用或參考這份教材。這些教材本應是世俗化的，但教會學校在其編制過程中有一定的影響力：在教青局就課程內容所諮詢的七家學校和機構當中，四家有基督教或天主教背景，其立場亦反映在一些章節中，比如「真愛的理想國度」，就是鼓勵學生「等待真愛，拒絕婚前性行為」。雖然有了這些輔助教材，但教會學校不一定要教授其中的內容。學校有自由決定自己的教材，也可以根據辦學理念改編、刪減或者增加內容。此外，許多學校都會邀請當地的非政府組織為學生提供性教育課程，例如澳門明愛、澳門天主教美滿家庭協進會和聖公會澳門社會服務處，而這些組織大都是有宗教背景的。澳門性教育學會是當地少數推廣性教育的非宗教組織。該學會在 2013 年成立，曾與當地數家學校和協會一起主辦工作坊和講座。學會理事長陳敬蓮說，每當跟教會學校合作時，他們必須小心設計合適的教學內容。「涉及性行為這樣的敏感題目時，我們必須先與學校討論，了解他們可以或不可以接受的內容，然後再調整教材。我們明白這是他們的立場，我們亦予以尊重。」

穿越青春期全面、進步的性教育應涵蓋與性相關的認知、情感、生理變化和社交關係，這有助於孩子在度過人生中最困惑的階段時，能夠保 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

want to provide them with the tools, skills, and moral understanding that they need to make their own informed decisions later on in life.” Many students from religiously affiliated schools in Macao say they rarely, if ever, had a chance to have meaningful conversations. “Our school will tell you about sexual intercourse, sexual harassment, and other topics related to sex education, but only on surface level,” says Ada*, who graduated two years ago from all-girls secondary school Sacred Heart Canossian College. “Students rarely have the chance to discuss and share their own views and experiences on these topics.” This felt particularly limiting in an all-girls school like hers. “Since we don’t have as many opportunities to interact with the opposite sex as the students in co-ed schools, I noticed that some of my classmates didn’t feel at ease when interacting with boys. We can’t learn how to interact with others based on theory.” In its content for secondary schools, the government’s Sex Education Supplementary Teaching Materials cover affection and attraction with videos that unpack the stages of relationships, from making friends and dating to a stable relationship, marriage and physical intimacy – in that 56

生育權 | arianalife.com

護自己的身心健康、作出知情的決定，以及擁抱性別平等。聯國學校是澳門的一家國際學校，其總監 Vivek Nair 認為，教育機構有責任與社會一同進步，為學生提供安全的環境，讓他們可以放心提出自己的疑問，無論是關於性，還是一般的人際關係。例如，在該校的語言及文學課上，老師會與學生討論英籍日裔作家石黑一雄在 2005 年出版的反烏托邦科幻小說《別讓我走》；這部小說主要探討關係和身分的問題，而聯國學校的老師就用它作為討論性的媒介。「我不認為我們有資格去進行道德說教，或者告訴別人『你該這樣做』，但我們希望賦予學生所需的知識和道德觀念，讓他們得以在人生中作出知情抉擇。」 Nair 說。不過， A r i an a 訪問過的教會學校學生都表示，他們極少有機會可以發聲，或進行有意義的對話。「學校會講解性交和性騷擾等性教育議題，但沒有講得很深入。」 Ada * 說。她在兩年前從澳門嘉諾撒聖心女子中學（聖心中學）畢業。「學生很少有機會討論或分享他們的看法和經歷。」這種受限的感覺在她就讀的全女子中學尤其明顯。「我們沒有男女校學生那麼多機會與異性接觸，所以我留意到有些同學不太懂得如何與男生相處。我們不能單憑理論學習如何與異性交往。」教青局《性教育教學輔助資源》的中學教學內容包括愛情和兩性間的互相吸引，附有錄像解說關係的不同階段，從交友到約會到發展出穩定的關係，到結婚和親密關係。該教材也鼓勵課堂討論和角色扮演，比如邀請人去約會，或者一般社交聚會。不

L E T ’ S T A L K A B O U T S E X 談性可以嗎？

order. The chapters also encourage discussions and role-playing activities in classes, such as inviting someone out on a date or a casual get-together. However, the local students Ariana spoke with don’t recall any such activities being carried out in school. Enya, the student from PHC, believes that sex is a precious gift that should be saved for marriage. However, she thinks that schools in Macao that focus heavily on abstinence are missing an opportunity to help students better understand their sexual needs, desires, and fears. “I’ve watched documentaries about sex ed and found that schools in the West are often very straightforward when it comes to discussing affection and attraction between two people during puberty,” says Enya. Gary*, a fellow student at PHC, made similar observations. “We might discuss affection between boys and girls among our friends or learn [about sex] from the movies or internet, but we are seldom given opportunities to raise questions or share our thoughts openly at school.” Gary says he has felt confused about his feelings for the opposite sex in the past and believes more open conversations in school could help students understand physical and emotional challenges.

過 Ariana 訪問過的澳門學生卻表示，學校並沒有進行這些活動。永援中學學生 Enya 也認為，性是一份「珍貴的禮物」，應該留給自己的丈夫。不過她觀察到，學校若過於排斥婚前性行為，就無法幫助學生更好地了解自己的性需求、慾望和恐懼。「我看過關於性教育的紀錄片，覺得西方學校通常會更直接地討論兩性在青春期間的彼此吸引和愛慕。」 Enya 說。永援中學另一位學生 Gary * 也有類似的觀察。「我們可能會與朋友討論男女之間的傾慕之情，或者從電影或網絡學習（關於性的事），但我們在學校很少有機會提問，或者分享我們的看法。」

"We want to provide the tools, skills, and moral understanding students need to make informed decisions." 「我們希望賦予學生所需的知識和道德觀念，讓他們得以在人生中作出知情抉擇。」 – Vivek Nair

arianalife.com | REPRODUCTIVE RIGHTS

ELEPHANT IN THE ROOM

COMPREHENSIVE SEXUALITY EDUCATION 全面性教育 The United Nations Population Fund provides guidelines for comprehensive sexuality education: 聯合國人口基金提供全面性教育指引： Foster respect for human rights

A lack of discourse about sex in schools hasn’t kept Macao’s teenagers from engaging in sex. In 2012, a survey conducted by Macau New Chinese Youth Association found that local students had it intercourse for the first time at 15.9 years old on average. However, a small study published in 2017 by the Sheng Kung Hui North District Youth Service Team revealed the average age has since dropped to 14.3, based on interviews with roughly 207 teenagers aged 12 to 18. This is barely older than the age of consent in Macao, which is 14 for both girls and boys, and two years younger than the legal age to marry, which is 16. By comparison, the average age in the US is around 17 for both men and women, according to a 2015 report released by the Centers for Disease Control and Prevention.

and diversity 建立對人權和多元性的尊重 Encourage critical thinking already stated below 鼓勵批判性思考和青年人參與決策 Nurture attitudes that promote gender equality and inclusion 培養推動性別平等和共融的態度 Include participatory methods to strengthen communication and decision-making 引入參與式教學方法來強化溝通技能和決策能力 Address gender inequality, vulnerabilities, exclusion and human rights violations 回應性別不平等、脆弱性、排斥性和侵犯人權等問題 Contain scientifically accurate information 獲取科學上準確的資訊

Gary 說他過去曾經有過困惑，不知道如何理解自己對異性的感覺，他認為學校應該提供更開放的對話空間，以協助學生理解自己的生理和情緒變化。

房間裡的大象雖然學校缺乏有關性的討論，但這不代表青少年會「不想不做」。 2012 年，澳門中華新青年協會的一項調查發現，澳門青少年發生初次性行為的平均年齡為 15 . 9 歲。五年後，聖公會北區青年服務隊對 207 名 12 到 18 歲的青少年進行了一項小規模調查，發現首次性行為的平均年齡已經下降到 14 . 3 歲，僅高於澳門的最低合法性交年齡 14 歲，而且比法定最低結婚年齡 16歲還要小兩歲。相較之下，據美國疾病控制和預防中心的 2015 年報告，當地青少年的首次性行為平均年齡是 17 歲。澳門大學教育系助理教授麥紫君認為，缺乏開放討論，容易令年輕人被網上的不實信息誤導。「孩子（和青少年）知道如何在沒有家長指引下搜索資料，他們有機會在荷爾蒙和青春期影響下較早接觸（性內容）。」

L E T ’ S T A L K A B O U T S E X 談性可以嗎？

Mak Chi Kuan, an assistant professor in the Faculty of Education at the University of Macau, says that the absence of open discussion can lead to other problems, such as misinformation found online. “Children [and teens] today know how to search for information without parental guidance, which can lead to early exploration [of sexual content] due to hormonal changes and puberty.” Statistics support her concerns: In a 2015 survey conducted by the General Association of Chinese Students of Macao (AECM), 45 per cent of 1,000 local students surveyed said they had seen pornographic information online within the past two years, while 13.9 per cent said that they came across it almost daily. Furthermore, a 2019 survey of 1,106 students by AECM required participants to answer a set of questions about pregnancy, abortion, and other sexrelated topics. Respondents answered just 50 per cent of the questions correctly on average.

CHANGING WITH THE TIMES Anecdotal evidence suggests that homosexuality is gradually becoming more accepted in Macao society, especially among the younger generation. However, in 2019, LGBT+ rights group Rainbow of Macau conducted a survey of 1,000 people from the local LGBT+ community where 53 per cent of participants believe that the effort made by local educational institutions to remove the stigma of homosexuality is “seriously inadequate” and about 27 per cent said it’s “inadequate.” To its credit, the Education Bureau’s Sex Education Supplementary Teaching Materials includes a chapter called “Respecting Diversity,” which aims to encourage the acceptance of sexuality diversity with language such as, “homosexual people are individuals that deserve respect in their daily life and love life.”

澳門中華學生聯合總會 2015 年的一份調查，證實了麥紫君的擔憂。調查發現，在 1 , 000 名受訪的澳門學生中， 45% 的人在過去兩年有在網上瀏覽過色情資訊， 13 . 9% 表示幾乎每天看。此外，澳門中華學生聯合總會在 2019 年訪問了 1 , 106 名中學生，並要求受訪者回答一系列關於懷孕和墮胎等方面的性知識問題。結果顯示，受訪者的正確回答率只有五成。

與時俱進雖然澳門社會普遍對同性戀的接受度越來越高，尤其是年輕一代，不過，由性小眾權利團體「澳門彩虹」發佈的「 2019 澳門同志調查」顯示，在 1 , 000 名受訪的性小眾人士當中，有一半以上的人認為澳門教育機構對消除同志污名化的工作「嚴重不足」， 27. 4%認為「不足」。在教青局出版的《性教育輔助資源》中，有一章節為「尊重多元」，用以鼓勵對性向和性別多元的包容，例如該章節指，「同性戀者不管是在生活上或是戀情中都是一個值得被尊重的個體」。 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

The chapter continues: “In the past, humans education in Macao since 2014, says the city’s delay in thought that boys must be in a blue box, and girls must introducing the curriculum might be part of the reason be in a red box. They thought that the world had only that many schools have yet to incorporate this topic. two colours, blue and red, but in fact, gender does not “[The lack of content on sexual diversity] may not have only two ends.” be 100 per cent about religious influence,” says Chan. However, many reli“As the teaching of sex edgious schools choose not ucation in Macao is in its to teach this chapter. Sister early stages, there are still "They thought that the world Cheung from PHC says a lot of topics to explore. had only two colours, blue she feels unprepared to The schools will likely discuss the topic with stuchoose the topics that are and red, but gender does not dents, because “there are more basic, such as teachhave only two ends." a lot of biological reasons ing students to protect behind [homosexuality] themselves from sexual 「過去社會以為天下只有藍與紅 that we are uncertain of.” abuse or simply, awareFrom a Catholic perspecness of sexual abuse.” 兩種顏色，但性別的表現不可能 tive she does not “think With the support of 只有兩端。」 [homosexuality] is corthe Education Bureau, rect.” Recent graduate Ada Chan says she has obconfirmed that sexual oriserved interest in proentation was never formally discussed during her time at viding more progressive, up-to-date sex education Sacred Heart Canossian College. amongst teachers, social workers and counsellors who SON also does not proactively provide classes on receive FPAHK’s training. “Every trial class we consexual diversity. However, Victoria Arjomand, the duct in Macao is attended by a lot of teachers who middle school’s administrator, says these types of dis- have meetings afterwards to discuss what they have cussions are welcome. learned,” she says. “I can see that a seed has been Keeley Chan, an education officer at Family planted in Macao.”  Planning Association of Hong Kong (FPAHK) which has been providing training and support for sexuality *Names changed at the request of subjects.

生育權 | arianalife.com

L E T ’ S T A L K A B O U T S E X 談性可以嗎？

AGE OF CONSENT 最低合法性交年齡 20

South Korea 南韓

18 India, Bhutan, Vietnam

印度、不丹、越南

AGE

16 15

15 L aos, Cambodia, Thailand, North Korea

14 13 Japan 日本

China, Macao, Myanmar, Bangladesh, Timor Leste

老撾、柬埔寨、泰國、北韓

Hong Kong, Nepal, Brunei, Taiwan, Malaysia, Mongolia, Indonesia, Singapore, Sri Lanka 香港、尼泊爾、文萊、台灣、馬來西亞、蒙古、印尼、新加坡、斯里蘭卡

中國、澳門、緬甸、孟加拉、東帝汶

Philippines 菲律賓

10 Source 來源: Age of Consent, Senate of the Philippines

這一章還提到：「過去社會認為男生一定在藍色框裡，女生一定在紅色框裡，以為天下只有藍與紅兩種顏色，但事實上性別的表現不可能只有兩端。」不過，許多教會學校都沒有在課堂中提及這一章。永援中學的張修女表示，該校未準備好與學生討論這個議題，因為「（同性戀）背後有很多未知的生物學原因」。從天主教的角度來看，她「不認為同性戀是正確的」。 Ada 也說，在她就讀聖心中學期間，從未進行過關於性取向的正式討論。

聯國學校也沒有主動提供關於多元性向的教育，不過校長 Victoria Arjomand 表示，學校歡迎有關討論。香港家庭計劃指導會（家計會）自2014年開始在澳門提供性教育的培訓和支援。家計會教育主任陳潔凌認為，澳門在推行性教育課程上起步較遲，這也是導致許多學校尚未引入有關課程的原因之一。「多元性向教育的缺乏，未必百分百與宗教影響有關，」陳潔凌說。「澳門性教育的發展仍然在早

期階段，還有很多題目需要探討，所以學校通常會更著重一些基本議題，例如教導學生保護自己，或者是防範性侵的意識。」陳潔凌也觀察到，在教青局的支持下，老師、社工和輔導員在接受家計會的培訓時，都展現出對多元進步的性教育的興趣。「我們每次在澳門試教時都有許多老師來參加，之後他們會開會討論學到的東西，」她說。「我可以看到種子已在澳門播下了。」  *已按受訪者要求使用化名。

arianalife.com | REPRODUCTIVE RIGHTS

Joan had an abortion at the age of 25 Joan在25歲時接受了終止懷孕手術

INVISIBLE TOLLS 自主之難 Long waits and social stigma hinder young women from obtaining safe, timely abortion services. 冗長的輪候時間及帶有偏見的醫護人員，均阻礙了年輕女性尋求適切的人工流產服務。

Words 文 Ruby Lai | Photography 攝影 Karma Lo

hen Sally* looked down at the two bars on her pregnancy test, she was devastated. Her period was a month late, but she never expected to be pregnant. Sally immediately sought help from Teen’s Key, an NGO supporting young women and their reproductive health. While a social worker talked her through the options, Sally's mind went blank. All she knew was that she couldn’t have the child. As an 18-year-old high school student, Sally was afraid that having a baby would disrupt her education and damage her relationships. At the same time, having an abortion would also interrupt her studies and anger her parents. Either way, she felt trapped. She told herself that terminating the pregnancy was the hardest option, but also the most rational. Accompanied by the social worker, she visited the Family Planning Association of Hong Kong (FPAHK) for help. But due to a pre-existing physical condition, which Sally declined to share, FPAHK could not admit her for surgery and referred her to Princess Margaret Hospital. She couldn’t have imagined how long the process would be. First, Sally had a thorough gynecological exam, followed by a series of follow-up appointments. If she failed to attend even one, she would have to wait a long time before she could reschedule. The teenager missed several days of school in the process, which affected her attendance and academic progress.

當

Sally* 看到驗孕棒的兩道杆時，只感到晴天霹靂。此前，她因為經期推遲了一個月便嘗試驗孕，沒想真的到懷孕了。確定懷孕後， Sally立即聯繫青躍──一個關注年輕女性及她們的生殖健康的非政府組織。當身旁的社工不斷鋪陳出各種資訊時，她腦中卻一片空白，僅有一個強烈的念頭：一定不可以生下來。那時她剛滿 18歲，仍然在學，如果選擇生產，不但會中斷學業，也會破壞她跟家人的關係。然而，如果她選擇終止懷孕，學業或會受阻，而她亦可能要面對父母的責難。眼前的兩難，令她進退失據。 Sally 對自己說，終止懷孕是最可行的艱難選擇。在社工陪同下， Sally前往家庭計劃指導會（家計會）求助。由於她的身體出現她不願意透露的特殊狀況，因此不適合在家計會進行手術，故被轉介到公立瑪嘉烈醫院。沒想到，這竟是漫長煎熬的開始。當時， Sally被轉介到瑪嘉烈醫院排期進行手術。從首次赴院到手術期間，檢查非常仔細，醫生其後再安排了多次檢查和覆診。 63

F E AT U R E 專題故事

Two months later, at three months pregnant, Sally still hadn’t had an abortion due to the long waiting list. When she was finally cleared for surgery, doctors found that her fetus no longer had a heartbeat and instead organised a medical abortion. During a surgical abortion – which is considered one of the safest and quickest methods – the patient is sedated. Once the anesthetic has taken effect the doctor inserts a tube into the uterus and, applying gentle pressure, removes the contents and lining of the uterus. In Sally’s case, doctors administered drugs orally to induce contractions and cause her to pass pregnancy tissue out of her body. After the abortion, Sally attended three more follow-up consultations so doctors could monitor her recovery. The whole process – from discovering she was pregnant to the medical abortion – lasted almost 17 weeks, or four months. Throughout, Sally felt exhausted, simultaneously shouldering pressure from school, her family, consultations, and her fragile emotions. “The hospital had already stipulated that the abortion needed to be done within a specific period [24 weeks, or six months], so why did the scheduling process last so long? I was already torturing and punishing myself internally. I didn’t need the hospital to do that for me.”

這些覆檢均不能改期，如果她錯過了就要重新排期。如是者， Sally因覆診而無法上課，令出席率不足，嚴重影響學業進度。因輪候時間漫長， Sally到懷孕差不多三個月時仍未能接受流產手術。待輪到她接受手術時，她的胎兒被判定為沒有心跳，醫生遂安排她接受藥物流產，而非流產手術。流產手術被認為是其中一種最安全和快捷的方法，手術期間，病人將接受麻醉。當麻醉藥生效時，醫生將會把吸管探入病人的子宮裡，輕柔地施加壓力，把胚胎組織吸出子宮。而 Sally的個案則是使用口服藥物以刺激子宮收縮從而排出胚胎引發自然流產。流產後， Sally還需要覆檢兩至三次以跟進恢復進度。 64

生育權 | arianalife.com

After terminating her pregnancy, Sally felt depressed and suffered from mood swings. She had a bad temper, refused to eat, and could not stop crying. With the benefit of hindsight, Sally believes that her reaction was caused by stress, uncertainty, and the hospital’s many delays. A number of studies have found that negative emotions can be mitigated with the right support: timely and professional care, respect for the woman’s decisions, and compassion during the recovery process. Unfortunately, in Hong Kong, many young women instead encounter long wait times and social stigmas.

A LONG WAIT In 1973, the US Supreme Court affirmed a woman's constitutional right to have an abortion in the landmark case Roe v. Wade. Over the following decades, more countries and regions began to legalise abortion, including Hong Kong. In 1969, a 17-year-old rape victim sought the right to have a legal abortion in Hong Kong, but the government denied her request, triggering a public debate. A few years later, in 1972, the government introduced the abortion bill and abortion was

從發現懷孕到藥物流產，整個過程共歷時約四個月。這趟經歷令 Sally身心俱疲，她不但要面對來自學校、家庭和應診的強大壓力，還有脆弱的情緒。「其實，醫院本來已有規定流產需要在特定期限內（ 24周，或六個月）進行，那為甚麼排期歷時這麼長？我的情緒也會折磨自己，我不需要醫院來折磨我了。」終止懷孕後， Sally 感到抑鬱，情緒亦常波動。她經常脾氣暴躁，拒絕進食，整天以淚洗面。現在回想起來， Sally覺得那時候的低落情緒，原是因為壓力、未知，以及醫院的漫長輪候。不少研究亦指出，終止懷孕並不一定導致負面情緒，關鍵在於能否得到適切的支援：能否得到適時

和專業的照顧、女性的決策和意願是否受到支持，以及在康復期間有否得到關懷等。不幸地，在香港，不少年輕女性卻要面對冗長的輪候時間以及社會污名。

漫長等待美國聯邦最高法院於 1973年的羅訴韋德案( Roe V. Wade)中，首次確認婦女的墮胎權受憲法保障。此後數十年，不少國家和地區陸續把終止懷孕合法化，包括香港。 1969 年，香港一名 17 歲少女因姦成孕，她要求合法地終止懷孕，卻被政府拒絕，事件引起公眾關注並開展了公共討論。幾年後，隨著港府於 1972年提出合法流產的法案，人工流產在 1976年正式合法

I N V I S I B L E T O L L S 自主之難

ABORTION LAWS AROUND THE WORLD 全球各地的墮胎法

P rohibited altogether

To save the woman's life

H ealth or therapeutic grounds

完全禁止

拯救孕婦性命

健康或治療理由

B road social or economic grounds

O n request (gestational limits vary)

廣泛的社會或經濟因素

按孕婦要求（胎齡限制不同）

legalised in 1976. According to Section 47A of the Offences Against the Person Ordinance (Cap. 212), an individual may undergo abortion surgery at a designated hospital with the consent of two registered medical practitioners on a case-by-case basis. There are currently 19 public and private hospitals providing legal abortions in Hong Kong. One of them is a clinic operated by the FPAHK, which provides medical and surgical abortions for pregnancies up to 10 weeks. In addition, the FPAHK provides free consultation and counselling services before the procedure. While private hospitals can usually schedule a procedure within days, the wait time for abortions in Hong Kong public hospitals takes roughly two to three months from the time of referral. Once the pregnancy exceeds the 14th week, doctors may need to induce labour to terminate a pregnancy due to the developmental stage of the fetus. When compared with early medical or

Source 來源: Centre for Reproductive Rights

化。根據《侵害人身罪條例》第 212章第 47A條，在兩名註冊醫生同意下，個人能於指定醫院接受終止懷孕手術，但醫生的批准需依據具體情況而定。目前在香港提供合法人工流產服務手術的醫院包括 19間公立和私家醫院。家計會轄下的診所亦為其一，提供藥物流產和手術流產，但只為懷孕 10週內的孕婦進行手術。除此之外，家計會亦會在手術前提供免費諮詢和輔導服務。在私立醫院，終止懷孕手術大多能於數天內安排，但公立醫院 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

surgical abortions, labour induction can create a greater physical and mental burden on the patient. Even with long waits, many women still choose public hospitals because they are the most affordable among legal abortion services. Public hospital fees range from a few hundred dollars to HK$1,000, while FPAHK charges HK$4,000-5,000, and private hospitals charge HK$20,000-30,000. Usually, women or their partners pay the fees out-ofpocket, while young couples without a stable income may borrow money from relatives and friends. Since Sally had an abortion in a public hospital, where the procedure cost roughly HK$1,000, the teenager was able to cover the fee with her savings. Public services are particularly important for young and underprivileged women like Sally – a student from a working-class family – who cannot afford the higher fees. However, these services are limited: Queen Mary Hospital provides one morning session per week for pregnancy abortion assessments and one afternoon session per week for surgical abortions. At the Legislative Council’s Panel on Health Services in 2019, LegCo council member Shiu Ka-Chun urged the

的終止懷孕服務一般要自轉介後排期兩至三個月。一旦妊娠超過了第 14個星期，醫生或需要以引產進行流產，因為胎兒那時的發展狀態未必再適合以吸引手術終止懷孕。引產為女性所帶來的身心負擔則更大。即使排期時間長，但仍有不少人選擇公立服務，因為費用較其他合法流產服務更可負擔。在提供合法流產服務的機構中。公立醫院收費最低，約數百至 1, 000港元，家計會收費約 4, 000至 5, 000元，而私立醫院則高達二萬至三萬元。一般而言，女性或她們的伴侶往往會自掏腰包付費，而不少沒有穩定收入的年輕情侶，則需要向家人或朋友借錢。 Sally在公立醫院接受終止懷孕，因此費用只需約 1, 000港元，她能自行用積蓄支付。公立服務對不少有經濟壓力或是收入不穩的年輕女性尤為重要，就像出身於基層家庭的學生 Sally 一樣，她們往往無法負擔高昂的費用。然而，公立服務比想像中更為短缺：瑪麗醫院轄下婦產科的專科門診每星期只有一個早上時段提供終止懷孕的醫療程序評估，以及一個下午時段提供終止懷孕醫療程序服務。 66

生育權 | arianalife.com

government to shorten wait times for abortions to alleviate the burden on women. The motion passed on 15 April 2019, but Bowie Lam, the founder of Teen’s Key, says the improvements have so far been insignificant since the root of the problem, limited access, has not been solved. Some women’s rights groups, including Teen’s Key, have reported that only two or three public hospitals (such as Queen Mary Hospital and Princess Margaret Hospital) actually provide abortion services, despite the government’s assurance that the service is widely available. In addition, Teen’s Key says the government has been reluctant to provide more resources and support for women seeking abortions. “We have proposed that the government publish more information about termination of pregnancy on public hospital websites, but an official from the Hospital Authority said this would encourage people to abort,” adds Lam.

KEY TAKEAWAYS 關鍵撮要 5 per cent of Hong Kong women between 18 and 27 have terminated a pregnancy 年齡介於18歲至27歲的香港女性有5%曾終止懷孕

DANGEROUS ALTERNATIVES While still a secondary student in Hong Kong, Catherine* had her first abortion at the age of 15. She and her boyfriend did not know how to use a condom properly and it fell off during intercourse, resulting in an unplanned pregnancy. Since Catherine was under 16 at the time, her 18-year-old boyfriend – who is now her husband – technically committed a crime, according to section 124 of the Crimes Ordinance, which deems sexual intercourse with a girl under 16

Many young and underprivileged women can’t afford private services 許多年輕和貧困的女性無法負擔私家醫生的服務

Wait times at public hospital

立法會社福界議員邵家臻在2019 年立法會衛生事務委員會上動議促請政府縮短公立醫院終止懷孕服務的輪候時間，以減輕婦女的負擔。動議最後在 2019年 4月 15日獲得通過，但青躍創辦人林寶儀批評，實際的改善並不顯著，因為服務短缺這個根本問題並未解決。關注年輕女性和生殖健康的非政府組織，包括青躍均指出，雖然政府聲稱已廣泛地提供終止懷孕服務，但實際提供服務的醫院只集中在兩至三間 (包括瑪麗醫院和瑪嘉烈醫院)。除此之外，青躍表示，政府並沒有積極地向尋求流產服務的女性提供更多資源和支援，「我們曾向政府提議在公立醫院的網站加設一些終止懷孕的資訊，醫管局官員卻認為這是鼓勵人們去流產。」林寶儀說。

危險選擇當 Catherine* 還是個中學生時，她在 15歲經歷了第一次流產。她和她的男朋友並不知道如何適當使用安全套，而安全套在性行為時脫落，導致她意外懷孕。由於 Catherine當時未滿 16歲，她的 18歲男朋友──亦即她現在的丈夫──干犯了《刑事罪行條例》第 124條，該條例訂明與 16歲以下女童性交，即使得到女方同意，亦屬違法。為免家計會或醫院會要求她供出父親的身分和通知警方，亦為男友免受可能被監禁的刑責，Catherine選擇了黑市服務。經朋友介紹下， Catherine在旺角覓得一家黑市診所。她記得，她到了一幢唐樓大廈尋找那間診所，兩房一廳的診所設備簡陋，等待區

can take two to three months 公立醫院可能需等候二至三個月

Some choose blackmarket clinics due to long waits and judgment by medical professionals 有些人因等候時間過長或畏懼醫療專業人士批評而選擇非法診所

The Education Bureau hasn’t updated its Sex Education guidelines for 23 years 教育局23年未曾更新性教育的相關指引

F E AT U R E 專題故事

UNSAFE ABORTIONS 不安全墮胎

25 million unsafe abortions performed

around the world every year 全球每年不安全墮胎的數量

women die for every 100,000 unsafe abortions in developed regions 在發達地區，每10萬次不安全墮胎就有30名婦女死亡

220

women die for every 100,000 unsafe abortions in

developing regions 在發展中地區，每10萬次不安全墮胎就有220名婦女死亡

520

women die for every 100,000 unsafe abortions in sub-Saharan Africa 在撒哈拉以南非洲，每10萬次不安全墮胎就有520名婦女死亡

Source 來源: World Health Organization

生育權 | arianalife.com

as an offense, even with consent. Worried that the FPAHK or hospital might ask her to identify the father and call the police, Catherine chose to have the abortion at an illegal clinic to protect her boyfriend from potential imprisonment. Through a friend, Catherine found a black-market clinic in Mong Kok. She recalls entering a tenement building to find the office, which had two bedrooms and a waiting room packed with other women. When it was Catherine’s turn, the doctor gave her some painkillers. After the medication took effect, she recalls entering the operating room and lying in a gynecological examination chair. The doctor used a vacuum suction to conduct the operation, which she estimates took less than 10 minutes. Though there are no official reports on how many illegal abortion offices operate in Hong Kong, anecdotal evidence suggests such clinics are common. Women usually find them through word-of-mouth and can book appointments relatively quickly, compared with public services. The procedure usually costs a few thousand Hong Kong dollars, depending on the stage of pregnancy, and black-market clinics do not usually offer follow-up consultations or check-ups. According to the Hong Kong Police Force, there were 26 cases involving the provision of illegal abortions between January 2007 and July 2017. Some of the medical workers at these clinics once worked as physicians in mainland China, but do not have licenses to conduct abortions in Hong Kong. For instance, in 2017, two women were sentenced to 17 and 10 months in prison, respectively, for providing illegal abortion services in a public housing apartment.

裡早早坐滿人。輪到 Catherine時，醫生便囑她吃止痛藥。待藥效發作後，她走進手術間並坐到婦科檢查椅上，醫生便開始以真空吸引術替她進行流產。她記得，大約 10分鐘後，手術便完成了。儘管缺乏官方的記錄，但長久以來一直有非法的流產診所在香港經營。女性大多透過口耳相傳來找到這些診所，比預約公共服務快捷得多。這些非法診所提供的流產服務索價數千元不等，根據懷孕週數而定。在終止懷孕後，這些診所亦不會提供術後諮詢或覆診服務。據警務處資料，在 2007 至 2017 年 7 月期間，涉及施行非法流產的案件共有 26宗。一些在這些診所工作的醫護人員可能是曾在大陸執業的醫生，但他們在香港並沒有施行終止懷孕的執照。例如，在 2017

年，兩名女士因為在一個公屋單位向女性提供非法終止懷孕服務而被判囚 17和 10個月。首次手術後， Catherine 卻未有學習到適切的避孕知識，半年後， 16 歲的她再次因為避孕套在性交時脫落而懷孕。這次她轉到家計會求助，卻沒料到這竟是一趟艱苦經歷。「醫護人員對我說，『你因為要讀書，因此不想生下來，所以你再次犧牲了一個生命。』」 Catherine 回憶她和家計會職員的對話說。青躍社工易君璧說青少女在家計會的經歷有時可能不太愉快。「一些我們服務的女生在家計會亦曾遇過不太好的經驗，」她說。「輔導員或醫護人員會跟她說：『為甚麼不生？你有能力生的。』

I N V I S I B L E T O L L S 自主之難

After the abortion, Catherine still did not fully mental principle should not differ from person to perunderstand how to use contraception properly and, son, it should be consistent.” half a year later, she was pregnant again at the age of 16, After scolding her, the FPAHK staff referred Catherine when a condom fell off during intercourse. This time, she to Queen Mary Hospital, where her surgery was scheduled turned to the FPAHK for help but was met with derision. to take place roughly two months later. At the hospital, “The medical staff said to me, 'You don’t want it to be Catherine says the experience was more difficult – both born simply because you are still going to school, so you physically and mentally – than the black-market clinic. She sacrificed another life again,’” recalls Catherine of her felt intense pain during the procedure, even after taking interaction with the FPAHK staff. pain medication, and was embarrassed to be surrounded Megan Yik, a social worker at Teen’s Key, says the by doctors and medical students who were openly experience at FPAHK can be unpleasant. “Some of our discussing her abortion in what Catherine says felt like a clients did not have good experiences at the FPAHK,” violation of her privacy. says Yik. “The counsellors When she became pregnant or medical workers would a third time after having unask them, 'Why don’t you protected sex about a year "I was already torturing and give birth? You have the later, Catherine returned to ability to do so.’ There are backstreet services. Many punishing myself internally. also counsellors who are domestic and internationI didn’t need the hospital to very considerate, dependal studies have shown that do that for me." ing on whether the girls are prejudice by healthcare prolucky enough to meet them. fessionals can prevent womHowever, the non-judgen from getting safe and af「我的情緒也會折磨自己，

我不需要醫院來折磨我了。」雖然如此，但家計會也有體諒女生的輔導員，要看女生能否有幸遇到。但不批判的原則不應該因人而異，而是要一致的。」在責難她後，家計會職員把 Catherine 轉介至瑪麗醫院，排期兩個多月後終能進行手術。在醫院， Catherine認為在生理和心理層面都經歷了一趟比黑市診所更難熬的過程。那天入院後，她注射了止痛藥，痛感仍然強烈，而身邊圍著醫生和實習的醫科生，他們公開地談論她的流產手術，並沒有尊重她的私隱，令她感到異常難堪。一年後，當她因為不安全性行為而第三度懷孕時， Catherine 轉投黑市流產服務，以避過責難和折騰。不少本地和外國研究均指出，醫護人員的偏見會阻礙女性

– Sally

獲得安全和可負擔的流產服務。以 Catherine為例，她害怕醫院人員的批評，以及公立醫院冗長的輪候時間和欠缺私隱的服務，因而不得不作出一個更危險的選擇。非法診所通常不會遵照衛生規定來經營，職員亦沒有足夠的醫療經驗和有效牌照。若術後出現併發症，更難以追究涉事人員，因為使用這項服務的女性可能基於私隱或個人情況的考慮而不願意向警察舉報。以 Catherine 為例，她害怕一旦向警察透露，她的伴侶將被處以刑責。根據「 2016 年青少年與性研究」，受訪的 596 位年齡介乎 18 至

27 歲的青少年中，大約每六宗終止懷孕的個案中便有一宗是非法的。整體而言， 32%的女性選擇家計會的服務， 39%在香港的醫院接受終止懷孕服務， 16%的女性則選擇在香港非法終止懷孕，包括在非法診所或自行進行流產。在香港，不時有女性因為自行以藥物流產後感到不適，需要送院治理。例如在 2019年，一名外傭懷疑以藥物非法終止懷孕後身體不適被送往醫院。該調查亦顯示，到中國大陸尋求服務的青少年亦佔 23%。一般而言，中國大陸的公立醫院和註冊診所均提供安全、適時和可負擔的終止懷孕服務，但一些牟利的私立醫院和無牌診所往往不受嚴格規管。 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

BY THE NUMBERS 終止懷孕數字 The number of legal abortions in Hong Kong have decreased by 27 per cent from 2006 to 2015: 香港的合法終止懷孕個案數字在2006年至2015年之間下降了27% TOTAL 13,510

13,515

13,199 12,028

11,864 11,298

11,231

10,653

10,359 9,890

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Source 來源: The Government of HKSAR

fordable services. Catherine, for example, was afraid of judgement from the 在 Ariana 訪談的七位女性中， medical workers, as well as the long waiting times and lack of privacy at pub- 一位曾於大陸接受手術。該位要 lic hospitals, so she chose a riskier alternative. 求匿名的女生指出，那間私立醫 Illegal clinics often operate without adhering to hygiene regulations and, in 院收費毫無清晰標準，而醫生 some cases, the staff do not have sufficient medical experience or valid licenses. 更不斷向她推銷不必要的醫療服 In the case of complications, it may be difficult for staff to be held accountable, 務，例如價格高昂的流產手術和 because women who use the services may be hesitant to file a police report, 流產後護理服務等。 fearing exposure and personal repercussions. In Catherine’s case, her partner 跟香港的非法診所一般，一些 could have faced criminal liability if her case was disclosed to the police. 內地的非法門診亦可構成極高風 According to the Report on Youth Sexuality Study 2016, which interviewed 險。 2014年，一位懷孕女性在東莞 596 women aged 18 to 27, nearly one in six abortions was conducted illegally 一所非法門診接受終止懷孕手術後 that year. Overall, 32 per cent of women who had an abortion chose services 嚴重出血，最後被送入醫院，醫生 at the FPAHK, 39 per cent attended hospitals, and 16 per cent chose illegal 更需要切除她的子宮來救她一命。 means such as backstreet clinics and self-induced abortions. In Hong Kong, some women have been sent to the hospital after using 「舊鞋」 medication to cause an abortion. For instance, in 2019, a domestic worker sought medical attention after a negative reaction to medical abortion drugs, 在香港，曾終止懷孕的女性在事後 which she had acquired illegally. 不但需要恢復身體和情緒，更需要 The report also revealed that 23 per cent of young women surveyed sought 面對根深蒂固的社會污名。這就像 services in mainland China. In general, public hospitals and registered clinics Joan*的經歷，她 25歲時因為體外射 in China provide safe, timely and affordable abortion services, however, some 精失敗而意外懷孕，伴侶的冷漠和 for-profit private hospitals and unlicensed clinics operate without oversight. 不擅支援令她感到創傷，而她亦深 Among the seven women whom Ariana interviewed, one had an abortion 深感受到自己被社會所譴責。 in mainland China. The woman, who requested anonymity, says the private 在搜尋服務資料時， Joan 看到 hospital did not transparently display fees and doctors aggressively promoted 無數批判墮胎和有此經歷的女性 unnecessary services, such as expensive treatment plans for surgical abortions 的討論。在高登討論區上，曾有 or post-abortion care. 網民的留言把流產的女性比喻為 Similar to backstreet services in Hong Kong, some of these illegal clinics 「死過人的舊鞋」。 can be extremely dangerous. In 2014, a woman suffered from a life-threatening 「那時候我真的很擔心，這件 hemorrhage after having an abortion at a backstreet clinic in Dongguan, a 事會不會影響我將來擇偶呢？我未 major city in southern China. She was then admitted to a hospital, where 來的伴侶會不會介意呢？」她回憶 doctors had to remove her uterus in order to save her life. 起當時的憂慮。 70

生育權 | arianalife.com

I N V I S I B L E T O L L S 自主之難

‘OLD SHOES’ Women who undergo abortions must heal physically and emotionally after the procedure. That process can be all the more challenging in Hong Kong, where abortion carries deep-rooted stigmas. This was the case for Joan*, who became pregnant at the age of 25 after having unprotected sex. She was not only traumatised by the indifference and lack of support from her partner at the time, but also felt condemned by society. While searching for abortion services online, Joan came across various discussions castigating abortions and the women who have them. On an online forum, called HKGolden Forum, one comment described women who have had abortions as “old shoes that someone died in.” “At that time, I was really worried that having an abortion would affect my future. What if my next partner has a problem with it?” she remembers wondering. After she had the abortion, Joan did not conceal her experience from her social circle. She told most of her close friends and, although some were supportive, others called her behaviour “wrong” and “irresponsible.” She never told her family, worrying she might face harsh criticism from her parents. “It's easy to just think of me as a woman who had an abortion,” says Joan. “People only remember that this happened to me, and that’s going to stay with me for the rest of my life.” Joan was deeply affected by the negative reactions of her friends, so much so that she considered staying single for the rest of her life. She thought that if a

在終止懷孕後， Joan 並不掩飾她的經歷，面對朋友她大多如實相告，雖然一些朋友表示支持她，但一些人也批評她，形容她的行為是「錯誤」和「不負責任」的。她亦從來沒有跟家人提起，因為害怕面對家人的責難。「我覺得大家很容易會把我定性為一個曾經墮胎的女人」， Joan 說，「只會記得在我身上曾經發生過這件事，而這件事將會跟隨我一生。」 Joan 曾經因為朋友的批評而感到情緒低落，甚至想過要不然一輩子單身。她還想到，將來的伴侶可能會因為嫌棄她的過去而離開她。但隨著時間過去，而她亦得到社工的支援和輔導，她最後想通了。「我覺得，既然這件事發生了，而它確切地在我的生命中存在過，那我就不要害怕告訴別人，」她說，「我希望我將來的伴侶明白這件事。」 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

partner knew the truth, he would leave her. But over time, “Many girls are too afraid to talk about their and with the help of a social worker and counselling, she abortion. They conceal it from their families, future has been able to see the situation in a new light. lovers, and friends. They keep silent because they want “Since this is a part of my life, I shouldn’t be afraid of to avoid the blame,” says Yik. However, silence only telling others,” Joan adds. “I just hope my future partner causes stigma to perpetuate in society. understands it.” According to Megan Yik of Teen’s Key, the social stig- GAPS IN EDUCATION ma surrounding abortions – and the women who experience them – is rooted in Hong Kong culture, religion, Young women like Joan, Catherine, and Sally are not and education. “At school, young people are often incul- alone in their struggles with unplanned pregnancies. cated with the idea that abortion According to the FPAHK’s Report is an evil deed, that it equates to on Youth Sexuality Study 2016, killing, that it’s a stigma in a per5 per cent of women surveyed be"Every woman son’s life,” she says. tween the ages of 18 and 27 had Religion can also play a part, terminated a pregnancy. Of those, should take control since abortion is considered im30 per cent were under 18 when over her own life." moral in common religions such they had their first abortion. as Christianity and Buddhism. In an article published in 2010, Some women who are religious which summarised the findings of 「女性應該要自己決 may feel guilty or think that a a 2007-2008 qualitative study on 定她的生命。」 “fetus spirit” is following them, the abortion experiences of teenage which can lead to a greater psywomen from underprivileged – Joan chological burden. backgrounds, Professor Suet Lin In addition, Hong Kong Hung from the Department of culture tends to be conservative Social Work at the Hong Kong about gender. Under this belief system, women who Baptist University explored the situation, writing: have had an abortion are considered unethical, while “It is in the world of deprived and marginalised their bodies become “damaged” and valueless. Such young women, such as those who participated in stigma has pressured many young women to keep their this research, that the hidden side of the abortion experiences a secret. experience in Hong Kong is revealed, largely due to

青躍社工易君璧說，終止懷孕和曾經有此經歷的女性在香港社會所承受的污名，源於本地的傳統性別觀念和宗教文化，以及教育，「在學校，年輕人往往被灌輸一種想法，即終止懷孕是一件很差的事，是等同於扼殺生命，是一個人生污點。」她說。宗教信仰亦有影響，例如在基督教和佛教的角度，終止懷孕被視為不道德。一些有宗教信仰的女生會感到更自責，甚至覺得有「嬰靈」跟隨自己，心理負擔 72

生育權 | arianalife.com

愈加沉重。再者，香港的性別文化傾向保守。在這種觀念下，曾終止懷孕的女性被視為不道德，而她們的身體已「受損」，其價值被貶低。這些污名令許多女生把自身的經歷視作秘密。「許多女生不敢向任何人提及終止懷孕的經歷，面對親人、後來的戀人或者朋友，都是三緘其口，因為害怕被責難。」易君璧說。然而，沉默也讓污名得以在社會上延續。

教育的落差還有其他像 Joan、 Catherine和 Sally 一樣的年輕女性因意外懷孕而感到掙扎。根據家計會「 2016年青少年與性研究」， 5% 的受訪者曾經終止懷孕，當中 30%曾於 18歲或以下首次接受人工流產。在一篇 2010 年發表的定性研究論文中，香港浸會大學副教授洪雪蓮根據她在 2007 至 2008 年訪談的一班弱勢青少女的人工流產經歷寫道：

I N V I S I B L E T O L L S 自主之難

ABORTION IN THE SARS 在港澳終止懷孕

MACAO 澳門

HONG KONG 香港

BASIC REQUIREMENTS 基本要求 Legal abortion must be performed by registered doctors at gazetted hospitals or at a branch of The Family Planning Association of Hong Kong. Two registered doctors sign medical forms, with a referral from a gynecologist 合法終止懷孕手術必須在刊憲醫院或家計會手術室內由註冊醫生進行，且必須獲得婦產科醫生轉介，並由兩名註冊醫生簽署同意

Legal abortions require two registered doctors to sign medical forms 合法終止懷孕手術必須得到兩名註冊醫生簽署同意

UP TO 前

AFTER 後

physical or mental health of the pregnant woman, more so than if the pregnancy were terminated 懷孕對孕婦生命、生理或心理健康所構成的危險較終止懷孕的大

Only if necessary to save the life of the pregnant woman 除非為了挽救孕婦的生命，否則懷孕24 週後不可終止懷孕

A physical or mental abnormality is detected that will severely handicap the unborn child 若嬰兒出生後將會因為身體或心理不正常導致嚴重殘疾 The pregnancy is a result of rape* 由強姦造成的懷孕*

MACAO 澳門

香港和澳門

HONG KONG AND MACAO

Abortion is permitted if continued pregnancy will risk the life,

HONG KONG 香港

WEEKS 週

Only if the fetus is not viable 只有在胎兒不能成活的情況下才被允許

*Or incest (only in Hong Kong). 或亂倫（只限香港）。 Source 來源： Family Health Service (Hong Kong), Healthy Matters, Centre for Reproductive Rights, Government Printing Bureau of Macao

practices and discourses representing the dominant, negative adult morality about sex and young people. “Despite research findings that an increasing number of young girls are having sex before age 18, sex education and health service promotion for young people in Hong Kong have never attempted to address unintended pregnancy, but instead condemn teenage sex. This has contributed to vulnerability and lack of support for teenage pregnant women.” Hung’s article is nearly a decade old, but not much has changed in terms of social stigmas or educational strategies. As a case in point: The Education Bureau issued The Guidelines on Sex Education in Schools for use in

「正是這些困乏和被邊緣化的年輕女性的世界，例如那些參與這項研究的女性，揭示了香港終止流產經驗中被隱藏的一面，這在很大程度上是源於成人對性和年輕人的主流和消極的道德觀念的行為和論述。儘管有研究發現， 18 歲以下青少女的性行為愈來愈普遍，但針對年輕人的性教育和生殖健康服務均沒有回應未婚懷孕的現象，卻只對青少年的性行為作出譴責。這導至了懷孕青少女處於弱勢和欠缺支援。」洪雪蓮的論文發表了幾乎 10年，但在社會污名或教育政策層面上，均沒有顯著改變。例如，當年的教育署在 1997年制訂了《學校性教育指引》以供中小學參考，惟事隔 23年，這份指引卻從未更新。 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

HERE’S WHY 主要原因 The most common reasons Hong Kong women have abortions: 香港女性選擇人工流產的主要原因：

24.9% 31.8% 46.8%

Timing 不合時機

Financial burden 經濟不許可 Psychologically unprepared 欠缺心理準備

primary and secondary schools in 1997, but the text has not been revised in the 23 years since. Carey Choi, a staff member at Teen’s Key who leads the NGO’s education programme, says that schools are an important agent of socialisation and should deliver practical sex education to their students. Such lessons might include how to use contraception effectively or what to do when facing an unintended pregnancy. One of Teen’s Key's goals is to make sexuality education more accessible to students and young adults across the city. However, the NGO often faces resistance in schools. For example, Choi says subjects such as sexually transmitted diseases or contraceptives are only taught in secular schools, since religiously affiliated schools tend to favour an abstinence-only approach. On one occasion, Teen’s Key conducted a lesson at a secondary school about unintended pregnancy, abortion policies, and adoption. But when the Teen’s Key representative finished speaking a teacher from the school quickly interjected, advising students that giving an infant up for adoption would result in a lifetime of misery for the child. Teen’s Key has not been invited back. In addition to providing sex education classes, Teen’s Key also works directly with young women who have had abortions by providing a social worker who will help with everything from processing their decision to navigating personal relationships and coping with as shame or guilt. “These young women feel that even though they made the decision, they knew they should’ve protected themselves and that the pregnancy could have been prevented,” says Yik. During these counselling sessions, Teen’s Key also prepares 74

生育權 | arianalife.com

young women for a better future, teaching them how to protect themselves with modern contraceptives, such as condoms, oral pills, intrauterine devices, or injections. “The most important principle,” says Yik, “is to support the decision of young women, and empower them to take control of their bodies and their lives.” But taking control is not always so simple. Looking back at her abortion experience, Joan has come to see the social stigmas and moralising around abortions as mechanisms of control. “Women do not always have control over their bodies. Very often, they are affected by their families, husbands, and traditional cultures, which all undermine their autonomy,” she says. “But after this experience, I understand that women should determine what happens to their bodies, and every woman should take control over her own life.”  *Names changed at the request of subjects.

From left to right: Carey Choi, Bowie Lam and Megan Yik of Teen’s Key 由左至右：來自青躍的蔡嘉莉、林寶儀及易君璧

負責性教育項目的青躍職員蔡嘉莉表示，學校作為社教化其中一個重要媒介，理應向學生傳遞符合他們需要的性教育。這些教育包括如何有效使用避孕措施，或意外懷孕後要如何自處。青躍的其中一個目標是使社會上更多學生和青少年能獲得適切的性教育，然而，非政府組織到學校提供性教育培訓往往會遇到來自學校的阻力。比如說，蔡嘉莉提到，一些培訓課題，例如是性病或避孕方法等，只有少數非宗教背景的學校接受，因為教會背景的學校均傾向採用禁慾為主的性教育。有一次，青躍到一間中學講解意外懷孕、人工流產政策以及領

養等主題。當青躍的代表完成發言後，一位老師隨即衝上台糾正她們，向學生呼籲說，把小孩送往領養會為孩子帶來一輩子的悲慘。從此，青躍再也沒有收到這間學校的邀請。除了提供性教育課堂外，青躍的社工更會直接支援終止懷孕的女性，包括決策過程的陪伴、協調個人關係，以及平復羞愧或內疚等負面情緒。「這些年輕女生會覺得，雖然自己做了這個決定，但她們也知道應該要做好安全措施，其實意外懷孕是可以預防的。」易君璧說。在這些輔導環節中，青躍還會讓這些女生為更好的將來作好準備，教導她們使用現代化的避孕方法保護自

己，包括安全套、口服避孕藥、子宮環或避孕針劑等。「最重要的宗旨，」易君璧說，「是支持女生的決定，使她們能得到充權，從而能主導自己的身體、自己的生命。」然而，達到自主毫不容易。反思自己的流產經歷時，Joan意識到社會污名和針對人工流產的道德論述其實是一種操控的手段，「女性對自己的身體一向沒有很大的自主權。很多時她們會受到家庭、丈夫和傳統文化的影響，令到她們不能自主，」她說。「但這次經歷後，我明白到，女性的身體應該由自己主宰，她應該要自己決定她的生命。」 *已按受訪者要求使用化名。

arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

OUT OF STEP 不一致的步調

Hong Kong’s sex education and health care provisions are failing transgender patients. 對於跨性別社群的支援，香港提供的性教育或醫療保健在許多層面都有缺失。

Words and illustrations 文字與插畫 Vincy Chan

生育權 | arianalife.com

“A

t your age, you're going to have a lot of urges. You're going to want to take off your clothes and touch each other. But if you do touch each other, you will get chlamydia... and die.” This scene from the 2004 film Mean Girls, in which a teacher lectures a group of students on matters of the flesh, may be a comic exaggeration of the absurdity of sexual education in American high schools, but it isn’t far off the message I received as a teen growing up in Hong Kong. The Hong Kong public education system is often criticised for its failure to provide comprehensive sex education to the city’s student population, and rightly so. Most of my friends, especially those who attended Christian or Catholic girls’ schools like I did, remember sexual education as a one-off session on how to use sanitary pads, as well as biology classes for those who took the subject. The lack of practical information is, in part, due to the extensive influences of Christian churches, which tend to take a conservative approach to sex education. There also tends to be a ‘don’t ask, don’t tell’ mentality in Chinese society around anything deemed ‘perverse.’ Even so, attitudes surrounding sexual and reproductive health (SRH) have improved in recent years thanks to society’s efforts in promoting SRH education and related services. But many programmes are still designed for cisgender people (those whose gender identity is congruent with the sex they were assigned at birth). Transgender people (who do not identify with the sex they were assigned at birth) and gender diverse people (who do not identify with conventional genders) often fall through the cracks of an outdated system.

CONFLATIONS ABOUND A closer look at sexual and reproductive health services in Hong Kong reveals some inclusive resources earmarked for the LGBT (Lesbian, Gay, Bisexual, and Transgender) community, however such services lean heavily towards cisgender gay individuals while overlooking trans people. This is because many people still incorrectly assume that gay cis men are the most likely group to be exposed to HIV. Even advocacy groups have fallen behind: AIDS Concern, for instance, declined an interview request, stating that they offer very little in the way of testing services for transgender clients, as opposed to cisgender.

在

2004 年上映的美國電影《辣

妹過招》的一幕中，一位老師對學生說︰「在你們這樣的年紀，會有很多性衝動。你們會想脫掉衣服互相撫摸。但如果你們真的互相摸了對方，就會得到性病，然後死去。」雖然電影誇大了美國中學性教育的荒謬程度，但我青少年時期在香港所接受的性教育其實也沒有好太多。香港的教育制度經常被批評未能向學生傳授全面式性教育，對於我大多數朋友而言，尤其是和我一樣就讀基督教或天主教女子學校的人，性教育就只是關於衛生巾的使用方法，或者是生物課的內容之一。基督教和天主教教會對性教育的保守態度，加上華人社會對被視為「荒唐」的議題「不問不說」的態度，都是導致全面式性教育缺乏的原因。近年來，在公民社會的推動下，人們對性與生殖健康等議題的態度已有所改善，但相關的教育和服務仍然傾向為順性別者（性別認同和出生時被指定性別一致）而設計。跨性別人士（指出生時被指定性別與其性別認同不一致），以及性別多元人士（無法以傳統性別分類之人士），往往遭到過時的系統所忽略。

社會存在各種誤解在性與生殖健康服務當中，縱然有些資源是標榜為LGBT(女同性戀、男同性戀、雙性戀和跨性別)族群服務,但其服務卻强烈地傾向於男同性戀者，而忽略了跨性別人士。這是因為很多人仍誤以為男同性戀者是更有可能感染愛滋病的群組。倡議團體也顯然跟不上需求，以「關懷愛滋」這個組織為例，他們拒絕接受採訪，並表示相對於順性別人士，他們極少為跨性別群體提供測試服務。

arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

The casual grouping of LGBT to represent different sexual orientations and gender identities contributes to a common misunderstanding that gender identity and sexual orientation are interchangeable. But conflating these identities does a disservice to the diverse individuals huddled under this broad umbrella. In the sexual and reproductive health space, the ‘G’ gets most of the attention while the rest of the letters are often left to fend for themselves. This leaves members of the transgender and genderdiverse community, especially those assigned female at birth, particularly vulnerable. Aiden* is one such individual. Assigned female at birth, Aiden is a gay trans man who uses dating apps like Grindr for casual sexual encounters. During a recent visit to the Family Planning Association Hong Kong (FPAHK) to test for a sexually transmitted infection, Aiden was asked: “How would you describe your sexual orientation?” The options were: heterosexual, gay, or bisexual. This might seem like a step in the right direction, but for trans and genderdiverse people, using sexual orientation as a proxy for gender identity creates problems on multiple levels. First, they may have to misgender themselves or their partners in order to receive adequate care. “I’ve had sexual relations with both cis and trans men, so the correct answer would have been ‘gay,’” says Aiden. However, since one of his partners was a trans man, Aiden selected “bisexual.” He understood what the question was getting at: What kinds of sexual behaviour had he engaged in? “I felt bad because I had to misgender one of my sexual partners.” For Aiden, having to misgender his sexual partner as a “woman” in order to inform his doctor of his sexual history felt disrespectful to his community. In addition, conflating sexual orientation with gender does not actually tell the SRH provider precisely what types of sexual behaviour the client engaged in, thus allowing potential health risks to go undetected. Let’s consider another example. If a trans man ticks “straight” on the Family Planning Association questionnaire, a doctor might assume he is exclusively dating cis women and proceed to check only for STIs. However, if the trans man is also dating trans women, the doctor could inadvertently overlook other risks, such as pregnancy. In such cases, simply choosing “gay” or “straight” does not fully explain sexual history or the associated health concerns.

生育權 | arianalife.com

以「 LGBT 」這詞彙去代表不同性傾向及性別認同的族群，亦導致了一個慣常的誤解，令人以為性別認同和性傾向是可以互換的概念。但這種身分上的混淆，卻讓被涵蓋在這詞彙組合下的個體，無法得到配合其獨特需要的服務。 G 所代表的男同性戀者成為性與生殖健康服務的最主要對象，其他字母所代表的族群就只能自求多福，這包括跨性別和性別多元族群，當中出生時被指定為女性的人則更為弱勢。出生時被指定為女性的 Aiden* 是一位年輕的跨性別男同性戀者。他在 Grindr 這類男同性戀社交應用程式尋找性伴侶。最近一次到香港家庭計劃指導會（家計會）進行性傳播感染檢測時，他被問到「你如何形容你的性傾向？」當中的選項包括異性戀、同性戀或雙性戀。這看似踏出了正確的一步，但對於跨性別者和性別多元人士而言，這種以性傾向來代表性別認同的調查方式，可能會令他們為了獲得適當的照顧而錯誤描述自己或伴侶的性別認同。他說︰「我跟順性別或跨性別的男性都有過性接觸，因此正確的答案應該是『同性戀』。」但他明白問題的目的是為了得知他所涉及的性行為以及所使用的身體部位。「所以我只得回答『雙性戀』，但這讓我感到不快，因為我無法正確表達性伴侶的性別認同。」為了向醫生披露他有過的性接觸而強行將他的性伴侶定義為「女性」，這讓 Aiden 感到對自己所屬的群體有失尊重。將性傾向等同於性別不只無法正確識別跨性別人士及他們的性伴侶，從性與生殖健康服務提供者的角度而言，更無法正確得知服務對象所涉及的性行為，以致未能監測到潛在的健康風險。舉例說，如果一名跨性男在家計會的問卷上勾選「異性戀」，醫生可能會以為他只是與順性別女性約會，而僅為他進行性傳播感染檢查。不過，如果這名跨性男也會跟跨性女交往，那麼醫生就可能會無意中忽略了其他風險，例如懷孕。在這種情況下，僅勾選「同性戀」或「異性戀」並不能完全解釋他的性經歷和可能引起的風險。

OUT OF STEP 不一致的步調

TRANS-INCLUSIVE VOCABULARY 跨性別友善詞彙 If you don't know them already, learn these terms to communicate more effectively with the trans and gender-diverse community. 學習以下詞彙，將有助提升對跨性別及性別多元人士的理解。

Cisgender 順性別者

Gender Diverse 性別多元人士

Those whose gender identity aligns with their sex assigned at birth. Abbreviated as ‘cis.’

Personal Gender Pronouns

指個人的性別認同和出生時被指定性別一致。

性別代詞

An umbrella term describing gender identity, expression, or perception which does not conform to norms and stereotypes. 這是一個傘式術語，描述一種性別認同、性別表達甚或性別觀念不符合社會期望或刻板印象的人。

無性別者

意指不認為自己屬於任何一種性別的人。有些自我認同為性別中立或無法界定性別的人，也會使用「無性別者」來作為其身分描述。

Non-binary

Genderfluid 性別流動者

任何不能歸類於男女二元性別的性別認同或性別表達。

非二元性別

People assigned female at birth who identify more with masculinity.

Transmasculine

指出生時被指定為女、性自我性別認同為男性。

跨性男

A person with different gender identities at different times – be that multiple genders at once, single identities, or none. 指在不同時侯會有不同的性別認同的人。性別流動者的性別認同有時是多重性別、單一性別，或沒有。

常見的第三人稱是他/他的及她/她的，而一些跨性別或非二元性別的人則會使用中性的代詞, 例如they/them/their(單人代詞用法) 或ze/zir/zirs。有些則避免使用任何代詞。

Any gender identity or expression that does not fit within the gender binary.

Meaning ‘without gender.' Refers to those who don’t identify with any particular gender. Some use 'agender' if they identify as genderneutral or have an undefinable gender.

Agender

Some transgender or non-binary people use pronouns like they/them/theirs, ze/ zir/zirs, among others. Some people don’t use any pronoun.

A person who identifies with neither, both, or a combination of male and female genders.

Genderqueer

指具備男女皆有、皆無或部分組合的性別認同。

性別酷兒

arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

DIY EDUCATION This flaw in the Family Planning Association survey is merely a symptom of the general lack of knowledge among frontline sexual and reproductive health providers about both gender-diverse identities and the medical procedures they may need. “I didn’t expect the nurse to be able to answer my question,” Aiden says, sipping a coffee before telling me about his experience getting a contraceptive vaginal ring inserted at the FPA. This is a common sentiment expressed by many trans and gender-diverse people who have sought healthcare services. Aiden says he told his nurse and doctor that he is transgender and would soon be undergoing hormone replacement therapy (HRT). “The doctor told me I could have the ring taken out once I start HRT,” he says. “That’s misinformation.”

A quick online search confirms that transmasculine people undergoing hormone replacement therapy still need to use birth control. Even if they stop getting their periods as a result of testosterone hormone therapy, they can still get pregnant if they practise unsafe or unprotected sex. This seems to be a common misconception among transmasculine people, which makes it all the more important for healthcare providers to bust, rather than perpetuate, myths like these. It was by chance that Aiden had done his research prior to his appointment. “I get most of the information from internet forums like Reddit,” he says. “There simply aren’t enough government resources [on sexual and reproductive health issues for trans men].” Even though he is comfortable raising his concerns with medical professionals, Aiden understands why others might be hesitant to do so since healthcare providers are assumed to be the authority. Aiden especially worries about younger trans people and those who have newly accepted their trans identity. They may lack access to the relevant information due to language barriers (as most services are in English) or because they don’t have a community to source knowledge from. Comprehensive sex education (CSE) continues to be a difficult subject in the trans and genderdiverse community. “Talking about bodies and bodily functions can trigger dysphoria [distress or unease arising from the conflict between a person’s gender identity and their sex assigned at birth] for trans people,” says Kaspar Wan, founder of grassroots trans-servicing organisation Gender Empowerment. “There is also a general lack of interest in CSE within the community.” Aiden speculates that the absence of conversations about sexual and reproductive health among trans men is a 'chicken or the egg' problem: There is “not enough SRH information for and about trans men" and trans men are "not being very sexually active."

OUT OF STEP 不一致的步調

自我教育 Aiden 在家計會填寫資料的經歷，反映性與生殖健康的前線服務者普遍缺乏對性別多元人士身分及其所需的醫療程序的相關知識。「我並不指望護士能夠解答我的問題。」 Aiden 說。許多跨性別者及性別多元人士尋求一般醫療服務時都有同樣的感受。 Aiden 其後分享了他在家計會置入避孕環的經歷。他告訴護士和醫生自己是跨性男，而且很快就會接受荷爾蒙補充療法（ HRT ），「醫生告訴我，一旦開始接受 HRT ，我就可以取出避孕環。這個觀念大錯特錯。」只要在網路上搜尋一下，就可以得知正在接受HRT的跨性男仍然需要使用避孕措施，因為即使接受了會引致

停經的睪丸素荷爾蒙治療，跨性男仍有可能因為進行不安全或無保護的性行為而懷孕。在跨性男的族群之間，似乎普遍存在這樣的誤解，因此醫療服務提供者更應該打破迷思，而非以訛傳訛。「我的資訊大部分來自 Reddit 之類的互聯網論壇，政府對於這方面（針對跨性男的性與生殖健康）資訊毫不足夠。」 Aiden 說。雖然 Aiden 很樂意向醫療人員提出疑慮，但他認為，由於醫療人員往往被視為權威，很多跟他一樣的人未必有勇氣主動提問。 Aiden 特別擔心那些年輕或剛接受自己身分的跨性別人士，他們可能會因為語言障礙（因為相關服務大多使用英語）或缺少社群支援而無法獲得相關資訊。

在跨性別和性別多元社群之間，全面式性教育仍然是一個難以開啟的議題。基層跨性別服務組織「性別空間」的創辦人溫澤仁（小強）說：「談論身體和身體機能都可能會引起跨性別人士的性別焦慮。」這些痛苦或不安的情緒是因自我認同的心理性別與出生時被指定性別產生強烈矛盾而造成的。他又指：「跨性別社群一般都對全面式性教育缺乏興趣。」 Aiden 認為，跨性男之間缺乏對性與生殖健康的討論，是由「先有雞還先有蛋」的問題造成的；一方面是，為跨性男提供且與他們相關的性與生殖健康資訊並不充足，而另一方面是，他們在性方面並不活躍。

KEY TAKEAWAYS 關鍵要點

9.5M There are 9-9.5 million transgender people in Asia-Pacific 亞太區有900至950萬名跨性別者

Current SRH programmes often overlook their needs 現有的性與生殖健康服務往往忽略了跨性別人士的需要

SRH providers should have a working knowledge of trans issues and risks

Healthcare providers should adopt trans-inclusive language to get the full picture

性與生殖健康服務提供者應對性別確認手術與荷爾蒙補充療法有基本了解

性與生殖健康服務提供者應該採用跨性別友善的語言

arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

‘AT THE WRONG CLINIC?’ Genderqueer athlete Kai*, who uses the pronoun ‘they,’ was assigned female sex at birth. Kai is muscular and strong – most would assume they are a cisgender man based on their physique and voice. Kai hasn’t had a lot of experience seeking sexual and reproductive health services but had an awkward encounter at an obstetriciangynecologist clinic four years ago. Kai started having irregular periods (something they had also experienced as a teenager) after taking testosterone. Kai didn’t want to see the obstetriciangynecologist they had visited during adolescence, fearing their former doctor might make comments about “how big they’ve become” or how “they looked like a man.” Instead, Kai thought it would be easier to go to a new ob-gyn who was referred by a friend. But they encountered

an equally alienating experience. “The receptionist kept asking me on the phone if I’m making an appointment for my wife, or my girlfriend,” Kai says with a hint of wry amusement as they recall the exchange. “I had to keep insisting that it was for me.” Kai recalls being the only person who turned up alone to the clinic, much to the dismay and surprise of some of the pregnant women (accompanied by their partners) who were sitting in the waiting area. “‘Sir, are you at the wrong place? This is an ob-gyn clinic,’ the nurse behind the reception desk said to me right off the bat. I told her I had made an appointment for myself and she asserted again that it’s an ob-gyn clinic,” says Kai. “I just said ‘I know. I’m a girl.’ She looked back and forth at me and my ID card before she finally registered me.” Kai entered the doctor’s

你是否去錯診所？性別酷兒運動員Kai*出生時被指定為女性，並使用「they」作單人代詞。從外表來看， Kai 體格健壯，一般人會根據其體格和聲音而認定they是順性男。 Kai 甚少接受性與生殖健康服務，但四年前在婦產科診所就有過一次尷尬的遭遇。由於接受睪丸素治療， Kai 開始出現經期不規律。 Kai 在青少年時亦有過這種情況，卻不想回去找當時看過的婦產科醫師，擔心那位老醫生會說出「 they 變得多麼魁梧」或「 they 看起來多麼像個男人」之類的評論。於是， Kai 決定一試朋友介紹的婦產科診所，以為會比較容易溝通，但事實並非如此。回憶起這段經歷時， Kai 以略帶嘲諷的口吻說：「打電話預約時，聽電話的姑娘一直問我是否要為妻子或女友預約。

生育權 | arianalife.com

我一再強調是我本人。」 Kai 是唯一單獨應診的人，這讓等候區一些有伴侶陪同的孕婦感到錯愕。「『先生，你是否走錯診所了？這裡是婦產科診所。』登記台的姑娘對我這樣說。我說我為自己預約了診症，但她再次強調這是婦產科診所。我只好說：『我知道。我是女人。』她來回看了我幾次、又核對我的身分證，最後才為我登記。」 Kai 終於在眾多好奇眼光的注視下走進醫療室，但事情還沒有結束。由於那時 Kai 剛開始健身，醫生很快就看出 Kai 是一名運動員，「她問我是否有服用任何營養補充劑或荷爾蒙。我說有，為了運動。然後她教訓了我半個小時，又問我這樣做是為了甚麼。我沒有再回去覆診。我需要醫生跟進我的病歷，而不是批判我。」

office amidst the curious gazes of the couples in the waiting area. “The doctor quickly figured out I was an athlete and asked if I used any supplements or hormones. I said I did, for sport," says Kai, who had recently started bodybuilding around that time. "She then lectured me for half an hour and asked me, ‘What did you do this [to your body] for?' I didn’t go back after that. I needed a doctor to follow up on my medical history, instead of judging me.”

GLOBAL RECOGNITION 國際認同 Non-binary gender markers are available on passports in at least 11 countries:

以下至少11 個國家的護照提供非二元性別選擇：

• Australia 澳洲

• Austria 奧地利

• Bangladesh 孟加拉 • Denmark 丹麥

• Germany 德國 • India 印度

• Malta 馬爾他

• Nepal 尼泊爾

• The Netherlands 荷蘭 • New Zealand 新西蘭 • Pakistan 巴基斯坦

OUT OF STEP 不一致的步調

F E AT U R E 專題故事

WHAT CAN BE DONE? Barriers to accessing trans-sensitive sexual and reproductive health information and services are not unique to Hong Kong, or even Asia. Several organisations, including Asia Pacific Transgender Network, have assessed transgender sexual and reproductive healthcare across the region and found the literature on HIV, STI, and sexual health lacking, particularly for trans men. For example, no Asia-wide data on HIV prevalence exists for trans men. In 2011, the National Gay and Lesbian Task Force and the National Center for Transgender Equality released the National Transgender Discrimination Survey, in which 62 per cent of trans men in the United States said they had to “teach their medical care providers about transgender care” at some point in their lives. SRH providers should have a basic understanding and respect for the needs of their trans clients. Knowledge about how certain SRH procedures and treatment might interact with the clients’ transitionrelated care, such as hormone replacement therapy and gender-affirmation surgery are the baseline. “The attitude of SRH providers is equally important,” says

生育權 | arianalife.com

Aiden. “Getting a ring inserted is painful enough, it would really take a toll on me if I also got misgendered by the medical staff during the process.” Instead of segregating SRH information and services into “men’s and women’s health,” SRH providers can adopt trans-inclusive language to make accessing SRH services less alienating for trans clients. Practices such as asking for the client’s pronouns and removing Mr, Mrs, Miss honorifics from documents are other suggestions made by people we spoke to. Transmasculine people still face many hurdles, which can be further complicated by issues such as oocyte cryopreservation (‘egg freezing’), abortion, and sexual violence. Overall, SRH for the trans community is a largely under-researched area in Hong Kong that could benefit from in-depth studies funded by the government and academic institutions. There isn’t a ‘one-size-fitsall’ solution, but trans people deserve the right to make informed decisions and be afforded access to adequate SRH services, just like everyone else.  *Names changed at the request of subjects.

OUT OF STEP 不一致的步調

亡羊補牢跨性別人士難以獲得性與生殖健康的資訊和服務，這並不是香港以至亞洲獨有的現象。亞太跨性別網絡等機構曾對亞太區跨性別人士的性與生殖健康服務進行評估，並發現針對跨性別人士，尤其是跨性男的愛滋病病毒、性傳播感染及性健康等方面的文獻相當缺乏。全亞洲的跨性男愛滋病病毒感染率的數據更是付之闕如。 2011 年，美國的全國男女同性戀工作組織和全國跨性別平等中心發佈了《全國跨性別歧視調查》，結果有62% 跨性男指出，有時他們必須「指導醫療服務提供者如何照顧跨性別人士。」性與生殖健康服務提供者應該對跨性別服務使用者的需求有基本的了解與尊重，知道某些特定治療可能會與服務使用者性別過渡的相關護理產生交互作用，例如基本的荷爾蒙補充療法及性別確認手術。Aiden 說：「（性與生殖健康服務提供者的）態度同樣重要，置入避孕環已經很痛苦，如果在過程中我被醫護人員用錯誤的性別來稱呼我，這確實

會對我造成二度傷害。」除了將性與生殖健康資訊及服務分為「男性和女性」之外，相關服務的提供者可以採用跨性別友善的語言，以避免使跨性別人士對服務卻步。我們接觸過的對象建議主動詢問服務使用者的稱謂，以及在廣播通知或文件上省略先生、太太、小姐等稱呼，因為使用不正確的性別代詞或稱謂來稱呼跨性別人士，往往會令他們感到尷尬及不被尊重。令人難過的是，跨性男仍須面對許多障礙，而卵子冷凍貯藏、墮胎和性暴力等情況，亦導致這些問題更顯複雜。在香港，跨性別人士的性與生殖健康是一個迫切需要研究的領域，有賴政府和學術機構出資贊助深入研究方可改善現狀。目前未有適用於任何情況的「一刀切」方案，但跨性別人士跟其他所有人一樣，有權獲得充足的資訊以做出明智決定，更理應獲得適當的性與生殖健康服務。 

*已按受訪者要求使用化名。

Around the world, at least 15 jurisdictions criminalise the gender expression of transgender people via ‘crossdressing’, ‘impersonation’ and ‘disguise’ laws. In many more countries transgender people are targeted by laws that criminalise same-sex activity and vagrancy, hooliganism and public order offences.

至少有15個司法管轄區視跨性別人士的性別表達為犯罪，所持的理由包括「變裝」、「仿冒」和「偽裝」等。在更多國家，跨性別人士甚至會被以下的一些法律所針對，包括同性性行為、流浪、流氓罪和妨礙公共秩序等罪行。

arianalife.com | REPRODUCTIVE RIGHTS

THE SURROGATES 借腹生子 For many women, India’s surrogacy programme has led to greater financial empowerment. But a new law could put an end to the practice. 印度的代孕服務為許多當地婦女帶來龐大的經濟力量，卻可能因為一項新法案而畫上休止符。

Words 文 Rhea Mogul | Photography 攝影 Deepti Asthana

F E AT U R E 專題故事

petite woman wearing a traditional salwar kameez dress peers through a crack in the doorway and smiles. As she enters, her gold nose ring casts a reflection on the wall. “I’m feeling a little shy about telling you my story,” she says, carefully taking a seat. Bharti* is a 27-year-old mother of two who is pregnant with a third child, though she holds no emotional attachment to the forthcoming baby. “I already have my own children,” she says. “This one isn’t mine.” As a first-time surrogate mother at the Akanksha Hospital and Research Institute in Anand, in the west Indian state of Gujarat, Bharti will earn 400,000 rupees (US$5,600) to carry someone else’s child following in vitro-fertilisation, or IVF (a procedure in which embryos are implanted into the uterus of a woman). It’s a sum neither Bharti nor her husband ever dreamt of and is more than three times the average annual per capita income in India. “My father made me leave school when I was 12,” she recalls. “I wanted to keep studying and learning. I wanted to get a well-paying job, but instead I stayed at home and helped with the cleaning and cooking.” Bharti lives in Nadiad, a small city in Gujarat, where her husband works as a rickshaw driver for 1,000 rupees (US$14) a month. “It’s not enough to put food on the table and send our children to school,” she says. “After watching my sister-in-law become a surrogate, I decided to do it. Now, we will buy a house and hopefully build a small business.”

一

名身材嬌小、穿著印度傳統服裝的女人，面帶微笑穿過門縫走進來。她小心翼翼地坐下來，鼻上的金環在牆上投射出一道反光，「我不太好意思說出我的故事。」她說。 Bharti*是一名 27歲母親，育有兩個孩子，腹中還懷著第三個孩子，但她對即將來臨的新生兒並無特殊情感。她說：「我已經有自己的孩子。這個不是我的。」她首次在印度西部古吉拉特邦 88

生育權 | arianalife.com

As of September 2019, there were 22 other surrogates at Akanksha Hospital – many of whom were able to pull their families out of poverty. But after the Surrogacy (Regulation) Bill 2019 is approved by India’s upper house of Parliament in 2020, the government will put an end to the industry. India opened its doors to commercial surrogacy in 2002 and soon became one of the world’s most popular destinations for couples from all over the world, owing to the low costs, skilled doctors, minimal paperwork, and abundance of willing surrogates. Commercial surrogacy for foreigners was banned in 2015; however, the industry still thrives due to the abundance of Indian couples who rely on surrogacy to start a family. While there are no official figures to quantify the scale of the industry, a 2012 study backed by the United Nations estimated that India’s surrogacy sector garners more than US$400 million in revenue per year. In 2004, Dr Nayana Patel, the medical director at Akanksha and an internationally acclaimed fertility expert, became the first doctor in Asia – and the fifth worldwide – to successfully deliver a child via surrogacy, which set the ball rolling for Patel to transform the surrogacy landscape in India. “Commercial surrogacy is the need of the hour,” Patel says pragmatically in her office, where photographs of happy families line the walls. “So many women are choosing it as a method of having a baby because it’s a last resort to having a biological child if you cannot conceive yourself.”

阿南德縣的 Akanksha 醫院和研究中心當代母，將體外受精（ IVF ）的胚胎植入體內，為委託的客戶懷胎十月並誕下其子嗣。事成之後， Bharti 將獲得 400 , 000 印度盧比（約 5 , 600 美元）的酬勞，這是一筆 Bharti 和她的丈夫做夢都想像不到的巨款，超過印度人均年收入三倍。她回憶說：「 12 歲時，父親叫我輟學。我想繼續讀書、學習，想找一份薪水理想的工作，但我必須

留在家裡，幫忙打掃和煮飯。」 Bharti 住在古吉拉特邦一個名為納迪亞德（ Nadiad）的小鎮，丈夫是人力車車伕，每月賺取 1 , 000 印度盧比（約 14 美元）工錢。她說：「這點錢不夠糊口和送小孩去上學。我看到我的嫂嫂替人代孕，便決定去試試看。有了這筆錢，我們可以買屋，還希望做點小生意。」 2019 年 9 月， Akanksha 醫院還有其他 22名代母，她們大部分人能

T H E S U R R O G AT E S 借腹生子

Dr Nayana Patel in her clinic Nayana Patel醫生在她的診所裡

藉此幫助家人擺脫貧困。可是，隨著印度聯邦院於 2020 年內核准《 2019年代孕（監管）法案》，這個「行業」將在印度壽終正寢。印度在 2002 年開始提供商業代孕服務，由於成本低，醫生技術純熟，申請手續簡單，再加上願意代孕的婦女為數眾多，使印度很快成為全球最受無法生育伴侶歡迎的國家。儘管印度在 2015年禁止為外國人提供商業代孕服務，但本國需要透過代孕建立家庭的

夫婦數目仍相當可觀，因此這個行業依然十分蓬勃。雖然印度政府未能提供此行業規模的實際數據，但一項聯合國在 2012年資助的研究則估計，印度代孕產業的年收入超過四億美元。 Akanksha醫院的醫療主任 Nayana Patel醫生是享譽國際的生育專家，她在 2004年成為亞洲首位（全球第五位）成功接生由代母分娩的嬰兒的醫生，開啟了印度「代孕產業」的新紀元。

Patel 的辦公室牆上掛了 10 多幅不同家庭的照片，她實事求是地說：「商業代孕是當前所需。如此多女性選擇以這種方式生下自己的下一代，因為對於無法生育的人來說，這是擁有親生子女的最後手段。」根據醫學雜誌《 Public Library of Science - Medicine》在 2012年發表的一項研究，全球約有 2% 女性患有原發性不育症（指全年有正常的性行為且沒有採取避孕措施卻無 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

According to a 2012 study published by Public Library of Science - Medicine, approximately 2 per cent of women worldwide experience primary infertility (the inability to become pregnant after sexual intercourse for one year without birth control) while 10.5 per cent experience secondary infertility (the inability to become pregnant after previously giving birth). Furthermore, one in 4,500 women worldwide is born without a uterus, a medical condition that’s called MayerRokitansky-Kuster-Hauser Syndrome, according to the US National Library of Medicine. In this case, even if a uterine transplant is successful, a woman would need to undergo IVF in order to become pregnant because she would be unable to produce an egg herself. Unfortunately, IVF is often unsuccessful, hence the reason many women seek a surrogate mother as a last resort.

‘SURROGACY CAPITAL’ The Akanksha Hospital and Research Institute has become so well-known in the fertility world that the Gujarat state, where the hospital is located, is considered the “surrogacy capital” of India. To date, Patel has helped deliver more than 1,400 babies via surrogacy at the hospital. However, the region may soon undergo a transition. When passed in 2020, the new legislature will limit surrogacy to altruistic purposes whereby the surrogate mother receives no financial compensation. The bill also states that only legally married, heterosexual Indian couples and single women (including widows and divorcées), can access surrogacy services, which means single men, non-married couples, widowers, and samesex couples will be excluded. Couples must be certified as “infertile” before proceeding. Age restrictions also apply: Married women must be between 23 and 50, while men must be 26-55. The bill also states that the surrogate mother must be a married woman between 25 and 35 years old with a child of her own. While the first draft of the amendment bill in 2019 stated that the surrogate mother must be a “close relative” of the couple, that requirement has since been scrapped. In February 2020, a Select Committee of Parliament decided to enable any "willing" woman to become a surrogate mother, provided all other 90

生育權 | arianalife.com

requirements are met. The revised bill also states that divorced and widowed women between 35 and 45 years old may choose surrogacy. The legislation has been criticised for being “too strict and too regressive” by medical professionals, including Patel. Moreover, it has been condemned for its discriminatory stance towards same-sex couples and unmarried persons. “We always felt the need for regulation, so women are protected, and clinics are well-run. But this new law is a near ban,” she says. “It’s not the right move.” The law follows a 2015 policy, which banned foreign couples from India’s surrogacy services as a result of complications with documentation and a string of incidents where foreign parents changed their minds during the surrogacy process. ‘Baby Manji,’ as she came to be known, is one of the most famous cases. Her would-be parents, an infertile Japanese couple, visited Patel in 2007 to have a baby via surrogacy, but the couple divorced while the surrogate was pregnant. After the divorce, the Japanese mother didn’t want to raise the baby; the father still wanted the child but couldn’t take her home, due to a colonial-era Indian law prohibiting single men from adopting girls. Four years later, the government announced plans to ban commercial surrogacy entirely, citing health concerns

Geeta keeps in touch with the commissioning parents from an earlier pregnancy Geeta仍繼續與第一次代孕生產的孩子父母定期聯繫

法懷孕），而 10. 5%女性患有繼發性不育症（指曾經分娩過，但其後無法再次懷孕）。此外，美國國家醫學圖書館的數據指，全球每 4 , 500 名婦女之中就有一名患有苗勒管發育不全綜合症，她們因基因變異而天生沒有子宮。患者即使成功移植子宮，也必須採用 IVF才能懷孕，因為她的身體無法自行排卵。不幸的是， IVF 的成功率極低，因此代母成為不孕婦女萬不得已的最後出路。

代孕首選之地位於吉拉特邦的 Akanksha 醫院及研究中心在生育領域聲名卓著，當地亦因此被視為印度的「代孕之都」。 Patel至今已成功在醫院協助分娩 1, 400多名代孕嬰兒。然而，這個現狀可能很快就會改變。印度將於 2020年內通過一項新法案，限制代孕必須為非商業目的，代母亦不會獲得金錢上的補償。法案還規定，只有印度籍的已婚異性夫婦及單身女性（包括寡婦及離婚人士）才能獲得代孕服務，換句話說，單身男士、未婚夫婦、鰥夫或同性伴侶均不得申請代孕服務。新法案規定要求代孕的夫婦必須經醫生證明為「不孕」。同時，年齡亦有限制：妻子必須是 23至 50歲之間，丈夫必須是 26至 55 歲之間；代母的規定則是年齡介乎 25歲至 35歲，已婚並育有子女。 2019年法案修訂初稿規定代母必須是要求代孕夫婦的「近親」，但這項要求現已取消。 2020年 2月，印度國會專責委員會決定，只要符合相關規定的要求，任何「願意」代孕的婦女均可擔任代母。修訂後的法案還訂明，年齡介乎 35至 45歲之間的離婚或喪偶婦女可選擇擔任代母。

包括 Patel 在內的醫療專業人員都批評法案「過於嚴苛和退步」。此外，法案對同性伴侶和未婚者的歧視態度亦受到譴責。 Pat e l 說：「我們一直認同監管的必要性，一來可以保護婦女，二來亦有助經營診所。但新法案幾乎斷了代孕之路。這是本末倒置的做法。」新法案延續 2015 年禁止外國夫婦在印度接受代孕服務的政策，這是由於登記程序過於繁複，加上有不少外國夫婦在代孕過程中改變主意。其中一個最著名的案例為「女嬰 Manji」。她的準父母是一對無法生育的日本夫婦，二人於 2007年來到 Patel的診所要求代孕服務，後來卻在代母懷孕期間離婚。離婚之後，日本母親不想撫養孩子，日本父親仍想要孩子，卻因為印度法律禁止單身男子收養女孩而不能帶她出境。四年後，印度政府基於健康考慮和代孕診所經營不善等理由，宣布全面禁止商業代孕。 Patel 稱這是「落後而不人道的舉措。」她認為在人類社會中，以規範完善的自願性契約換取金錢是天經地義的事。她說：「代孕是一個雙贏的局面。一個真正的家庭獲得生命的恩賜，而代母也有能力讓下一代接受教育，以及購買房屋、養活一家大小。」

KEY TAKEAWAYS 文章要點 Commercial surrogacy was legalised in India in 2002 印度於2002年合法化並實施商業性質代母的安排

The practice has since lifted many women out of poverty 當地不少婦女因成為代母擺脫貧困

In 2015, India banned foreigners from surrogacy services 印度政府於2015年禁止向外國人提供代母服務

When passed, the Surrogacy (Regulation) Bill 2019 will prohibit commercial surrogacy 《2019年代孕（監管）

代母生涯 29歲的 Geeta*也在阿南德待產，她和從事體力勞動的丈夫亦可藉代孕獲享經濟利益。她說：「我是第二次當代母。我用第一次賺到的錢蓋房子和送孩子上學。」 Geeta14歲離開學校，開始下田工作，每個月只能賺到 500 至 800印度盧比（約 7至 11美元），丈夫的收入跟她差不多，

法案》於今年正式通過之後，將會禁止商業性質的代母安排

The bill has been criticised for being too restrictive 有批評指該法案限制太多

F E AT U R E 專題故事

and poorly run surrogate clinics. Patel calls it “a backward and inhumane step.” She believes there is nothing wrong with a well-regulated, voluntary contract between human beings, in exchange for money. “[Surrogacy] really is a win-win situation. A genuine family gets the gift of life, and [the surrogate mothers] are able to educate their own children, buy a house, and put food on the table.”

LIFE AS A SURROGATE The wife of a local manual labourer, 29-year-old Geeta* is another woman from Anand who has benefited financially from surrogacy. “This is my second time,” she says. “With the money from the first, I was able to build a house and send my children to school.” Geeta left school when she was 14 years old and began working in the fields, earning between 500-800 rupees (US$7-11) per month, while her husband earns about the same. They were scraping by, struggling to feed their family of four. After hearing about the surrogacy programme through other women in her village, she visited the hospital. Patel says women are thoroughly screened before being accepted into the programme: They undergo a pap smear, blood tests, and various exams to check for genetic diseases, including diabetes. For the first four months of their pregnancy, the women must live on the hospital grounds, though their families are welcome to visit, to ensure any medical needs can be addressed as soon as possible. When they reach their fourth month of pregnancy, surrogate mothers have the option to visit home for 10 days. While Geeta was pregnant, she lived in an airconditioned room in the basement of the Akanksha Hospital with eight other women. Just after 1pm every day, the women queue for thali – a traditional Indian meal of rice, lentils, vegetables and pickles. They also eat iron-rich fruits and nutritious snacks throughout the day. The women have medical check-ups two to three times a day, otherwise the time is theirs. They play card games or watch television together in the evenings – usually a soap opera or a Bollywood film – and become very close, almost like sisters, during their pregnancies. Like many of the women, Geeta’s children visited regularly and often stayed with her at the hospital on weekends. “[My children] knew I was a surrogate mother, although they didn’t understand what that meant. They are only three and nine,” Geeta says. 92

生育權 | arianalife.com

After they give birth, surrogate mothers and all of their dependents have access to free checkups provided by the Anand Surrogate Trust, also founded by Patel, for up to three years. The child’s parents are allowed to continue a relationship with the surrogate mother if they choose, but are not contractually required to do so. Geeta keeps in regular contact with the parents of the child from her first pregnancy. “They are an Australian couple. They both work in the corporate sector and have well-paying jobs. The baby is well loved,” she says. “I am so happy [being a surrogate]. I wouldn’t have dreamed I could give my family so much.”

DIVIDED OPINIONS Not everyone believes that surrogacy is a worthwhile service. In a 2010 interview with the Indian news channel NDTV, Mohan Rao, a professor at the Centre of Social Medicine and Community Health of Jawaharlal Nehru University in New Delhi, likened it to “reproductive trafficking.” He believes that surrogate mothers – most of whom are cash-strapped – see surrogacy as a quick way to make money.

T H E S U R R O G AT E S 借腹生子

僅能勉強養活一家四口，生活捉襟見肘。聽見村裡其他婦女說起代孕計劃之後，她便跑到醫院打探消息。 Patel 表示，診所裡的代母必須事先通過徹底篩檢，包括柏氏抹片檢查、血液檢查，以及包括糖尿病等遺傳性疾病的檢查。她們在懷孕期間的前四個月一定要在醫院留宿，以確保任何醫療需求都能盡快解決，不過孕婦的家人可以前來探視。到了孕期第四個月時，便可選擇返家探親 10天。懷孕期間， Geeta 和另外八名婦女一起住在 Akanksha 醫院地下室一間有空調的房間。每天下午一點左右，婦女們就排隊領取傳統印度套餐 thali ，盤子裡有米飯、小扁豆、蔬菜和一些醃漬醬菜。

她們每天還會進食富鐵質的水果和營養小食。每天除了兩、三次身體檢查之外，其他時間她們都可以自由活動。晚上大家會一起玩紙牌遊戲或看電視，通常是肥皂劇或寶萊塢電影。懷孕期間朝夕相處，讓大家培養出情同姐妹的閨蜜關係。跟大部分代母一樣， Geeta 的子女也會定期來探訪，並且經常在周末留在醫院陪她。 Geeta 說：「他們知道我是代母，但不明白那是甚麼意思。兩個孩子不過才三歲和九歲。」分娩後，代母和她們的家屬均可在 Patel 創立的信託基金 Anand Surrogate Trust得到三年免費檢查。委託代孕的父母可選擇與代母繼續保持聯繫，但不是硬性規定。 Geeta與第一次代孕生產的孩子父母定期聯繫。她說：「他們是一對澳洲夫婦，兩人都在大型企業公司工作，擁有高薪厚職。嬰兒備受疼愛。我很高興（成為代母）。我做夢都沒想到能帶給家人這麼多東西。」

眾說紛紜然而，並非所有人都認為代孕是一項物有所值的服務。新德里賈瓦哈拉爾・尼赫魯大學的社會醫學及社區衛生中心教授 Mohan Rao 於 2010年接受印度新聞電視台 NDTV 訪問時，將代孕比作「生殖販賣」，他認為大部分代母都面臨經濟困難，於是將代孕視為一種「賺快錢」的方法。在孟買工作的律師及性別平權倡導人士 Nishma Jethwa 認為，代孕法案雖然旨在防止不道德行為，例如保護代孕兒童免遭遺棄，並且對診所作出規範，但當中仍有許多不足。「立法顯然已經（在防止剝削方面）作出嘗試。然而，禁止某 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

Nishma Jethwa, a Mumbai-based lawyer and gender activist, believes that the surrogacy bill has been framed as a way to prevent unethical practices, including exploitation of surrogate mothers and children. “It is clear that in some areas of the legislation, an attempt has been made to [prevent exploitation],” she says. For example, she says the bill aims to protect surrogate children from abandonment and regulate clinics. “Unfortunately, banning certain types of couples – like live-in couples, non-heterosexual couples and single parents – from using a surrogate creates an unnecessary value judgement on who should and shouldn't be able to use surrogate mothers,” adds Jethwa. She argues that the bill could backfire.“There could be cases of manipulation,” she says. “Women in an unequal power dynamic, for example, hired help and daughters-in-law could be forced to become surrogate mothers with no compensation whatsoever.” Some critics also argue that the bill is elitist and sexist. They believe that by highlighting examples of malpractice, rather than successes, the bill not only denies genuine opportunities and freedom for women who choose surrogacy as a career but also denies them agency over their own bodies. Unsurprisingly, all the women at Akanksha are opposed to the bill. They are happy to be surrogates, saying that they value the opportunity to provide for their families. At the same time, since India has no laws to regulate the trade, many other women have been left vulnerable to exploitation by profit-driven infertility clinics. As a primary concern, the bill argues that, due to the "lack of legislation to regulate surrogacy,” the practice has been “misused by surrogacy clinics.” According to Akanksha’s infertility researcher who spoke with Ariana on the condition of anonymity, it is true that there are many unregulated and unhygienic clinics in India where surrogate mothers are exploited or not well cared for. “The women who visit these clinics to become surrogates are severely underpaid, not well taken care of, not given proper counselling or medical treatment,” adds Patel. “This is one of the reasons the government is introducing the bill. But I feel it will make the matter worse, as the trade will go even further underground. Where there is a demand, there will always be a supply.” 94

生育權 | arianalife.com

In October 2019, the death of a surrogate mother sparked a debate over the concern for exploitation of women. A 42-year-old Delhi-based woman allegedly concealed a number of medical issues – including tuberculosis, hydrocephalus (a buildup of fluid in the brain) and depression – from a clinic that had hired her as a surrogate. However, a report by the Times of India in October 2019 revealed that the clinic didn’t properly screen the woman during the hiring process. The woman died due to complications when she was 17 weeks pregnant with twins. The government also cited concerns about women’s awareness about the risk factors of surrogate work. A small-scale study conducted in 2015 by Wiley’s Obstetrics and Gynaecology Journal on surrogate mothers in New Delhi, found that none of the 14 mothers interviewed was able to explain the risks involved in the in-vitro fertilisation process. Furthermore, the study found that the majority of doctors at fertility clinics in New Delhi make unilateral decisions when it comes to medical procedures. In some cases, they only consulted the commissioning couple, while surrogates were not adequately informed. The lack of knowledge and agency raises concerns about the interests of surrogate mothers.

Surrogate mothers practice Indian ceremonies, such as mehndi body art, to celebrate births 代母們以印度手繪等傳統儀式慶祝新生命誕生

些特定人士（例如同居伴侶、非異性戀伴侶和單親父母）使用代孕服務，等於是對誰可以、誰不可以使用代母作出不必要的價值判斷。」她說。她認為法案可能會有反效果，「這當中可能會出現人為操縱的情況。例如，在男女不平等的社會中，若有家人需要這方面的協助，媳婦可能會被迫成為代母，卻拿不到任何金錢補償。」亦有評論家指出，這項法案屬於精英主義和性別歧視。他們認為法案僅強調少數疏失個案而非成功案例，不僅剝奪了婦女選擇從事代孕服務的實質機會和自由，亦否定了她們對自己身體的自主權。不出所料，所有在 Akanksha 待產的代母都反對這項法案。她們心甘情願做代母，珍惜這個改善家庭生活的機會。但同時，由於印度對這類交易沒有法律規範，不少婦女因而受到唯利是圖的不良診所剝削。

法案主要關注的問題是，由於「缺乏監管代孕的法律」，導致代孕服務「遭到代孕診所濫用」。 Akanksha醫院的不育症研究人員匿名接受 Ariana 訪問時表示，印度的確有許多不受監管、不注重衛生的診所，使代母受到剝削或沒有受到合理照顧。醫生 Patel 補充說：「在這些診所擔任代母的婦女沒有得到合理的工資及妥善照顧，亦沒有得到適當的諮詢或醫療服務。這是政府推出法案的原因之一。但我認為此舉反而會令情況惡化，因為嚴禁代孕只會使交易化明為暗，從地上轉為地下。因為只要有需求，就一定會有供應。」 2019 年 10 月，一位代母去世，引發各界關注婦女被剝削的問題。這名來自德里的 42歲婦女，向聘請她擔任代母的診所隱瞞了許多健康問題，包括結核病、腦積水和抑鬱症。根據《印度時報》於 2019年 10 月的報導，該診所在聘僱過程中並未妥善地檢查代母的身體。這名懷

著一對雙胞胎的婦女在妊娠第 17週時死於併發症。政府還表示擔心婦女對代孕工作的危險性缺乏足夠的意識。《 Wi l e y ’s O b ste t r i c s and Gynaecology Journal》於 2015年進行一項針對印度代母的小型調查發現，在 14名受訪的母親當中，沒有一人能說明體外人工受孕過程中的風險。研究亦發現，新德里生育診所的大多數醫生通常在醫療程序方面作出單方面決定。在某些個案裡，他們只諮詢要求代孕夫婦的意見，卻沒有向代母提供充足的資訊。在缺乏知識與自主權的情況下，代母的權益備受關注。

前途未明在重男輕女的印度社會中，婦女注定是家庭主婦，但 Bharti 和 Geeta都扛起了養家的主要責任，顛覆了原來的社會結構。這兩個女人一度生活在貧窮線以下，代孕後卻有能力蓋新屋、讓家人溫飽，並且讓子女接受更好的教育。 B h ar t i 說：「我希望（我的孩子們）明白，認真讀書就可以過他們嚮往的人生。」同樣的， Geeta 也希望她的女兒長大後成為一名老師或醫生。 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

UNCERTAIN FUTURE

marry elsewhere.” Patel goes on to say that the shame and stigma felt by women in these situations will give rise to In India’s patriarchal society, where women are expected problems, including depression and anxiety. to be homemakers, both Bharti and Geeta are challengIn September, Patel met with prospective surrogate ing social structures by becoming their families’ prima- mothers at Akanksha to discuss the law. All of them, says ry breadwinners. The two women once lived below the Patel, are scared and uncertain of their future. “I will have to poverty line, but have since go back to becoming a maid, been able to build homes, or working in the fields,” feed their families, and says Bharti. “The money pay for their children’s edwill not be enough, but what "I will have to go back to ucations. “I hope [my chilother choice do I have?” becoming a maid, or working dren] understand that by Meanwhile, Geeta hopes in the fields. The money will studying they can become that the money she has not be enough, but what whatever they want,” says saved will allow her and her Bharti. Likewise, Geeta husband to start their own other choice do I have?" hopes that her daughter business. She says that they will eventually become a are hopeful they will not 「我必須重操舊業，替人幫傭 teacher or a doctor. have to return to manual In addition to creating labour. “Maybe we can open 或下田工作。賺的錢肯定不夠養 an unregulated, undera vegetable stall or sell fruits,” 家，但我還有甚麼選擇？」 ground trade, Patel says she says. that many infertile women Though the forthcomwho choose surrogacy will – Bharti ing law directly affects the suffer from the bill’s restricwomen at Akanksha, Patel tions. In India, where womsays she is proud that suren are primarily seen are rogacy has enabled her to child-bearers, there is already pressure on married women turn the clinic into a world-renowned institute, offering to have children. Patel feels that these issues will be exac- women from low-income families a chance of a better erbated by the bill. life. “Because of surrogacy, I have been able to build such “In Indian culture, a woman can face ostracism and facilities for the women and ensure their well-being.”  even be kicked out of her home [if she can’t conceive],” says Patel. “The man may even divorce the woman and *Surnames withheld at request of subjects.

醫生 Patel 覺得法案除了製造不受監管的非法交易，許多選擇代孕的不育婦女亦會受到法案的限制。在印度，婦女的主要職責是生兒育女，已婚婦女要面對難以想像的生育壓力。 Patel認為，這些問題將會因為法案而變本加厲。 Patel 說：「在印度文化中，一個不育的女人可能會遭到排斥，甚至被趕出家門。男人甚至可能與女人離婚並在他處結婚。」在這種情 96

生育權 | arianalife.com

況下，女性所背負的恥辱和污名會引起各種問題，包括抑鬱和焦慮。去年 9 月， Patel 在 Akanksha 醫院與準代母面對面討論法案，當時所有人都表示對未來感到擔憂。「我必須重操舊業，替人幫傭或下田工作。賺的錢肯定不夠養家，但我還有甚麼選擇？」 Bharti 說。 Geeta則希望她存下來的錢能夠讓她和丈夫做點小生意，不必回去做體力勞動的工作：「也許我們可

以開一個蔬菜攤或賣點水果。」儘管即將通過的法案對Akanksha 醫院的婦女帶來直接影響，但 Patel 說代孕使她的診所變成舉世聞名的機構，為來自低收入家庭的婦女提供改善生活的機會，這些成就都令她深感自豪：「因為代孕，我才能夠為婦女建立這樣的設施，並且妥善照顧她們的身心健康。」  *按當事人要求不透露姓氏。

T H E S U R R O G AT E S 借腹生子

香港在代孕方面之缺失

SURROGACY SHORTCOMINGS IN HONG KONG Hong Kong-based lawyer Evelyn Tsao unpacks the city’s surrogacy laws and their impact on same-sex couples. 香港律師曹喬茵為我們說明香港的代孕法規及其對同性伴侶的影響。

For many couples who are struggling to conceive,

對許多在生育方面有困難的夫婦來

surrogacy has become a promising alternative, along with

說，代孕及其他輔助生殖技術，如體

other assisted reproductive technologies, such as in vitro

外受精和人工授精，是讓他們達成心

fertilisation and intrauterine insemination. But in Hong Kong,

願的另類選擇。然而，在香港，商業

commercial surrogacy is totally prohibited, while altruistic

代孕是不合法的，而無償代孕僅適用

surrogacy (involving no compensation), is available only to

於已婚夫婦。

married couples.

由於香港不承認同性婚姻，因此

By default, same-sex couples can’t access surrogacy

同性伴侶不能合法使用代孕服務。如

legally, since Hong Kong does not recognise same-sex unions.

果他們不顧一切選擇代孕，結果可能

Should they choose to arrange surrogacy regardless, they

會遭受嚴厲處罰，甚至入獄。我們邀

could face stiff penalties and potentially even prison time. We

請何珮芝律師行的合夥人及性小眾社

asked Evelyn Tsao, a partner at Patricia Ho & Associates and a

群成員曹喬茵律師分享她的見解：

member of the LGBT+ community, to unpack this issue: ARIANA When did you first become interested in reproductive rights?

ARIANA 你何時開始對生育權利有興趣？曹喬茵八年前我在哈佛唸書時，選了一門關

EVELYN TSAO Eight years ago, I took a class on reproductive technology and

於生殖科技和相關法律問題的課程。

the legal issues surrounding it while I was studying at Harvard.

當時香港的生殖科技尚未普及，所以

At the time, reproductive technology wasn’t as widespread in

我對這方面很感興趣⋯⋯我認為很多

Hong Kong, so I was really interested in it… It’s something

進行這些事的人都不願張揚，尤其是

that I think a lot of people are doing, but it’s a bit hush-hush,

性小眾社群。

especially for the LGBT community. ARIANA What is the legal situation in Hong Kong?

ARIANA 香港在這方面有何規定？曹在香港，已婚的異性夫婦可以合法使

ET In Hong Kong, surrogacy is legal for married heterosexual

用代孕技術，不過他們要遵守《人類

couples so long as they comply with the Human Reproductive

生殖科技條例》的規定，尤其在獲得

Technology Ordinance. When obtaining a parental order,

判定為父母的命令時，必須向法庭提

in particular, they must be able to satisfy the courts that no

出代孕安排並未涉及金錢或利益的證

money or benefit (other than for expenses reasonably incurred)

據（合理招致的費用除外）。

has been given or received in the arrangement.

arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

Under the Human Reproductive Technology Ordinance,

根據《人類生殖科技條例》的規

commercial surrogacy is illegal. It is also illegal to use

定，商業代孕是非法的。代孕使用捐贈

donated gametes [i.e. gametes not belonging to the married

者的配子（即不屬於委託的已婚夫婦）

couple] in a surrogacy arrangement.

亦屬違法。這實際上就表示男同性戀伴

This means gay male couples are excluded since the city

侶無法獲得代孕，因為香港不承認同性

does not recognise same-sex marriage. For a lesbian couple,

婚姻。想要生育的女同性戀伴侶反而沒

it is not really a concern because usually a lesbian does not

甚麼問題，因為女同性戀者本身就擁有

have to resort to surrogacy to have a baby.

生育能力，無需尋求代孕協助。

For gay male couples, however, it’s harder. Neither man

不過，這對男同性戀伴侶來說就難

has a womb, obviously, so they must depend on a woman

如登天，因為他們雙方都沒有子宮，所

to bear their child. Many male couples in Hong Kong are

以必須依靠女性懷胎生育。香港許多男

interested in surrogacy, but they can’t pursue it openly

性伴侶想找人代孕，但由於香港禁止使

because of the prohibition against using donated gametes

用捐贈者的配子，所以他們在承認同性

in surrogacy, even if they are in a same-sex union recognised

婚姻的國家也不能公開徵求代孕。

by another country.

ARIANA So how can gay male couples have children in Hong Kong?

ARIANA 那麼男同性戀伴侶在香港如何養兒育女？

ET The legal reality is far from ideal. It is illegal for gay male

曹目前的法律對這方面很不利。當男同

couples to use donated gametes in a surrogacy arrangement,

性戀伴侶沒有婚姻關係時，他們不能

and commercial surrogacy is also dangerous grounds.

合法使用捐贈者的配子，商業代孕也

Instead of surrogacy, I’d say the other route is to adopt a

是違法。

child that’s not genetically related to either parent. However,

除了代孕，我想另一個方法是收養

it’s unclear how receptive the Social Welfare Department

一個跟伴侶雙方都沒有血緣關係的子

and the courts in Hong Kong are towards two same-sex

女。但是，目前香港社會福利署和法院

parents adopting. The gay couple may choose to apply as

對同性伴侶收養子女的看法尚不明確。

single parents when adopting but, even so, they may need

同性伴侶可能會選擇以單親的身分提出

to wait a long time for a match because there is obviously a

收養申請，但即使如此，他們也可能需

preference for married couples over single parents.

要等上一段很長的時間，才能找到合適

的收養對象，因為已婚夫婦顯然比單身

ARIANA What are the legal consequences if couples arrange surrogacy in Hong Kong?

ET If caught engaging in commercial surrogacy [except where

人士更佔優勢。 ARIANA 如果他們在香港安排代孕會面對甚麼法律後果？

there is court approval or authorisation] or using donated gametes, each person is liable to a fine of HK$25,000 and

曹如果被發現使用商業代孕服務（除非

imprisonment for six months on the first conviction under

經法院批准或授權）或使用捐贈者的

the Human Reproductive Technology Ordinance. On a

配子，根據《人類生殖科技條例》，

subsequent conviction, the fine increases to HK$100,000 and

一經首次定罪可處港幣25,000元罰

imprisonment for two years.

款及監禁六個月。一經再度定罪，可

處港幣100,000元罰款及監禁兩年。

生育權 | arianalife.com

Mitch Lui

T H E S U R R O G AT E S 借腹生子

ARIANA 這種情況是否普遍？曹目前尚無正式估計香港有多少性小眾伴侶經由代孕產子。同性伴侶即使想找人代孕也會守口如瓶，因為這是不合法的。儘管大家不公開談論，但我相信代孕的個案比想像中更為普遍。我有許多同性戀朋友，或是朋友的朋友，尤其同性伴侶，都是經由代孕產下子女。我認為代孕只會越來越普遍，因為現在同性伴侶更容易前往海外註冊結婚，他們婚後可能想撫養自己的孩子。

"Gay couples are excluded since the city does not recognise same-sex marriage."

Hong Kong-based lawyer Evelyn Tsao 香港律師曹喬茵

「男同性戀伴侶無法獲得代孕，因為香港不承認同性婚姻。」 – Evelyn Tsao 曹喬茵

ARIANA How common is it? ET There are currently no official estimates for how many LGBT+

ARIANA 同性父母經代孕產下的子女會有任何風險嗎？

couples in Hong Kong have had children through surrogacy. If they decide to pursue surrogacy, same-sex couples usually

曹通常在子女出生後六個月內，委託代孕

keep it very quiet since it’s illegal. Even though people

者其中一方必須向法院申請判定為父母

don't talk about it openly, I believe surrogacy is a lot more

的命令。有關命令賦予委託代孕者永久

widespread than it seems.

合法的父母身分和責任，並且為子女提

A lot of my gay friends, and friends of friends – particularly

供終生保障。此外，命令廢除了代孕母

couples in same-sex unions – have had children through

親對子女的權利。當然，父母得到合法

surrogacy. I think surrogacy will only become more common

身分和認可，子女亦可從中受惠。如果

since it’s now easier for gay couples to get married overseas and,

沒有獲得判定為父母的命令，同性父母

after marriage, some may want to raise their own children.

和子女的權益將得不到合理保障。

ARIANA Are there any risks for the child of gay parents conceived through surrogacy?

如果公共政策能夠體認同性夫婦跟異性夫婦一樣，也渴望建立自己的家庭，也應該被允許以這種方式享受家庭生活，這將會有助改善目前的情

ET Generally, within the first six months after the child is born, at least one of the commissioning parents should seek a parental

況。歸根結底，法律需要被重新審視和修改，為這些家庭提供保障。 arianalife.com | REPRODUCTIVE RIGHTS

F E AT U R E 專題故事

order from the court. A parental order confers permanent legal

ARIANA 香港社會是否越來越接受同性家庭？

parenthood and responsibility on the commissioning parents and provides lifelong security for the child. It also removes

曹普遍來說，對於同性關係的接受程度

the surrogate mother's rights over the child. Obviously, it is

逐漸提高。香港中文大學性小眾研究

paramount to a child's best interest to have his or her parent

計劃於今年1月發表的報告指出，六

legally defined and recognised. So gay parents and their child

成受訪者支持立法保障性小眾人士。

are hugely unprotected if left without a parental order.

不過，我無法評論社會大眾對代

What would help the situation is for public policy to

孕和收養的看法。香港在這方面仍然

recognise that, just like heterosexual couples, same-sex

相當保守，我們尚未衝破第一個關

couples may have the desire to start their own families

口，就是承認同性婚姻！

and they should be allowed to enjoy family life in this way. Ultimately, the law needs to be revisited and changed to provide protection for these families. ARIANA Is Hong Kong society becoming more accepting of samesex families?

ET In general, acceptance of same-sex relationships is increasing. A recent study released in January by the Chinese University of Hong Kong’s Sexualities Research Programme found that 60 per cent of respondents supported LGBT rights in the city. But I can’t really comment on the general sentiment about surrogacy and adoption. Hong Kong is still so backward that

"The law needs to be changed to provide protection for these families." 「法律需要被重新審視和修改，為這些家庭提供保障。」

we haven’t gone through the first hurdle, which is recognising

– Evelyn Tsao 曹喬茵

same-sex marriages! ARIANA What can Hong Kong society do to improve awareness about LGBT+ rights?

ARIANA 香港社會可以採取哪些措施來提高民眾對性小眾權益的關注？

ET We need to drastically revamp relevant legislation to reflect modern times. Ideally, the government should be looking

曹我們必須因應時代變遷，大刀闊斧地修

at legislation from the perspectives of protecting all LGBT

改相關法規。最理想的情況是政府從保

minorities, but it would take a lot of changes to get there.

障所有性小眾社群的角度審視立法，但

The government rarely initiates or amends legislation to

100

生育權 | arianalife.com

需要做出許多改變才能實現這個目標。

promote human rights and they usually require a ‘kick’ by

政府很少主動創立或修改促進人

the courts through judicial review or other court processes

權的法案，通常需要在司法審核或其

to do so. Religion plays a role too, and it’s alarming how

他法院程序的推動下才會執行。宗教

influential the Catholic and Christian communities are when

也扮演了舉足輕重的角色，天主教和

it comes to developing secular laws. I think Hong Kong is

基督教團體對發展世俗法的影響力令

ready, it’s just that the people influencing these decisions

人擔憂。我認為香港已經準備好了，

are against it. 

只是那些有影響力的人仍在反對。

T H E S U R R O G AT E S 借腹生子

arianalife.com | REPRODUCTIVE RIGHTS

101

TOMORROW’S HARVEST 希望在明天 Egg-freezing offers women greater reproductive freedom, but does it come at a cost? 凍卵讓女性掌握更多生殖自由，但需要付出怎樣的代價？

Words 文 Anna Simpson | Illustrations 插圖 Gonçalo Viana

n June 2017, Karissa Chen flew from the United States to Taiwan with one purpose: to freeze her eggs. Chen first learned about mature oocyte cryopreservation (as the procedure is officially known) from a friend when she was 28 years old, but six years passed before she considered doing it herself. Now 37, Chen regrets waiting so long. Over time, she’s become more aware of the impact age has on fertility. “I wish I had received more information about my own body years ago and made a more informed choice ahead of time,” Chen says over the phone from Taiwan, where she has since moved to teach creative writing. “If you think about it, the numbers [and quality of eggs a woman produces] aren’t as good as they used to be [when I was younger].” Concerns about her personal fertility peaked a year earlier, when Chen had walked away from a five-year relationship. The decision left her acutely aware that, by doing so, she was leaving behind any ideas she may have had about starting a family in the near future. “I’d envisioned sports practices, museum visits, and, sometimes, I could practically hear the sound of little hands pattering on the congas that my partner loved to play,” she recalls in ‘My Fertility, My Future,’ a regular column in web-based magazine Catapult, which Chen began writing in early 2019 to share her reproductive experiences. When she finally made the decision to freeze her eggs, Chen felt relieved and empowered, as if she was defining pregnancy and motherhood on her own terms: “I suddenly felt like Superwoman,” she writes. “I was proud of myself. I had already proven I was capable of more than I thought. I was taking control of my life.” At the same time, Chen was well aware that this back-up option isn’t foolproof: “The chances of getting a viable baby from frozen eggs is pretty slim. It’s a last resort.” It’s also not without its drawbacks, from emotional and physical challenges to prolonging gender inequality in the workplace.

017年 6月， Karissa Chen從美國專程飛到台灣，只為了一個目的：凍卵。她在 28歲時第一次聽朋友提及冷藏成熟卵子的技術，但六年後她才認真考慮這件事。進行凍卵的一年前， Karissa 結束了一段五年的戀情，這使她意識到自己在短期內不太可能成家立室，亦開始擔心自己的生育能力已經過了高峰期。因此，當她終於決定冷凍保存自己的卵子時，她感覺如釋重負，好像掌握了懷孕和做母親的能力。「我突然覺得自己像個女超人。我為自己感到驕傲，證明了自己擁有超乎意料的能力，可以掌控自己的生命。」這是 Karissa從 2019年開始在網絡雜誌《 Catapult》撰寫專欄「 My Fertility, My Future」時，寫下對凍卵的感想。當時她已遷居台灣，在當地擔任創意寫作老師。「我會想像帶小孩去運動、參觀博物館，有時，我甚至幾乎可以聽到一雙小手在敲打康加鼓的聲音，那是我伴侶愛玩的樂器。」她這樣描述。不過，今年 37 歲的 Karissa 後悔自己過了這麼久才採取行動，因為她越來越明白年齡對生育能力的影響；隨著卵子的數量和 arianalife.com | REPRODUCTIVE RIGHTS

103

F E AT U R E 專題故事

A GROWING TREND For the IVF market, women like Chen represent a huge opportunity. Experts say the industry anticipates a 9.8 per cent compound annual growth rate for the next six years, bringing the market value to US$38.7 billion by 2026.The egg freezing industry in the US alone is estimated to be valued at US$4.3 billion. “You can imagine, it’s big business,” observes Professor Ernest Ng, a specialist in assisted fertility at The University of Hong Kong. “Around 15 per cent of couples will have problems conceiving and go for IVF. Egg-freezing has much bigger potential, particularly if you can persuade younger women to do it.” Indeed, egg-freezing has become more popular in high-income countries, where an increasing number of women are choosing to start families later in life. According to a study by the Organisation for Economic Co-operation and Development (OECD) Social Policy Division, in most OECD countries, the average age of first-time mothers is 30 or above, representing an increase of two to five years in several countries since 1970. In Hong Kong and Singapore, it’s 29.8, while Hong Kong has also seen a 90 per cent surge in the number of women aged 40 or older giving birth in the last decade. Experts attribute this change to the increasing emphasis on a woman’s career development and the absence of support for childcare – in policy and in employment practices. A comprehensive 2018 report by the Hong Kong Federation of Youth Groups, entitled “Improving incentives for Women’s Employment,” found that most Hong Kong residents believe women

should take care of children on a full-time basis, creating a tension between employment and family responsibilities. According to the 2016 census, the labour force participation rate of single women is 65 per cent, but only 44 per cent for married women. In terms of fertility success rates, the chances of pregnancy from frozen eggs has increased substantially since the procedure’s first live birth in 1986 globally. In 2008, a study by the Valencian Institute of Infertility in Spain found no notable difference between fertilisation rates of fresh and frozen eggs, with both methods seeing over 75 per cent success rates. Subsequent studies confirm these findings, and many private clinics have since advertised rates in the region of 80-90 per cent. However, these often quoted fertilisation rates do not necessarily result in successful pregnancies. “If you’re approaching 40, freezing your eggs is technically possible and you may be able to finance it, but the chances of getting a live birth further down the line are pretty low,” says Ng. “The best time is when you’re in your early 20s, but at this age women may not have the funds and don’t see the need: They’re still confident they’ll find Mr Right.” “It’s important for a woman to understand that her individual success rate depends on a number of factors,” adds Dr Patrick Chan, a Hong Kong-based obstetrician and gynecologist. “First and foremost, there’s egg quality, which depends on a woman’s age at freezing [the younger, the better], but also the sperm quality, her uterine conditions [such as the uterus lining], and other questions relating to her gynecological health [such as fibroids or endometriosis].”

HOW EGG FREEZING WORKS 凍卵的操作原理 1

104

As with IVF, injections stimulate the growth of follicles in the ovaries and the release of eggs

Ultrasounds check ovulation potential,

Doctor harvests as many eggs as possible from ovaries. More than

(typically over a period of 10-12 days) combined

examining the size

one cycle to stimulate ovulation and

with other medications to support fertility and

and number of

harvest the eggs may be needed to

regulate the menstrual cycle.

follicles.

collect a sufficient number.

與IVF一樣，首先注射藥物刺激卵巢内的卵泡生長，

利用超聲波檢查排卵

醫生從卵巢採集所有可用的卵子。為

繼而生產卵子（通常在10至12天的時期），再配合其

機率，檢查卵泡的大

了採集足夠的卵子，可能需要進行多

他藥物來提高受孕率，並調整月經週期的規律。

小和數量。

次週期刺激排卵和採集卵子。

TOMORROW’S HARVEST 希望在明天

質素隨年齡下降，懷孕的機會越來越渺茫。她透過電話告訴我：「我希望數年前就知道更多關於自己身體的資訊，並儘早做出明智的選擇。如果年紀越大才考慮，卵子的數量和質素都不如前。」與此同時， Karissa 也很清楚冷藏卵子這個後備方案並非萬無一失：「靠凍卵成功誕下存活嬰兒的機會其實相當渺茫。這是萬不得已的最後手段。」而且凍卵也存在一系列問題，包括對身體和情緒的影響，以及在職場上引起更多性別不平等的現象。

蓬勃前景在人工受孕（ IVF）市場，像 Karissa 這樣的女性代表了龐大商機。專家說，這個行業預計在未來六年內，將會以 9 . 8% 的複合年均增長率成長，產業價值將由 2019年的 27億美元，上升至2026年的387億美元。據估計，凍卵產業目前價值約 43億美元。香港大學婦產科學系吳鴻裕教授觀察道：「不難想像，這是一筆大生意。約 15%的夫婦面臨不育的問題，他們將會尋求 IVF協助。凍卵的潛力更大，若能說服更多年輕女性接受這種做法，前景將十分樂觀。」

Eggs are tested for quality and

在一些高收入國家，由於選擇許多私人診所開始宣傳凍卵的成晚婚的女性越來越多，凍卵亦變功率為 80 至 90% 。得日益普遍。根據經合組織社會然而，經常被標榜的受精成功政策部的一項研究，在大多數經率，卻不能代表妊娠成功率。吳教合組織國家中，生第一胎的女性授說：「如果你已經臨近 40歲，凍平均年齡為 30 歲或以上，某些國結卵子在技術上是可行的，而且你家的平均年齡自 1970 年以來提高的經濟能力或許能夠負擔，但成功了二至五年，香港和新加坡的平誕下試管嬰兒的可能性卻相當低。均年齡為 29 . 8 歲，而香港年屆 40 凍卵的最佳時機是 20歲出頭，但這歲或以上的產婦人數，近 10 年來個年齡階段的女性可能負擔不起，更大幅提升了九成。也不認為有必要，因為她們仍相信專家將這些改變歸因於女性的自己會找到另一半。」職業發展，以及政策和就業環境香港婦產科醫師陳世樂補充中缺乏支援育兒的配套措施。香道：「女性必須了解每個人的成功港青年協會在 2018 年的專題研究率受許多因素影響。首先最重要的《釋放香港女性勞動力》中指出，是卵子質素，這一點取決於女性凍大多數香港市民認為女性應全職照卵時的年齡（越年輕越好），還有顧年幼子女，使女性在就業與家庭精子的質素、子宮狀況（如子宮內之間面對兩難。根據政府統計處的膜）及其他婦科健康的相關問題，「 2016年中期人口統計」顯示，未例如她是否有子宮肌瘤或子宮內膜婚女性的勞動人口參與率約 65%，異位症等。」但曾經結婚女性的勞動人口參與率則只有 44%。「保存你的未來」就生育成功率而言，從全球首個冷凍卵子嬰兒在 1986 年誕生美國的私人診所逐漸把 20 歲左右到現在，利用凍卵懷孕的成功機的年輕女性當作目標，鼓勵她們率已大幅提升。 2008 年，西班牙「保存自己的未來」，並警告瓦倫西亞不孕症中心瓦倫西亞大「卵子是不可再生的資源」。僱學做過一項研究，發現新鮮卵子主亦開始為員工提供凍卵福利，和冷凍卵子的受精率沒有明顯差例如 Facebook 和蘋果公司，都為異，兩者的成功率均超過 75% 。女性員工提供高達 20 , 000 美元的後續研究證實了報告結果，自此凍卵補助金額。

Eligible eggs are frozen (‘vitrified’) at -196°C and kept in storage for up to

The woman returns to thaw and fertilise her eggs, using

supported to mature

10 years or until the woman reaches a

her partner’s sperm or donor

if necessary.

certain age, depending on local laws.

sperm, as with IVF.

測試卵子質素，需要

將合格的卵子以攝氏零下196度的溫度冷

將凍卵者的卵子解凍並嘗試培養

的話會施以輔助措施

凍（玻璃化）並冷藏10年，或等到凍卵

胚胎，可使用伴侶或捐贈者的精

來促進卵子成熟。

者達到當地法規限定的年齡。

子進行體外人工受精。

105

F E AT U R E 專題故事

‘FREEZE YOUR FUTURE’ Commercial clinics in the US are increasingly targeting women in their 20s, with invitations to “freeze for your future” and warnings that “eggs are a nonrenewable resource.” Some companies have also started offering egg freezing as an employment benefit. Both Facebook and Apple, for example, offer egg-freezing coverage up US$20,000. “The cost of egg-freezing can be prohibitive, and it’s nice to have the option. But it’s not ‘no strings attached.’ It's because they want you to work harder and longer,” says Chen. “It seems to be pushed as some sort of insurance for women who are focused on their careers or haven’t found their partners.” What seems like a win-win situation on the surface may end up benefiting companies and clinics rather than women. As Dr Jude Browne of the University of Cambridge Centre for Gender Studies points out, egg freezing gives working women the option to become mothers later in life, and yet does little to fix the systemic problems that hamper women during their career-building years, which coincide with their natural child-bearing years. Few, if any, companies in Asia offer egg-freezing as part of their employee benefits packages, but it is an increasingly available option for women who can selffund the procedure. In Hong Kong, both single and married women may freeze their eggs, but they must be married under Hong Kong law to harvest them, a restriction that poses a barrier for both single women and same-sex couples. The same restrictions apply in Taiwan, so Chen would have to ship her eggs to the US to be able to implant them if she is single upon retrieval. In Singapore, you can only freeze your eggs if certain medical conditions ‘justify’ it, such as the need for chemotherapy in cancer patients, which can damage a woman’s eggs. In China, you need a marriage certificate to qualify. Freezing your eggs by choice, often referred to by practitioners as ‘elective’ or ‘social egg-freezing’, as opposed to being offered the option due to medical conditions, is also available in Thailand, Malaysia, India, Japan, and South Korea. In 2016, the Japanese city of Urayasu, east of Tokyo, began to subsidise 106

生育權 | arianalife.com

the cost to boost the country’s low birth rate as the population rapidly ages. Depending on where a woman lives, it sometimes makes sense to schedule the procedure abroad. In Chen’s case, she chose Taiwan because it was more affordable than in the States where retrieving eggs for freezing costs US$8,000 or more, sometimes with multiple cycles in order to obtain a sufficient quantity of mature eggs, plus fees for testing and medications. On top of these initial fees, storage costs around US$600 per year. Chen’s total bill for the medications, testing, and procedure in Taiwan, by comparison, came to US$4,400, while storage costs roughly US$200 a year. It’s a cost she plans to carry on paying while she splits her time between New Jersey and Taipei. “I would rather conceive naturally, without using those eggs, if I can. The clinic would never get rid of them without my permission, so at least I know they're there as long as I need them. I can budget a couple of hundred dollars a year for this. It does offer me some measure of security,” she says.

EGG FREEZING IN HONG KONG 在香港凍卵須知 Who can freeze their eggs? Any woman can freeze her eggs, but only women in heterosexual marriages can harvest them. 誰可以凍卵 ? 任何女性都可以凍卵，但以卵子培養胚胎時必須是已婚且配偶為異性。 How long does it take? An eggfreezing cycle takes approximately four to six weeks. Often, multiple cycles

are

recommended

increase the number of eggs harvested, and the chances of fertilisation. 需時多久 ? 每次凍卵的週期為四至六個星期。醫生通常建議多次

Karissa 說：「凍卵費用高昂，可能令人卻步，能夠得到資助是很好的機會。但這並非無條件的『福利』，因為公司希望你工作更賣力、更長久。這似乎是針對專注事業或未找到伴侶的女性員工所提供的某種保險。」表面看來，這好像是個雙贏的措施，可惜最終受惠的可能只有公司和診所。劍橋大學性別研究中心的 Jude Browne醫生認為，凍卵讓職業女性可以選擇於日後成為母親，但是對女性在建立事業期間面對的系統性問題卻無濟於事，因為這段時間正是她們的自然生育期。儘管很少有亞洲公司提供凍卵福利，但越來越多有經濟能力的女性作出這個選擇。根據香港法律規定，單身和已婚女性均可凍卵，但只有已婚的異性夫婦才可培養胚

胎，這對單身女性及同性伴侶均是一大障礙。台灣也有相同的限制，因此 Karissa不得不把冷凍的卵子運到美國，以備日後仍是單身卻想懷孕時可以植入胚胎。新加坡規定必須通過某些醫療評估才可以凍卵，例如需要進行化療的癌症患者，因為治療過程可能會破壞卵子。中國則必須出示結婚證書才能凍卵。因非醫療原因而選擇凍卵的做法被業界稱為「自願凍卵」，目前泰國、馬來西亞、印度、日本和韓國均可提供這類服務。 2016 年，位於東京以東的浦安市開始為市民提供凍卵補助，希望藉此提高日本的出生率，從而解決人口急速老化的問題。此外，部分女性也會選擇前往其他國家接受凍卵程序。以 Karissa

週期以增加卵子數量，從而提高受孕機會。 How long can you store them? Frozen eggs may be stored up to 10 years or until the patient reaches age 55. 最長的儲存期是多久 ? 儲存卵子的最長期限為10年，或病人年滿55 歲為止。 What does it cost? Costs range from HK$30,000 to HK$100,000, including all testing, monitoring, and the first year of storage. 費用如何 ?約為三萬港元至10萬港元不等，包括所有測試、監測及第一年的冷藏費。

107

F E AT U R E 專題故事

HIDDEN TOLLS Yet despite the glowing promises offered by the IVF industry, physical and mental health tolls of egg-freezing are largely absent from promotional literature. When Chen arrived in Taiwan, she began taking hormonal medications about 10-12 days ahead of the egg-freezing procedure. These included Duphaston, a hormonal stimulant, and self-administered injections of follicle-stimulating hormones, such as Elonva and Merional, to encourage healthy ovulation. Injected fertility drugs are associated with more severe side-effects than those taken orally, with common reports of bloating, headaches, breast tenderness, stomach issues, hot flushes, and mood swings during the prescribed treatment cycle. Chen at first felt a sense of fatigue, which quickly descended into total exhaustion as her body directed more resources into producing eggs. “I felt like a heavy cloak had been draped over every single one of my cells,” she says. She also suffered from a heavy emotional toll. At her first ultrasound appointment in Taiwan, doctors assessed the volume and viability of her egg follicles (small fluid sacs in the ovaries full of potential eggs). Chen had a relatively low number of visible follicles, which meant that she may need to undergo several retrieval attempts in order to collect enough eggs. Chen went home with a to-do list designed to boost her chances of a successful egg-retrieval procedure. She had to change her hormone medication, eat more protein, drink more water, and get lots of rest before attempting to freeze her eggs. “Over the next week, my life consisted only of sleep, clinic visits, hot pot, injections, crying, more sleep. I was always hungry but had no interest in food.” There are only a handful of studies detailing the impacts of fertility treatment on women’s mental and physical health, let alone egg-freezing in particular. A 2004 study in Taiwan examined the prevalence of 108

生育權 | arianalife.com

anxiety and depression amongst a small group of 112 women seeking assisted reproductive technology. Researchers found 26.8 per cent had a depressive disorder while 28.6 per cent of the women had an anxiety disorder, echoing previous research which found high frequencies of such disorders among women in assisted reproduction clinics. For comparison, a much broader study of general medical outpatients found 16 per cent had a depressive disorder and only 11 per cent had anxiety. Besides the physical challenges – painful injections, cramps from swollen ovaries, spotting, fatigue – Chen also suffered from severe loneliness. In the IVF clinic in Taiwan, she recalls being surrounded by couples, and her earlier sense of ‘superhero’ independence crumbled under the weight of feeling completely alone. “Something about egg freezing made it seem easy, aside from the financial aspect, which is prohibitive for many… It was actually a lot harder than I had expected.” Three days after the procedure, Chen says she “crashed into inexplicable despair” and entered a depression that lasted several months. “I no longer had the energy to be angry about anything. I was tired, I was lonely, and I was sad in ways I didn’t know how to explain.” While postnatal depression is widely researched and acknowledged, with support systems in place, ‘post-extraction depression’ (a term Chen coined) is not. There are currently no studies on the issue, but there is substantial anecdotal evidence across personal blogs and news articles that many women experience anxiety and depression following egg-freezing procedures. In addition to the impacts of hormonal stimulants, the invasive nature of the procedure and the sense of loneliness that she felt, Chen also wonders whether anxiety could be aggravated by the prolonged uncertainty, the lack of closure, that accompanies egg-freezing: There are no immediate results beyond a number of eggs in storage. After her procedure, Chen says she was not offered any professional support or guidance, nor did she seek

TOMORROW’S HARVEST 希望在明天

為例，她選擇台灣是因為費用比美國便宜，美國的凍卵費用介乎於 600 美元至 18 , 000 美元之間，根據需要多少次刺激排卵和取卵週期以獲得足夠的成熟卵子而定。除了初期費用，每年還要支付約 600 美元的儲存費。相比美國， Kar i s s a 說台灣的費用，包括藥物、測試和程序加起來為 4 , 400 美元，再加上每年約 200 美元的儲存費。她打算在持續支付這筆費用期間在新澤西和台北兩地居住。她說：「如果可以的話，我寧願自然懷孕，不必冷凍卵子。未經我的允許，診所永遠不會丟棄它們，所以我知道只要有需要，凍卵可以隨時派上用場。每年幾百美元的費用我還負擔得起。這確實為我提供了一定程度的保障。」

隱藏的傷害儘管 IVF 為女性保留了懷孕的希望，但宣傳文獻大都沒有提及凍卵對身心健康的傷害。抵達台灣後， Karissa必須在進行凍卵之前，先持續接受 10 至 12 天的荷爾蒙治療，包括激素劑 Duphaston ，以及自行注射 Elonva 及 Merional 等促卵泡激素。注射生殖藥物針劑的副作用比口服來得更嚴重，這包括在療程週期內感到腹脹、頭痛、乳房脹痛、胃部不適、潮熱及情緒波動等。 Karissa說她先是感覺倦怠，然後很快因為身體加倍製造卵子而耗盡體力。「我感覺像是身體的每個細胞都被沉重的斗篷壓住。」她說。除此之外，她也感受到嚴重的情緒低落。當她首次在台灣接受超聲波檢查時，醫生為她估算卵巢內的卵泡數量及質素，並發現可見卵泡數量相對較少，這意味著 Karissa

可能需要進行多次週期取卵才能採集到足夠的卵子。 Karissa 帶著一份待辦事項清單離開診所，準備回家努力嘗試提高成功取卵的機會。進行凍卵之前，她必須服用其他荷爾蒙藥物、吸收更多蛋白質，喝更多水並得到大量休息。「在接下來那個星期，我的生活只有睡覺、覆診、打邊爐、打針、哭泣，再去睡覺。我總覺得肚子餓，但完全沒有食慾。」她說。目前只有極少數研究，詳細說明輔助生殖科技療法對女性身心健康的影響，遑論凍卵方面的報告。台灣於 2004 年所做的一項研究調查了 112 名接受輔助生殖技術的女性，並與一般護理門診的對照組互相比對。研究發現，這批女性當中有 23%的人出現焦慮反應，比例是對照組（ 11%）的兩倍。此外，近 17%的人被診斷出患有抑鬱症，而對照組只有 6%。除了對身體的眾多影響，包括注射針劑的痛苦、卵巢腫脹引起的痙攣、點狀出血及疲勞等， Karissa 說她也有嚴重的孤獨感。她回憶起在台灣的生殖醫學中心時，身邊都是結伴而來的夫婦，初期令她引以自豪的「女超人」感覺亦在沉重孤獨感中瓦解了。「除了費用高昂，凍卵似乎是件輕而易舉的事。但事實上，整個過程比我預期的更難熬。」進行取卵程序三天之後， Karissa說她「墜入莫名的絕望」，並陷入了抑鬱的情緒，這種狀況持續了好幾個月。「我再也沒有力氣為任何事生氣。我感到疲倦、孤獨、悲傷，卻不知道這些情緒從何而來。」針對產後抑鬱症的研究已相當廣泛和具公信力，支援系統亦相當完善，但被

Karissa 形容為「取卵後抑鬱症」的研究卻付之闕如。雖然目前尚無這方面的研究，卻有許多女性在個人網誌及新聞報導中表示，在凍卵程序之後經歷了焦慮和抑鬱。除了荷爾蒙刺激的影響、侵入性的取卵過程和嚴重的孤獨感， Karissa 懷疑伴隨凍卵的長期不確定性、看不到最終結果等因素，都會使焦慮感加劇，因為除了凍卵的數量，其他事情一概都是未知數。 Karissa表示，她在取卵之後沒有得到任何專業支持或指導，也沒有主動尋求幫助。「我並不指望診所為我提供心理諮詢師，但我希望在決定凍卵之前，可以預先得知注射荷爾蒙帶來的影響，以及可能造成的情緒困擾。」或許，如果有更多人討論這件事對心理和情緒的影響， Karissa就會更主動一點：「我不知道多少女性遭受跟我一樣的經歷，但就像人們關注產後抑鬱症的徵兆一樣，我們也需要研究這個問題。」

科技新突破步入 30及 40歲的女性面對兩個跟年齡有關的現實問題：生育能力受限及卵子質素下降，於是她們開始感到驚慌。根據廣泛引用的醫學研

arianalife.com | REPRODUCTIVE RIGHTS

109

F E AT U R E 專題故事

it out. “I didn’t necessarily expect the clinic to offer a therapist, but I wish I’d been counselled on the impacts of the hormones, and the emotionally taxing nature of eggfreezing before doing it.” Perhaps, were the mental and emotional impacts more commonly discussed, she might have been more proactive herself: “I don’t know how many women feel like I did, but just as people watch for signs of postpartum depression, maybe there needs to be a practice.”

Ovarian tissue freezing is another emerging solution that may become mainstream in the next decade. By harvesting small amounts of tissue from a young woman’s body via fibre-optic surgery, freezing it, and transplanting it later, women could regain fertility later in life. Over the past decade, stem cell researchers have also challenged nature through experiments that create reproductive cells from ordinary tissue cells. In this procedure, doctors take a non-reproductive cell, such as a blood or skin cell, and inject it with NEW FRONTIERS OF FERTILISATION genes to transform it into a stem cell. The stem cell is then capable of becoming a gamete, or Some women have attested to a sense of panic as they move reproductive cell. through their 30s and 40s, due to two generally accepted While infinite fertility and super-charged facts: fertility is finite and egg quality eggs are a long way from declines with age. According to the mainstream marwidely cited medical research, an ket, women will have "I felt like a heavy average woman at puberty will have more choices when it cloak had been around 300,000 eggs, but only onecomes to reproducdraped over every tenth will be left by her mid-30s, and tion in the future. none by the time she reaches 51 – the For Dr Chan, these single one of my average age of menopause. emerging possicells." Egg quality also declines with bilities raise difage, affecting a woman’s chances of a ficult questions: 「我感覺像是身體的 successful pregnancy. Chromosomes “Are we encourare particularly affected: If an egg aging women to 每個細胞都被沉重 has too few or too many chromohave children at a very advanced 的斗篷壓住。」 somes, it may fail to implant in the age? In theory we can impregnate a uterus and lead to a miscarriage. At 50-year-old woman, but what about the age of 25, around 75 per cent of the risk of complications in pregnan– Karissa Chen a woman’s eggs are chromosomally cy? What about social taboos?” ‘normal’, compared to just 10-15 per Chen welcomes the growing cent by the age of 40. pool of options but says it’s The combination of egg quality and quantity means important for society to value women beyond their that a healthy 30-year-old has a 20 per cent chance of capacity to become mothers. “We emphasise the getting pregnant each cycle, but by 40, her chance is less child, but we don’t always emphasise the person than 5 per cent. However, conflicting research also points bringing the child into the world, and how to towards healthy, if diminishing, rates of conception for make it work for her. Or if a woman chooses not women in their late thirties. to become a mother, we should value the myriad Those like Dr Patrick Chan believe new advances contributions she makes to society.” in technology could challenge these natural laws of After her personal experience, Chen wishes aging. He points to ongoing experiments to improve egg the focus was not on women getting pregnant quality through the transfer of mitochondria (the power but on a better understanding of biology and generators of a cell) to help more eggs reach maturity. its impact on fertility, so women can make The process, called in vitro follicle activation, could be informed choices and take more control commercially viable in the near future. over their lives.  110

生育權 | arianalife.com

TOMORROW’S HARVEST 希望在明天

究，女性在青春期間體內的卵子數量平均約有 30萬顆，但到了 35歲左右，就只剩下約十分之一，到了更年期的平均年齡 51歲，幾乎就所剩無幾了。卵子的質素也會隨年齡增長而下降，同樣對女性的受孕機率和染色體造成影響：一顆卵子如果帶有太多或太少染色體，都可能無法在子宮內著床而導致流產。 25歲的女性，約有 75%的卵子擁有數量剛好的染色體，而 40歲的女性則只有 10%至 15%。卵子的數量和質素這兩大因素使 30 歲的健康女性在每次月經週期都有兩成的受孕機會，但到了 40 歲，機率就下降至 5%以下。但還有一些其他研究顯示，健康的女性如果年近 40歲，受孕的機率雖然有所下降但仍維持正常。陳醫生這類專家卻認為，嶄新的科技可以抵抗老化的定律。他所指的是目前正在實驗階段的卵子質素提升技術，即透過轉移提供能量給細胞的線粒體（ mitochondria），幫助更多卵子成熟。這個過程稱為體外卵泡激活法，可望於不久的將來面世。卵巢組織冷凍是另一項嶄新解決方案，有望在未來 10 年內成為主流。方法則是利用微創手術從年輕女性體內抽取小塊卵巢組織進行冷凍，再於日後植回體內，使女性恢復生殖能力。過去 10年，幹細胞研究人員也曾試圖利用普通組織細胞培養生殖細胞，挑戰自然限制。過程中，醫生會抽取非生殖細胞，例如血液或皮膚細胞，注入基因使這些普通細胞轉化為幹細胞。培養出來的幹細胞將可能成為配子或生殖細胞。儘管我們不太可能在近期內見到不受限制的生育能力和超級卵子面世，但未來女性仍可望擁有更多解決生育問題的選擇。然而，對陳醫生而言，這些新湧現的選擇引發了一連串難題：「這是否變相鼓勵超高齡生育？理論上我們能夠令 50歲的女性受孕，但如何應付孕期併發症？如何處理社會禁忌問題？」 Karissa樂於見到更多元化的選擇，但她認為更重要的是社會不能單以是否「為人母」來評價女性。她說︰「我們看重孩子，卻經常忽視了懷胎十月誕下孩子的那個人，以及如何為她提供協助。女性若是選擇不成為母親，我們又該如何珍視她們對社會做出的無數貢獻。」經過這段心路歷程， Karissa希望社會不要只看重女性的生育行為，而要深入了解人體的生物構造及其對生育機能的影響，令女性做出知情的選擇，讓她們更充分掌控人生。 

UP FOR DISCUSSION 尚待商榷 Many medical journals circulate anxiety-inducing statistics about women’s fertility. But as a 2013 article by The Atlantic argues, those fears may be outdated: “The widely cited statistic that one in three women between the ages of 35 to 39

will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless – 30 per cent – was also calculated based on historical populations.” A more recent study published in 2014 by Obstetrics & Gynecology found that, amongst 770 European women, the fertility rates of those in their late 30s was nearly identical to those in their late 20s and early 30s. A 2013 Dutch

study published in Fertility and Sterility and a US study by the University of North Carolina School of Medicine that same year also found that fertility rates do not drop off dramatically until a woman enters her 40s.

許多醫學雜誌均發表過令人焦慮的女性生育能力數據。但一篇由《The Atlantic》雜誌在2013年發表的文章提出這些擔憂可能已經過時：「目前廣泛引用的統計數據指出，年齡介於35至39歲的女性當中，大約三分之一有不孕的問題，這個數據其實是來自一篇2004年發表在《Human

Reproduction》雜誌

的文章。很少人提及這個數據的來源是法國在1670 年至1830年的出生記錄，而30%無子女的機率，也是基於人口的歷史記錄來計算。」《Obstetrics & Gynecology》雜誌在2014年發表的研究報告指出，在770名歐洲女性當中，年近 40歲女性的生育率，與年近30歲及30歲出頭的女性不相伯仲。《Fertility and Sterility》雜誌在2013年發表一項於荷蘭所做的研究，以及同年在美國北卡羅來納大學醫學院所做的研究，同樣指出女性的生育能力至40歲之後才會顯著下降。

arianalife.com | REPRODUCTIVE RIGHTS

111

MY CHILD-FREE CHOICE 無孩人生

In her personal essay, Tanja Wessels explains why choosing a life without children works for her. Tanja Wessels 撰文闡釋為何選擇不生育對她而言是正確的決定。 Photography 攝影 Alex Macro

am in my mid-40s, happily married to a man who would make a wonderful father. And perhaps ironically, we chose to be child-free. Whether or not we would have children was a conversation my husband and I had early in our relationship. We had to; I was in my early 40s, and he was a few years older. Like many women, growing up, I assumed that I would one day have children. However, if parenthood was something we wanted, it wasn’t going to happen by chance. In addition to age, there was also the added fact that my husband had a vasectomy years before in a prior relationship. Unexpected pregnancies or “happy accidents” weren’t on our horizon. We spent days, weeks, months talking it over. If we wanted to have children, we would have to make it happen. This reality prompted deep reflection and introspection and changed my outlook on the subject. I took stock not only of the person I’d become but also of the world around me. It looked very different from what I had imagined growing up – economic disparities, political instability, environmental decline... I also asked my closest friends how they really felt about motherhood. Their answers surprised me. There were no regrets, but nor was there an unanimous flood of enthusiasm. No one said, “It’s the best thing that will ever happen to you!” Instead, I heard many levelled, honest answers: “Do it if you really, really want to have children.” That was my first wake up call.

我

是個40多歲的已婚婦女，婚姻幸福，丈夫也可以是個好爸爸。可是我們都選擇不生孩子。我和丈夫在交往初期就經常討論要不要生育下一代，因為我們必須知道對方的心意。當時我剛過40歲，他比我年長數年。跟很多女性一樣，從小我一直以為自己將來會有孩子。但對我們來說，為人父母並不是一件自然發生的事。除了我們都已屆生育高齡，我丈夫也已在數年前的一段關係中做了輸精管結紮手術。突然懷孕或「開心的意外」都不可能會發生在我們身上。我們討論了幾天、幾個星期，甚至好幾個月。如果想要孩子，我們就必須採取行動。這個現實令我們不得不深思熟慮，也令我逐漸改變看法。我不但評估自己將要扮演的人生角色，還深入觀察周遭世界──經濟差異、政治動盪、環境惡化⋯⋯這一切都跟我成長以來所想像的極為不同，我詢問身邊閨蜜有關她們對為人母的感受。她們的回答出乎我的意料。她們不覺得遺憾，但也沒有異口同聲表現出天大的喜悅。沒有人說：「這是你這輩子最美好的事！」相反地，我聽到平淡而誠實的回答：「如果你真的、真的很想要孩子，那麼你就生。」那是我的第一次覺醒。

arianalife.com | REPRODUCTIVE RIGHTS

113

P E R S O N A L E S S AY 個人陳述

The second came from an even more unexpected My relationship with motherhood has taken as place: When we sat down in the office of a fertility many variations as there are opinions on the topic. I expert in Hong Kong’s Central district, the doctor grew up imagining that I would have three children – I didn’t glance up while she filled out a form on her toyed with names, mapped out our family photos and desk. She confirmed our names and ages, then asked believed it was just a matter of time. bluntly: “So you want to have a child?" Then life happened: relationships came and went, “Well, we would like to find out what would be I moved around the world and, as my 40s rolled closer, involved,” I offered, nervously. She put down her the cliched ‘biological clock’ grew more deafening pen and looked directly at us. “Let me give you some with its socially endorsed ticking. In our society, advice,” she began. “Having children will not improve having children is perceived as a fulfilment of your your life. It will just make it different.” genetic duty, first to the individual family or genetic I was shocked to hear this, line, second to the immediate particularly coming from community. someone who specialises in Though I am a very helping people get pregnant. independent person, I always What if, instead of I was also delighted. knew that I didn't want to focusing so much on It felt like we’d been given raise a child on my own. If creating more humans, permission, from an expert I was going to have a baby, I no less, to acknowledge wanted to first have a healthy we invested more in the way we felt deep down: partnership and offer that being better humans? happy without kids. Even child two points of view on so, she talked us through the world. With all of life’s the practicalities of getting uncertainties, I wanted to 我們為何不把花在製造更 pregnant, given the need for stack the odds in my favour 多人類的精力，用於讓自 a vasectomy reversal and from the beginning. I always 己變成更好的人？ fertility treatments, and the had clarity on this. fertility process. This left me in a tricky She also encouraged spot. I loved my life and us to enjoy our lives, no matter what we ultimately would have happily waited to make the motherhood decided, and arranged for us to see a psychologist to decision. However, biology was not in my favour. make sure we had the necessary emotional support Though some sources argue that fertility research is to handle the decision. outdated, it’s generally accepted that female fertility About a week later, we came to our decision. As starts to decline when a woman reaches her early 30s we sat with our psychologist, I cried. I was mourning and slows more rapidly after the age of 35. the life I now knew for certain I would never have. As I passed my mid-30s, biology quietly There are many ways to have an incredible life, and moulded my decisions: Where should I live? Should parenthood is an irreplaceable one. I take that job? Go on that date? Freeze my eggs? My choices felt like a series of irreversible trade-offs REFLECTIONS ON MOTHERHOOD and a murmur of anxiety hovered above me like a big empty speech bubble. Once the decision was made, a weight lifted. I started As much as I love being a woman, that part of feeling more at ease with the certainty of our child-free the deal riled me. I felt limited, fettered by biology. future – a lifestyle many consider socially unacceptable. However, with time, it has also re-framed my At the same time, I found myself reflecting on the idea thinking and brought me to a place of peace – as well of motherhood and what it meant to me now that I as excitement. knew I would not experience it. And I am not alone.

114

生育權 | arianalife.com

MY CHILD-FREE CHOICE 無孩人生

第二次覺醒來自一個更出人意表的場合：我們坐在中環一家輔助生育專科醫生的辦公室，醫生低著頭在桌上填寫表格，連頭都沒有抬起來看我們一眼。跟我們確認了姓名和年齡之後，她直截了當地問：「所以，你們想要生孩子？」我緊張地回答她說：「這個嘛⋯⋯ 我們想知道會涉及哪些事情。」她放下筆，直率地看著我們說：「我會給你一些建議。生孩子不會改善你們的生活。只會改變你們的生活。」她的話令我震驚，尤其是來自一位專門幫女性懷孕的專家。不過我也很慶幸。這猶如得到專家的認可，而且讓我們理解自己內心深處的想法：沒有小孩也能過得開心。即使如此，她還是告訴我們懷孕的實際情況，包括輸精管復通手術、各種生育療法，以及生育過程。她鼓勵我們不管最終的決定是甚麼，最重要的是享受人生。她還為我們安排一位心理學家，確保我們獲得感情上的支持以作出理智決定。一個星期後，我們去見心理學家時，我哭了。我在哀悼永遠不會發生在自己身上的人生。擁有豐盛人生的方式很多，為人父母是無可取代的方式之一。

我對母職的看法作出決定之後，我們感到如釋重負。我開始對自己這輩子注定與孩子無緣釋懷，許多人認為這種生活方式不被社會接受。同時，確定自己不會成為一個母親之後，我開始反思對「為人母」的看法，以及這件事對我的意義。我和母親這個身分的關係，隨著對這件事的不同看法而產生各種變化。我從小就幻想自己將來會有三個孩子，我替他們取名字、描繪我們的家庭照片，相信假以時日這個幻想將會成真。然後日子一天天過去，我曾跟一些男生交往、分手，曾在世界不同地方生活，當我即將邁入 40歲時，在社會風

氣的壓力之下，我的「生理時鐘」也開始大聲地滴答滴答響起。在我們的社會中，傳宗接代被視為與生俱來的天職，這不僅是對個人家庭或家族血緣，也是對社會的責任。雖然我很獨立，但我很清楚自己不想做一個獨自撫養子女的單親媽媽。如果我要生孩子，我想先擁有一段健全的伴侶關係，讓孩子對這個世界有平衡的兩性觀點。人生充滿各種不確定因素，但我想要從一開始就掌握有利條件。我對這一點堅信不疑。這使我面臨兩難的處境。我熱愛自己的生活，很樂意等待適合做母親的時機來臨。可惜生理方面不允許我順由天

命。儘管有些資料顯示生育能力的研究已經過時，但普遍接受的觀點是，女性的生育能力在30歲初開始下滑，在35歲之後加速衰退。當我 30多歲時，生理時鐘暗地裡左右了我的決定：我應該住在哪裡？我應該接受那份工作嗎？要不要去赴約？要不要凍卵？所有選擇都像不能回頭的單行道，焦慮的呢喃像個巨大的泡沬籠罩在我的頭頂，縈繞不散。我喜歡身為女人，但生理現象令我氣惱。我感到受限制，女性的生理構造束縛了我。但是，隨著時間過去，這種限制令我重新思考，帶給我平靜，同時還有一點雀躍。而且我並不孤單。

arianalife.com | REPRODUCTIVE RIGHTS

115

P E R S O N A L E S S AY 個人陳述

CHOOSING TO BE CHILD-FREE Childlessness has been on the rise over the past three decades particularly in Organisation for Economic Co-operation and Development (OECD) member states, according to a 2018 report published by the OECD Family Database. In Finland for example, the proportion of women aged 40-44 who are childless increased by over 5 per cent between 1990 and 2010. Similarly, rates of childlessness in the United Kingdom amongst women 45 and older increased by 6 per cent between 1995 and 2010. In Austria and Spain, at least 20 per cent of women between 40 and 44 do not have children. Likewise, in South Korea, the birth rate is at an alltime low – last year, it fell to less than one child per woman for the first time ever. And recently, the Financial Times reported that the number of new births in China dropped for the second consecutive year since the country repealed its one-child policy. Meanwhile, the fertility rate in Hong Kong is the fourth lowest in the world at just 1.19 per woman as of 2017, according to the Central Intelligence Agency’s World Factbook. My personal decision to be child-free led me to think more deeply about children, and how they’re viewed by society. In our collective mind, we see children as the purest

form of life – a well of abundant innocence, the blank canvas on which it is safe to pin expectations. But when we view children as a bastion of virtue and hope and assign a best-before date in terms of value or importance, we miss opportunities for society as a whole. We overlook the chance to employ the knowledge, skills, and experience that people have cultivated over decades – to learn from their victories and fears. Life doesn't stop and start at childhood, rather it is, if all goes well, a long and diverse experience with value at every stage. When we spend so much energy admiring babies and children, we often overlook our peers, the disenfranchised or the elderly, who are as much a part of the world as the young. And as we idolise children, we simultaneously put pressure on women to produce them. In turn, motherhood has become a subject of public commentary, judgement and scrutiny; however, one’s value in this world should not be conditional. Being a mother should be optional. Kindness and compassion should not. When people feel loved and appreciated they are more generous and giving, this creates a knock-on effect that benefits all. What if, instead of focusing so much on creating more

不生育的選擇根據經合組織（ OECD ）家庭數據庫 2018 年的報告顯示，在過去 30 年裡，無子女比率在全球許多 OECD 國家中有上升趨勢。例如在芬蘭， 1990 年至 2010 年間 40 至 44 歲無子女的女性比率增加了 5% 以上。同樣地，英國 45 歲或以上無子女的女性比率在 1995 年至 2010 年間增加了 6% 。在奧地利和西班牙，年齡介乎 40 至 44 歲的女性之中有 20% 以上的人沒有孩子。亞洲也出現類似的現象。去年，韓國的出生率首次降至每名女性低於一名胎兒，創下歷史新低。《金融時報》近期的報導指，中國自取消「一孩政策」以來，出生率連續第二年下降。同時，根據美國中央情報局出版的《世界概況》，香港 2017 年的生育率是全世界第四低，每名女性僅生育 1.19 名嬰兒。不生育的個人決定，令我更認真思考孩子，以及社會如何看待他們。我們每個人都把兒童視為最純潔無瑕的生命，他們充滿純真，是一幅可以讓我們盡情揮灑希望色彩的空白畫布。但是，當我們把兒童當作高尚品格和希望的堡

116

生育權 | arianalife.com

壘，並且根據價值或重要性為他們標上「最佳日期」時，我們就錯失了作為一個整體社會的機會——我們忽視了去利用長久以來人類在勝利與恐懼中習得知識技能與經驗的機會。人生並不是從童年開始和結束，如果順利的話，每個階段都會有漫長而多元化的寶貴經歷。當我們將大量精神投注在愛慕嬰兒和兒童時，我們往往忽略了自己的同輩、被剝奪權利的弱勢族群，或是年長一輩，他們跟年輕人一樣都是這個世界的一部分。當我們將孩子捧在手心上時，同時也是向生育孩子的婦女施加壓力。於是，「母親」已經成為大眾評頭論足、批評判斷及監視審查的對象。然而，一個人在世上的價值不應該有附加條件。是否成為一個母親應該是可以選擇的。仁慈和同情心則否。當一個人感到被愛和欣賞時，他們會更慷慨和樂施，這會產生惠及所有人的連鎖效應。那麼，我們為何不把花在製造更多人類的精力，用於讓自己變成更好的人？何不更多聆聽彼此心聲，

MY CHILD-FREE CHOICE 無孩人生

humans, we invested more in being better humans? Better at listening to each other, better at nurturing both the young and old, better at caring about our world and its limited resources? Letting go of the idea of motherhood has only strengthened my resolve to commit more deeply to my other roles in life. I am an aunt to three wonderful children, whom I absolutely adore, and am a big part of their lives. I am also a daughter, sister, wife, neighbour, colleague, writer, artist and environmentalist. I care deeply about the natural world, and I don’t want to rely on future generations to fix it. I want to be part of the solution, too. That which I have to offer the world won’t come through my children – expecting them to act on values that may or may not resonate with them – it will come through me. Fully expressing and being ourselves in this world is something we should strive for as humans. Creating a world where people feel valued and celebrated is our individual responsibility. That is not up to the children we may or may not have, that is up to you and me. A wise fertility expert once told me to make the most of my life, I have every intention of doing just that. 

更悉心照顧年幼和年長者，更關心我們的世界和有限的資源？放棄當母親的想法，更加強了我的決心，令我承諾做好人生中的其他角色。我是三個了不起的孩子的阿姨，我非常愛他們，也是他們人生的重要一部分。我也是女兒、姐妹、妻子、鄰居、同事、作家、藝術家和環保分子。我非常關心大自然，而且不會把問題留給後代解決，我希望現在就盡一己之力。我為這個世界做的貢獻將不會經由我的子女實現，而會由我親手實現。現在我毋須在子女身上強加他們認同或不認同的價值觀，並要求他們為世界付出。作為人類，我們應該努力在這個世界上完整表達自己，勇敢做自己。創造一個讓人感到受尊重和讚賞的世界，是我們每個人的責任。這並非取決於我們決定要生或不要生的小孩，而是取決於你和我。一位很有智慧的生育專家曾經告訴我：活出精彩的人生，我正有此意。 

arianalife.com | REPRODUCTIVE RIGHTS

117

LIFE STUDIES 生命何去 Experts from the fields of religion, biology, and psychology unpack challenging ethical dilemmas. 來自宗教、道德倫理、生物科技和心理學四個不同領域的專家，分析生育權的道德問題。 Words 文 Cathy Lai | Photography 攝影 António Sanmarful and Krollfilm

eproductive rights catapulted onto the world stage in 1968 during the first United Nations’ International Conference on Human Rights, where member states and delegates assured citizens of the “basic human right to determine freely and responsibly the number and spacing of their children.” In theory, this meant that women would have improved access to education, contraception and legal abortion services, as well as greater self-determination in family planning. Half a century later, reproductive rights have once again entered international discourse. In the US, for example, a number of states have attempted near-total bans on abortion as ultra-conservative and religious factions push the Supreme Court to overturn the landmark 1973 abortion case Roe v Wade. In China, He Jiankui, an associate professor from Southern University of Science and Technology in Shenzhen, stirred controversy when he announced in 2018 that he had created the world's first genetically engineered babies immune to HIV. In the wake of these developments, we have invited four experts to explore several ethical questions, from the legitimacy of abortions in instances of rape to controversies surrounding human genome-editing.

118

968 年，生育權首次成為國際議題，聯合國第一次國際人權會議的與會國家及代表承諾，確保公民「享有自由並負責任地決定子女人數及其出生時距之基本人權」。理論上，女性會因此獲得更佳的教育機會，以及避孕和合法墮胎服務，並在家庭計劃方面擁有更大的自主權。半世紀後，生育權再次受到國際社會關注。以美國為例，在極端保守分子和宗教人士推動下，最高法院推翻對墮胎法影響深遠的 Roe v Wade 案（ 1973 年），以致多個州份幾乎完全禁止墮胎。在中國，前深圳南方科技大學副教授賀建奎於 2018 年宣佈全球首兩名對愛滋病免疫的基因編輯嬰兒誕生，隨即惹來各界爭議。鑑於以上最新發展，我們請來四位專家，探討多個道德問題，包括因姦成孕的墮胎合理性，以及人類基因編輯所引起的爭議等。

119

120

WOMEN FIRST

女性為先

There were over 97,000 reports of sexual assault recorded in Taiwan between 2008 and 2018 – and 90 per cent of the victims were women, according to the Ministry of Health and Welfare. Michael Tang, founder of Tang's Psychiatric Clinic and Mind Center in Taiwan, says that rape victims who become pregnant face an impossible choice. 台灣衛生福利部的資料顯示， 2008 至 2018 年間，台灣共有逾 97,000 宗性侵案件，當中九成受害人為女性。台灣精神及心理治療中心唐子俊診所創辦人唐子俊表示，因姦成孕的受害人面對極其艱難的抉擇。

I’ve handled a great number of cases related to sexual violence throughout my 20-year career in trauma therapy; many victims choose to have an abortion after they find out that the rapist is the father. Friends and family will often encourage the victim to terminate the pregnancy and start a new life, free from any connections to their attacker. It’s rare for victims of rape to have the baby, but it does happen. For instance, one woman decided to keep her child and marry the man who had raped her because she knew him. Initially, she was angry but after she made the decision to stay with him, her mindset changed and she began to believe that the assault had, in fact, been consensual. Other factors affecting a victim’s decision to go through with a pregnancy are her age and ability to take care of a child. Some people may think that the child is innocent and, as the victim’s offspring, should be cared for. But the victim may have a very different thought process. In some cases, a woman is incapable of taking care of a child due to depression, which can affect the child. I think victims should take care of themselves first before going ahead with a pregnancy. In the US, states like Alabama have passed near-total bans on abortion [which was later blocked by a federal judge in October 2019] with no exception in instances of rape and incest. Policies like these can only work if there is adequate professional help and the right resources to provide continued support for both mother and child. From a medical perspective, if the psychological condition of the mother does not allow her to take good care of her child, and if society is unable to support the baby, then abortion may be the best option to help minimise any further suffering for the victim.

我從事創傷治療 20年，處理過許多性暴力相關的個案，許多因姦成孕的受害人會選擇墮胎，親友亦會鼓勵她們終止懷孕，重過新生，切斷跟加害者之間的所有牽連。不過，當中亦有少部分受害人選擇留著胎兒。在我處理過的其中一個個案裡，因為受害人與加害者是舊相識，所以最終決定與他結婚，並把孩子生出來。她起初也非常憤怒，但當決定跟他在一起後，想法就改變了，她開始相信那次性侵其實是雙方同意的性行為。年紀和能否獨力照顧孩子也是影響受害人決定的因素。有人認為，孩子也是受害人的骨肉，是無辜的，應該受到保護。然而，受害人的想法可能會很不同。有些受害人會因為抑鬱而無法照顧孩子，這樣反而會對孩子的成長造成影響。我認為受害人在決定是否墮胎時，應該優先考慮自己。在美國，阿拉巴馬等州份已通過幾乎完全禁止墮胎的法案，就連因為強姦和亂倫而懷孕的人也不能墮胎（該法案於 2019 年 10 月被聯邦法庭推翻）。不過，當事人必須能夠獲得專業服務和相關資源，以支持母子的生活，這樣的政策才會奏效。從醫療角度看，如果母親的心理狀態不容許她好好照顧孩子，而社會又無法為孩子提供支援，墮胎可能是減輕受害人痛苦的最佳選擇。 arianalife.com | REPRODUCTIVE RIGHTS

121

STRIKING A BALANCE

尋求平衡

In 2016, the Hong Kong Population By-census recorded 56,545 single mothers in the city – more than three times the number of single fathers. Arita Chan, a senior lecturer in the Department of Psychology at the Education University of Hong Kong who counsels children with emotional and behavioural problems, explains why she feels it’s important for fathers to stay involved in children's lives. 根據人口普查的數據顯示， 2016年香港共有 56,545位單親媽媽，比單親爸爸的數字高出兩倍。香港教育大學心理學系高級講師陳詠欣博士，專門為有情緒和行為問題的孩子提供心理諮詢。她認為，父親在孩子的成長中扮演關鍵角色。

In cases of unplanned pregnancy, the father may feel unprepared about having a child even though the mother prefers to keep the baby. When a father abandons his child, it’s often because he is frightened of parenthood or has personal issues stemming from a troubled family history. In this case, counselling or other professional support can help the father overcome his issues. The father’s family could also try to provide support by helping him prepare and sharing the responsibilities. After many years, the father may come to regret abandoning his child and feel a great deal of guilt. By that stage, it may be too late. He would probably need to make a tremendous effort to overcome his guilt and rebuild a relationship with his child. We can’t force a father to support his children, but he should try his best to take responsibility and participate in the care of the child, because his role is central to the nuclear family. Any unwillingness to bear that responsibility can lead to a child feeling rejected, which in turn affects a child’s self-esteem. As a result, the child may think it's his or her fault and believe they do not deserve to be loved by others. In general, fathers and mothers have different ways of interacting with their children in a family system. Traditionally, mothers tend to be more nurturing – providing emotional support, love and care – while a father plays the role of mentor when it comes to his child’s decision making and career prospects. This is especially true in Asia. Ultimately, the presence of both the mother and the father can provide a balanced approach in terms of the child’s moral compass and social skills. As a counsellor, I have helped many children whose parents have separated. Some of these children, especially boys, feel a strong sense of responsibility when it comes to taking care of their family once their father has left. But this kind of pressure can adversely affect their development and how they interact with others in society. 122

在意外懷孕的情況下，即使母親願意把孩子生出來，父親心理上也可能未準備好，以致他有可能因為對父親的責任感到恐懼，或受到自身的家庭問題影響而遺棄自己的孩子。在這種情況下，心理諮詢或專家的協助可以幫他克服障礙。父親的家人也可以嘗試提供支援，幫助他適應新角色，並協助他照顧嬰兒。遺棄孩子的父親日後很可能會感到後悔並愧疚，但那時可能已恨錯難返，他需要用更大的心力來克服罪疚感及重建親子關係。我們不能迫令父親撫養他的孩子，但長遠而言，他應該盡力負起責任及參與照顧孩子。父親是家庭的核心成員，一旦他對父親的責任感到抗拒，孩子就會覺得被父親拋棄，自尊心會因此大受影響。孩子甚至會以為是自己的過錯，並認為自己不值得被愛。一般而言，父親和母親會採取不同的方式跟孩子互動。傳統上，尤其是在亞洲家庭，母親傾向花更多時間照顧孩子，給他們情緒上的支援、母愛和關懷；父親則是孩子的人生導師，在孩子作出決定和職業選擇時提供意見。因此，雙親的存在有助孩子培養健全的道德觀和社交能力。我曾為許多父母離異的孩子提供心理諮詢，部分孩子，尤其是男孩，會在父親離家後強烈地感到自己有責任照顧家人。這種壓力會不利他們的成長，影響他們的人際關係。

123

F E AT U R E 專題故事

124

LIFE STUDIES 生命何去

GENOME HACKING

基因黑客

In 2019, Chinese researcher He Jiankui was sentenced to three years in prison after he created the first genetically modified human babies. Using a technique known as CRISPR-Cas9, He claimed to have rendered the babies immune to HIV by introducing mutations in the embryos’ C-C chemokine receptor 5 (CCR5) genes. William Chao, an associate professor at the University of Macau’s Faculty of Health Sciences, shares his concerns about genome-editing technology.

2019 年，中國科研人員賀建奎因為「製造」了第一對基因改造嬰兒被判刑三年。賀建奎採用 CRISPR-Cas9 技術來編輯胚胎內的 CCR5 基因，並聲稱可令嬰兒天生就能抵抗愛滋病。澳門大學健康科學學院副教授周昶行談到他對基因編輯的疑慮。

Like many scientists, I have considerable concerns about human genome editing, which is a relatively new technology based on CRISPR-Cas9. Although well-studied, CRISPR-Cas9 is still beset with issues, such as the potential to introduce unintended mutations in the human genome. Without knowing where these mutations may occur, the edited subject could have unforeseeable health risks. The majority of the scientific community remains unconvinced about the implantation of genetically modified human embryos into mothers. Yet, the community hasn’t reached a consensus about performing gene editing for the purpose of improving a person’s [cognitive or physical] ability if the technology becomes risk-free in the future. From an ethical perspective, He’s work is controversial because it was carried out without peer review or obtaining approval from the relevant government bodies. With this procedure, He has changed the human gene pool indefinitely – the edited genome can be passed on through reproduction. We may not even realise the true impact for several generations. He shouldn’t be allowed to artificially change the gene pool without consulting the rest of the human species. Furthermore, the twin sisters whom He created will see their freedom and privacy violated, as they will be subject to monitoring by scientists and media for the rest of their lives. This is one example of how technology can progress much faster than the laws and ethics of our society. It has sparked an urgent debate in regard to genome-editing regulations. For now, it’s important to regulate the technology through legal means and restrict it to treating diseases, rather than augmenting human abilities. My biggest concern is that genome editing will become an exclusive service for the wealthy, who may use the technology to augment their children’s cognitive and physical abilities. In the future, these groups of modified humans may prefer to marry each other. After several generations, their cumulative superior traits may allow them to form an absolute ruling class whose abilities could not be matched by unmodified humans. As a species, we must encourage discussions about the direction in which our civilisation should head. Under what circumstances are we allowed to modify the human genome? Do we want genetically augmented babies? Are we happy to see the human race evolve into a new species through artificial design?

我跟許多科學家一樣，對基因編輯抱持相當大的疑慮。 CRISPR-Cas9是相對新穎的技術，雖然已有大量研究，但仍然存在許多問題，譬如是否會導致意料之外的基因變種。由於不能確定哪裡會產生變種，接受基因編輯的嬰兒將來可能會面對不可預見的健康危機。目前科學界普遍反對將被基因改造的胚胎移植到母體，但如果將來所有安全問題都得到解決後，是否可以透過基因編輯來改善人的認知能力或體能，科學界至今未能達成共識。從道德觀點來看，賀建奎的研究在沒有諮詢適當專家的情況下進行，也沒有通過有關部門審批，因此極具爭議。該實驗已永久改變了人類的基因庫，因為編輯過的基因會通過世代繁衍進入人類的基因庫，而真正的影響可能要幾代之後才會顯現。他不應該在沒有諮詢世人之前，擅自以人工方法改變人類基因庫。再者，被賀建奎基因編輯過的孿生姐妹，將會終身受到科學家和傳媒的監視，其自由和私隱必然會受到侵犯。這事件不僅說明了科技的發展可以遠遠超前社會上的法律和道德倫理，還催生了一場關於基因編輯條例的緊急討論。目前最重要的是透過法律來規管這項技術，將它局限於疾病治療，而不是提升人類的能力。我最擔心的是，基因編輯技術會成為有錢人的專利，被他們用來提升子女的能力。將來，這些「改造人」會選擇跟同類通婚。幾代之後，他們累積起來的優越性會讓他們成為絕對的統治階層，普通人的能力根本無法跟他們相提並論。作為一個物種，我們必須積極討論人類文明的發展方向：在哪種情況下可以改造人類基因？我們是否希望在基因編輯上著手加強嬰兒的能力？是否希望透過人工技術將人類改造成新的物種？ arianalife.com | REPRODUCTIVE RIGHTS

125

126

CAUSE AND EFFECT

因果循環

Abortion is illegal in Macao except in cases of rape, incest, or fetal impairment. Wai Chi Lin, a Tibetan Buddhist monk who moved to Macao 10 years ago, explains why he believes abortion in the case of disabilities is unethical. 在澳門，只有因為強姦或亂倫而懷孕的人，以及胎兒有先天缺憾的情況下，才可以合法墮胎。 10年前移居澳門的藏傳佛教僧人慧持蓮認為，因為胎兒有缺憾而墮胎是有違道德的。

Buddhists believe that Hetu-Phala (meaning, cause and effect) is the driving force behind everything in life. According to ancient texts known as Sutras, Buddhists believe that babies are born with limb deformities because they have harmed someone else’s body in a previous life and, as a result, will suffer the consequences. However, this does not mean that these babies do not deserve a second chance. Buddhism shows great compassion and treats all beings equally. Therefore, even if a fetus is found to have a disability, the parents should not give up on their child. This is a matter of morality. Moreover, miracles do happen. I know a woman from Macao who had been advised to terminate her pregnancy because they detected limb deformities and the doctor predicted that the baby might not be able to walk. But the mother insisted on keeping the child. Her son is now six years old and perfectly normal. If the parents had listened to their doctor, they would have killed their own child. A baby is not a product, it’s a life. Buddhists believe that once a fetus is conceived, the spiritual mind will fill it with life. Babies have a right to live – even though they cannot speak to us, we cannot make decisions on their behalf, not to mention end their lives without their consent. It’s easy for us to think that, if we let a deformed baby live, then that baby will endure many hardships in life. But it’s natural for a person, even a baby, to fight for survival. The will to live is a force within us all. When it comes to humanity, if you understand the concept of Hetu-Phala then you will be able to make sense of many things. 

佛教相信萬物眾生均由因果主宰，根據古時的佛教經典，嬰兒天生肢體殘缺，是因為前世曾經傷害他人身體而得到報應，但即便如此，這些嬰兒的出生機會也不應該被剝奪。佛教慈悲為懷，強調眾生平等。即使胎兒天生有缺憾，父母也不應該放棄他們，這是道德問題。況且，奇蹟是會發生的。我認識一位澳門女士，醫生本來已建議她終止懷孕，因為他們發現胎兒雙腳畸形，未必能自己走路。可是那位女士堅持把孩子生下來。現在，她的兒子已六歲了，身體健全。如果當初聽從醫生建議，他們就會白白殺死了自己的孩子。嬰兒不是物品，而是生命。佛教相信，胚胎在受孕一刻開始就有了神識。嬰兒有生存權，就算他們不能用言語表達自己，我們也不能代他們作出決定，更遑論是未經他們同意就結束他們的生命。人們傾向認為，讓殘障的嬰兒出生，可能會令他們承受更多痛苦，但求存是人的本性，嬰兒也不例外。生存的欲望是與生俱來的。談到人道問題，只要你明白因果的道理，許多事情都會變得合理。 

All interviews have been edited for length and clarity. 由於篇幅所限，受訪者言論曾稍作修改。

arianalife.com | REPRODUCTIVE RIGHTS

127

LOCAL VOICES 本地之聲

128

生育權 | arianalife.com

BREAKING THE CYCLE 打破宿命 We speak with doctors, lawyers, professors, and teenagers about reproductive rights in the SARs. 我們與醫生、律師、教授和青年討論港澳兩地的生育權。

Words 文 Chermaine Lee, Rafelle Allego and Kary Lam Photography 攝影 Karma Lo and António Sanmarful

HONG KONG 香港 TAKE CARE Dr Kelly Chain, a registered Chinese medicine practitioner and co-founder of Chain’s Medicare Centre, helps women with reproductive issues: “Nowadays, women are either getting married or starting family planning later, often in their late 30s. With age, complications in reproduction can arise, including a low ovarian implantation period. “Diet and exercise are some of the ways to overcome these challenges. For women who have miscarriages early in their pregnancies, I advise them to take a confinement break for 12 days, during which they are advised to drink only rice tea and start their day with spoonfuls of rice to improve their spleen and gastrointestinal circulation. This helps their body and mind recover from the trauma and prepare for conception.”

照顧與保養萬全堂聯合創辦人兼註冊中醫師錢楊佩娟醫生提供治療不孕的療程：「今時今日，很多女性都會將結婚或養兒育女的計劃推遲至35歲之後，然而，高齡女性往往會面對不少生殖問題，例如卵子的數量與質量降低，以及胚胎移植困難等。」「健康飲食和適當運動均有助於緩解這些問題。對於在懷孕初期流產的女性，我建議她們進行12天的分娩休息，其間以米水代替清水，每天早上先吃一湯匙米飯來改善消化。這樣有助她們的身心從創傷中恢復過來，並為受孕做好準備。」

arianalife.com | REPRODUCTIVE RIGHTS

129

LOCAL VOICES 本地之聲

FREEDOM TO CHOOSE Dr Ng Man-lun, foundation president of the Hong Kong Sex Education Association, says Hongkongers are typically aware of their reproductive rights:

PHYSICAL AUTONOMY Helena Wong, a pro-democracy lawmaker, says the government fails women in its policies: “Women in Hong Kong can abort but doctors still get to decide whether they can terminate their pregnancy. Do women have autonomy of their own body, when the abortion has to be determined by two registered doctors? Decisions around pregnancy or termination should belong to women. “Hongkongers still enjoy the freedom to have children, according to the Basic Law Article 37, unlike in China [where there’s a two-child policy]. Yet, families now only give birth to one child, if any, and many prefer keeping pets instead. The government has nearly no effective policies to encourage reproduction. The lack of space, short maternity leaves, insufficient public childcare centres – all discourage women from giving birth.”

身體自主權民主黨立法會議員黃碧雲說政府的政策令女性失望：「香港的女性可以選擇人工流產，但必須由醫生決定她們是否可以終止懷孕。如果人工流產必須由兩名註冊醫生決定，那麼女性是否真的擁有身體自主權？繼續或終止懷孕的決定應該掌握在女性手中。」「有別於採取二胎政策的中國，根據《基本法》第37條，香港居民享有生育的權利，不過即使香港的家庭願意生育下一代，但大部分都只肯生一個孩子，許多寧願養寵物。政府幾乎沒有任何有效的鼓勵生育政策。生活空間狹窄、產假過短及公共托兒設施不足，這一切都令女性對生育卻步。」

130

生育權 | arianalife.com

“In general, the reproductive rights situation is not bad in Hong Kong – at least there are no laws to restrict the number of births. Couples have the freedom to use contraception and access to abortion, while artificial fertility is reasonably regulated. “Many people know how to find alternative solutions easily, in case the local laws interfere with their special reproductive needs. They can go abroad for fetal selection service or an illegal abortion [after six months of pregnancy]. So, there is no need for them to ‘fight’ for those ‘minor’ rights.”

選擇的自由香港性教育促進會創會會長吳敏倫醫生認為香港人大都很清楚自己的生育權：「一般來說，香港在生育權方面的情況還不錯，至少沒有法律限制生育數目。夫婦可自由使用避孕措施及選擇人工流產，而人工生育的技術則受到適當監管。」「即使在香港受到法律阻礙，人們都可以很容易地找到替代方法，例如前往其他國家接受胎兒篩檢服務，或者（在懷孕六個月後）接受非法人工流產，因此沒有必要『爭取』這些較為『次要』的權利。」

YOUNG VOICE Emily Cheung, an 18-year-old student, supports reproductive rights:

OUTDATED SERVICES Dr Jean Hee Kim, social epidemiology professor at the Chinese University of Hong Kong, explains what’s lacking in the city’s reproductive legislation: “Most of Hong Kong’s legislation on reproductive services was created decades ago. Currently, only married, thereby heterosexual, couples have access to assisted reproductive services such as invitro fertilisation, egg donations and gestational surrogacy in Hong Kong. It is illegal to procure reproductive services as a single person and it is not locally available for women older than 40. “We conducted small surveys and found that Hongkongers are highly supportive of expanding these services and lowering the costs for married couples, but they are less supportive of nonheterosexual couples or single parents. The government needs to re-examine reproductive technology laws in accordance with Hong Kong socio-cultural norms rather than simply taking the advice of the medical establishment, which views infertility as a disease to be managed.”

過時服務

“Women should have autonomy on issues of abortion, artificial reproduction and surrogacy. These rights completely challenge the traditional Chinese belief that women have to give birth to carry on the family name. “I think if a family doesn’t have the financial capability to raise a child, or a teenage girl cannot afford to give birth, abortion is a good choice. It might not be as good, though, if the family has the ability to raise a child but chooses to abort it. If I couldn’t give birth in the future, options like artificial reproduction and surrogacy would be totally acceptable to me. I don’t think these are immoral at all; they should both be legal.”

青年之聲 18歲學生張意欣表示支持生育權：「女性應該擁有接受人工流產、人工生殖和代孕等事項的自主權。這些權利與中國傳統認為女性必須為了傳宗接代而生兒育女的觀念完全背道而馳。」「我認為，如果一個家庭或一個十幾歲的少女因經濟問題或其他原因而無法撫養子女，那麼人工流產是一個理想的選擇。但如果這個家庭明明有能力撫養孩子，最終卻選擇人工流產，這種做法則令人無法苟同。如果將來我不能生育，我完全可以接受人工生殖和代孕等選擇，兩者並無不道德之處，都應該全面合法化。」

香港中文大學社會流行病學教授金真希教授闡釋香港生育法的缺失：「香港大部分有關生育服務的法規都是在數十年前制定的，目前只有已婚的異性夫婦才能獲得生育服務的協助，例如體外人工受精、捐卵和妊娠代孕等。法例規定，不得為單身人士提供生殖科技程序，而40歲以上的女性亦無法在本地獲得相關服務。」「我們進行了一些小規模的調查，發現香港人高度支持擴大這些服務，以及降低對已婚夫婦的收費，但對於非異性夫婦或單親父母的支持度則較低。政府必須按社會的文化規範重新審視生殖技術法規，而不是單單地接受醫療機構的建議，將不孕不育視為需要處理的疾病。」

131

LOCAL VOICES 本地之聲

MACAO 澳門 HER CHOICE Helen*, a psychology graduate, believes women should have greater access to abortion services:

LEGAL BLUEPRINT Vera Lúcia Carapeto Raposo, an associate professor at the University of Macau’s Faculty of Law, says the city needs a legal framework for reproductive techniques: “Many of the current laws in Macao are similar to Portugal’s, but Macao is an even more conservative community. Here, there is no pre-existing regulation on reproductive techniques. In May 2017, the Health Bureau drafted a bill on assisted reproductive techniques but it has not yet entered the legislative process. “Should couples suffer from infertility or other reproductive complications, they’d need to seek help outside of Macao since, at best, local hospitals just have the most basic procedures. If clinics start offering procedures before a legal framework is in place, it is like opening Pandora’s box. Many scenarios could happen, like destroyed embryos, but judges won’t know how to deal with it.”

法律藍圖澳門大學法學院副教授 Vera Lúcia Carapeto Raposo指出澳門需要立法規範生殖技術：「澳門許多現行法律都與葡萄牙大同小異，不過相較之下更為保守。澳門目前並沒有任何關於生殖技術的相關規定。衛生局在2017年5月公佈了《關於使用醫學輔助生殖技術的指引》，但至今仍未正式進入立法程序。」「由於本地醫院只能提供最基本的醫療程序，因此患有不孕不育或其他生殖問題的夫婦必須向澳門以外的地區尋求協助。倘若診所在立法之前就開始提供相關醫療程序，這可能會像打開潘朵拉的盒子一樣，引發許多不堪設想的後果，例如胚胎受到破壞，但法官卻不知道該如何處理。」

132

生育權 | arianalife.com

“I’m pro-choice even though it might not be a choice I’d pick for myself. That’s my stance, simply because I think that people should be given access to these services instead of opting for illegal and dangerous means – though prevention is usually better than having to deal with the consequences.” “Some people may go through mental health difficulties – pre-existing or not – after having an abortion. It’s not the same for everyone. There should be mental health support available if needed, especially after the operation due to hormonal issues, emotional distress, grief, or even PTSD.” *Name changed at the request of the subject.

她的選擇本地心理學系畢業生Helen*相信女性應該有權接受人工流產：「儘管我自己可能不會做這樣的選擇，但我支持女性擁有選擇權，這就是我的立場。我認為人們應該有權得到這些服務，而無須選擇非法和危險的方法，當然，事先做好預防措施總比處理後果要好。」「對於流產的反應因人而異，有些人可能會遭受某些精神障礙。我們應該在她們有需要時提供精神健康的支持，尤其是在手術之後，她們可能會因為荷爾蒙變化而感到情緒困擾、悲傷，甚至出現創傷後壓力症候群。」

*根據當事人要求使用化名。

BREAKING THE CYCLE 打破宿命

NATURAL METHODS

自然方法

Carmen Iu Pek Man, a consultant from the Macao Catholic Family Advisory Council, says more families should use natural family planning methods:

澳門天主教美滿家庭協進會顧問余碧雯認為應該採用自然的計劃生育方式：

“Because of society’s development, late marriages are on the rise. Many couples are usually advised by doctors to use artificial means to solve problems of infertility, sometimes without providing a clear diagnosis. “A natural family plan can be developed instead, allowing women to know their fertile and infertile days by systematically observing and recording changes in cervical mucus. Doctors should look to natural means to respect the beauty of life and serve human fertility and dignity. Science that lacks conscience will only destroy humanity.”

「隨著社會發展，晚婚的趨勢亦不斷上升。許多夫婦可能未經明確診斷就接受醫生建議，採取人工方式解決不孕不育的問題。」「其實自然的計劃生育是可行方法之一，女性可以透過系統觀察和記錄子宮頸黏液的變化，計算出自己的排卵週期。醫生應該尋求自然的方式以示對生命的尊重，盡力維護人類的生育和尊嚴。缺乏良心的科學只會摧毀性。」

SERIOUS PENALTIES

嚴重後果

Dr Chan Iek Lap – a doctor, lawmaker and head of Macau Medical and Health Federation – suggests legislative improvements:

身兼醫生、議員及澳門醫務界聯合總會會長的陳亦立醫生建議改善現有法律：

“As a medical worker, we cannot terminate a pregnancy at will. If the fetus is found to have developmental, intellectual or genetic problems during pregnancy, doctors and parents can choose to terminate the pregnancy after discussion. In that case, medically or personally, I’m in favour of terminating the pregnancy. “As for Macao, it is legal to have an abortion as long as two gynecologists sign their names. When there is a dispute, it will be referred to the court, but sometimes it may take several years. In this case, women might try to access abortions illegally in neighbouring areas, which could pose a great risk to their health and safety.”

「作為一名醫護人員，我們不能隨意終止懷孕。但如果在懷孕期間發現胎兒有發育、智力或遺傳方面的問題，醫生和父母可以在討論後選擇終止懷孕。在這種情況下，無論是從醫學角度還是個人觀點而言，我都贊成終止懷孕。」「至於澳門，只要得到兩位婦科醫生簽字，就可以合法進行人工流產。如果發生糾紛，就要交由法院審理，有時可能訴訟多年才有判決。在這種情況下，女性可能會考慮前往鄰近地區接受非法人工流產，這令她們的健康和安全面臨極大風險。」

arianalife.com | REPRODUCTIVE RIGHTS

133

LOCAL VOICES 本地之聲

YOUNG VOICE Alice Kong, a 16-year-old student in Pui Ching Middle School, says there are a few missing pieces:

PATERNITY TIME Debbie Yip, who is in her second trimester, believes that fathers should have longer paternity leave: “Macao offers 70 days of maternity leave for mothers, which I think is acceptable. But at the same time, paternity leave is only five days long. I think at least 14 days should be given to fathers so they have two weeks to spend time with the baby and adapt to this new life. “That way, mothers will have support from the father, too. Mothers are already very exhausted after giving birth and need a lot of rest. If fathers have only five days of leave, it doesn’t allow them to help at home and ensure their partners have time to recover.”

親子時間懷孕中期的葉濬思認為父親應該享有更長的侍產假：「澳門為母親提供70天產假，我認為可以接受，但相較之下，父親的產假卻只有五天。我認為至少應該給父親14天產假，讓他們有兩個星期陪伴孩子，適應新的生活。」「而且母親在分娩後已經非常疲累，需要大量休息，因此很需要父親的支持。如果父親只有五天產假，肯定不足以讓他們在家中照顧伴侶，讓伴侶有足夠時間恢復體力。」

134

生育權 | arianalife.com

“There is still room for improvement in the regulation of abortion. For instance, if a woman gets pregnant after being raped, the procedure can become lengthy and complicated if the accused party denies the rape. This also indirectly supports rapists, which causes serious harm to women physically and psychologically. “As for schools, sex education is provided, however, most teachers only cover the biological differences between men and women. At most, they teach students how to prevent pregnancy. But they seldom mention reproductive freedom, reproductive health care or family planning.”

青年之聲澳門培正中學的16歲學生鄺羨洳說目前的制度仍有疏漏：「目前針對人工流產的法規仍有改善的空間。例如，如果一名女性被強姦後懷孕，但被告卻否認控罪，整個程序可能會變得漫長而複雜；這等於間接支持了強姦犯，對女性的身心均會造成嚴重傷害。」「儘管學校會提供性教育，但大多數教師僅說明男女之間的生理構造差異，頂多也只是教學生如何避孕。他們很少提及生育自由、生殖保健和計劃生育。」

THROUGH THE LENS 眾鏡透視

UNDER THE SKY 同一天空下 Words 文 Gayathri Durairaj | Photography 攝影 William Liu Translation 翻譯 Ng Mei Kwan

Through the Lens is a recurring photography and poetry series that champions creativity and collaboration. In this edition, we invited a Macao photographer and a Hong Kong-based poet to share their perspectives. 攝影詩集眾鏡透視旨在促進創意與合作。今期我們邀請了一名來自澳門的攝影師以及一名旅居香港的詩人分享他們的作品。

A bud waits for the sun, opens its arms, Its parent ascends in resilience Sense of belonging is like rooted plants, A secure feeling when holding hands 芽蕾張開雙臂，佇候陽光單親的母親提升了復原力歸屬感像生根的芬芳抓緊便有安全感

136

生育權 | arianalife.com

arianalife.com | REPRODUCTIVE RIGHTS

137

THROUGH THE LENS 眾鏡透視

138

生育權 | arianalife.com

UNDER THE SKY

同一天空下

Old shophouses narrate a story A humbling abode of past glory Memorable talks with a little game Only friends are left to share the pain 舊商鋪述一個故事曾經光輝的小店在麻雀耍樂中難忘談天的樂趣只剩下朋友分擔苦惱

arianalife.com | REPRODUCTIVE RIGHTS

139

THROUGH THE LENS 眾鏡透視

Green parks filled with people’s daze Responding in an amiable gaze Excitement bright, dancing in the eye, A oneness of community under the sky 青翠的公園內人們充滿迷惘回應一種融和的凝望奮發著光明，眼眶內舞動同一天空下，同一個世界

140

生育權 | arianalife.com

UNDER THE SKY

同一天空下

arianalife.com | REPRODUCTIVE RIGHTS

141

THROUGH THE LENS 眾鏡透視

Little help when the body turns weak, A slowdown in life as it completes, Contemplating identity it tells thee: ‘Age singles out but doesn’t restrict me.’ 當身體日漸衰退便無法阻止開始慢活當人生邁向終止，思索著自己的身分便印證了自己「年紀雖大不能對我限止。」

142

生育權 | arianalife.com

UNDER THE SKY

Ad ARIANA 20190816 OUTLINED.pdf

16/8/19

同一天空下

7:08 PM

arianalife.com | REPRODUCTIVE RIGHTS

143

LAST WORD 流芳之語

144

生育權 | arianalife.com

HONG KONG’S DAUGHTER 香港女兒

Remembering Dr Joanna Tse Yuen-man, who lost her life while treating victims of SARS. 追憶謝婉雯醫生，一位因治療沙士病患而殉職的好醫生。

Words 文 Andrea Lo | Illustrations 插畫 Lauren Crow

n 22 May 2003, a hearse made its way from Hong Kong Funeral Home in North Point towards Gallant Garden, the final resting place for civil servants who have died on duty. Thousands of onlookers wearing surgical masks watched the poignant procession in silence. Outside the funeral home, a TV crew caught a woman waving goodbye in tears. “My heart breaks,” she told reporters. “She is someone’s daughter, and we see her as our own daughter.” This was the burial of Dr Joanna Tse Yuen-man, who passed away at 35 years old. Remembered as “Hong Kong’s Daughter,” Joanna was one of eight medical professionals to die from Severe Acute Respiratory Syndrome (SARS), which devastated the city in 2003. Of the estimated 8,273 cases worldwide, 1,755 (21 per cent) were identified in Hong Kong. The city also saw one of the highest mortality rates, accounting for 299 (40 per cent) of 775 total deaths.

EVERYDAY HONGKONGERS Born on 31 March 1968, Tse grew up in a roughly 200-square-foot flat at Shek Yam Estate in Kwai Chung, a district in Hong Kong’s northwestern New Territories. According to Tse’s older brother Steven, the family of four were a working-class family of “everyday Hongkongers.”

003年5月22日早上，送殯車隊從北角的香港殯儀館駛往安葬殉職公務員的浩園。沿途數以千計戴著醫療口罩的民眾，靜靜地朝車隊默哀。電視台攝製隊在人群中捕捉到一名女士流淚揮手告別。她對記者說：「自己也很心痛。她是人家的女兒，我們也把她當成自己的女兒。」這是謝婉雯醫生出殯的日子。2003年，香港爆發嚴重急性呼吸系統綜合症（SARS，俗稱沙士），八位醫護人員因此而捐軀。「香港女兒」謝婉雯醫生是第一位獻出寶貴生命的公立醫院醫生，過世時她年僅35歲。據估計，沙士時期，全球感染個案達8,273宗，香港有1,755宗，佔總體21%。香港也是死亡率最高的地區之一，在全球死於沙士的775人當中，香港人佔了四成，共有299人喪生。

平民英雄謝婉雯出生於1968年3月31日，從小住在新界葵涌石蔭一個面積不過200平方呎的公屋。她的兄長謝卓智形容，自己和妹妹成長於普通的香港基層家庭，父親在旺角經營一家手錶店，母親則在家裡做些手工藝品補貼家用。兄妹二人在成長的過程中沒有太多娛樂活動，也不曾出國旅行，但父母經常會帶他們到現已拆除的荔園玩樂。這些溫馨的情景，至今仍讓謝卓智記憶猶新。

arianalife.com | REPRODUCTIVE RIGHTS

145

LAST WORD 流芳之語

Their father ran a watch shop in Mong Kok and their mother produced handicrafts at home to sell for extra money. “We didn’t have a lot of entertainment, and we never travelled,” says Steven. But he fondly recalls visiting the now-defunct Lai Yuen amusement park as a family. His sister, he says, was a quiet, gentle girl and 2004 book Love Cannot be Buried: Joanna Tse Yuen-man, echoes this characterisation. Having compiled memories from Tse’s loved ones, author Velentina Ma describes Tse as a hardworking student who loved to read and had little desire for material things. The book also highlights a pivotal moment in Tse’s childhood. When she was in primary school, Tse realised she wanted to be a doctor after watching an emergency medical team respond to an accident on the news. She turned and told her father abruptly: “I want to save people.” Throughout her school years, Tse diligently worked towards this goal. She was an excellent student, achieving eight A grades on her Hong Kong Certificate of Education Examination (then the public exams undertaken by high school students) – a near-perfect score. Tse’s scholastic accomplishments enabled her to pursue medical studies at Chinese University of Hong Kong (CUHK), where her childhood dream came to fruition. While Tse did not openly discuss her motivations for becoming a doctor, she wrote in her medical school admissions handbook: “Become a doctor to serve the people and utilise my strengths.” “My first impression of her was that she was a good student,” says So Wing-yee, a doctor at Prince of Wales Hospital, who attended both secondary and medical school with Tse. The two were friends and even roomed together at one point during university. “She was top of the class every year.” Not only was Tse dedicated to her studies, but So says she was also “smart, determined, and considerate” – important traits for medical professionals. “She was quietly determined in what she wanted to do. Some people loudly declared they wanted to be heroes. She wasn’t like that.”

146

生育權 | arianalife.com

While studying pre-med at CUHK, Tse worked shifts at various hospitals where she displayed a cheerful bedside manner, according to the book. After she graduated in 1992, Tse took a job in the Accident & Emergency Department at Tuen Mun Hospital. While working in the emergency room for the next two years, she met her future husband Albert Chan, a fellow doctor. They started dating in 1995, bought a home together in 1998 and made plans to get married. But that same year, Chan was unexpectedly diagnosed with leukaemia. After two years of difficult cancer treatments, the couple married in 2000, when Tse was 32. Unfortunately, Chan passed away from the disease just two years later in 2002. Tse’s brother Steven recalls a particularly moving moment at Chan’s memorial service. When a moth – believed by some in Chinese culture to represent the spirit of the departed – appeared at the funeral home, Tse said gently: “You have to go.”

SARS TAKES ITS TOLL While her husband was sick, Tse found solace in her Christian faith and further studies to become a respiratory specialist. About half a year after Chan died, Tse passed the specialist exams and officially shifted her focus to respiratory medicine. In March 2003, the SARS outbreak – which began in mainland China in November 2002 – gripped the city and, by extension, the medical community. But no one at that time understood the disease fully. “You can see from its name [severe acute respiratory syndrome] that it doesn't actually tell you what the disease is,” So explains. “It had never happened before – where half of the medical team didn't know what they were dealing with.” As SARS patients began flooding Hong Kong hospitals, doctors divided their staff into “clean” and “dirty” teams, with the latter responsible for treating SARS patients in the wards. During the first month of the outbreak, Tse volunteered to join the dirty team. “Because she was a respiratory expert, she wanted to work on these cases and felt she should be on the dirty team,” So says.

Tse had an outgoing side as a Girl Guide, the equivalent of a Girl Scout in the West 謝婉雯曾參與童軍多年，展示好動一面

HONG KONG’S DAUGHTER

香港女兒

他說，妹妹是一個性格內向而文靜的女孩。2004年出版的回憶錄《愛是不能埋——謝婉雯》亦有這樣的描述。作者馬靄媛訪問了謝婉雯的親友，收集眾人對她的印象之後，描述她是一個勤奮好學、喜愛閱讀，幾乎沒有甚麼物質慾望的人。書中特別提到謝婉雯的一段童年往事。她唸小學時，看到電視新聞播放救傷隊搶救意外中的傷者的片段，令她萌生了當醫生的念頭，當時她告訴父親：「我想做醫生救人。」求學期間，謝婉雯一直為這個目標而努力讀書。她是個品學兼優的好學生，在香港中學會考取得接近完美的八優成績。由於成績優異，謝婉雯順利進入香港中文大學醫學院，實現她的童年夢想。雖然從未公開談論自己想成為醫生的動機，但她曾在入學手冊中寫下志願：「加入醫生的行列，為社會和人民服務，更發揮自己所長。」當時任職威爾斯親王醫院的蘇詠儀醫生是謝婉雯的中學和醫學院同窗好友，兩人在大學期間更是室友。蘇醫生說：「我對她的第一個印象是，她是一個好學生。她在班上每年都名列前茅。」蘇醫生表示，謝婉雯不僅讀書認真，而且具備了「聰明、堅定、體貼」等適合擔任專業醫療人員的重要特質。「她會默默地完成自己想要做的事。有些人喜歡大肆宣揚自己想成為英雄，但她絕非那樣。」書中提到，謝婉雯在中大唸醫學預科時曾於多間醫院值班，她對病人態度親切、體貼入微，深得病人喜愛。她於1992年畢業後入職屯門醫院急症室。接下來兩年，她在急診室工作期間結識了陳偉興醫生，兩人於 1995年開始交往，三年後開始談婚論嫁，並合資購屋。可惜好景不常，陳偉興醫生在同一年被診斷出罹患血癌。與癌症搏鬥兩年後，二人在2000年步入教堂，當時謝婉雯醫生32歲。不幸的是，結婚兩年後，陳醫生依然不敵病魔，在2002年撒手人寰。謝卓智憶起妹夫的追悼會上有一個感人的小插曲。當時謝婉雯看見一隻飛蛾在殯儀館內來回盤繞，於是輕輕地對飛蛾說：「你該走了。」

慘痛教訓丈夫患病期間，謝醫生透過基督教信仰找到慰藉，並再去呼吸系統科深造。丈夫去世約半年後，她通過專科考試，正式成為呼吸系統科醫生。 2002年11月，中國大陸出現沙士病毒，2003年3月，病毒在香港爆發，全城出現大規模感染，連醫護人員亦無可倖免。蘇醫生憶述，當時大家對這個病毒所知甚少，「單從嚴重急性呼吸系統綜合症這個名字來看，我

arianalife.com | REPRODUCTIVE RIGHTS

147

LAST WORD 流芳之語

After resuscitating a SARS patient who later died 們無法得知這是甚麼疾病。這是前所未見的疾病，大 of the disease, Tse began to experience symptoms of 約半數的醫療團隊都不知道自己在處理甚麼。」 her own, starting with an intense fever. At first, she 由於大量沙士患者湧入香港的醫院，醫生將醫護 had been optimistic, even assuring her family that 人員分為兩支專責團隊，一支負責普通病房，另一支 she would celebrate her birthday with them after 負責沙士病房。在疫情爆發的第一個月，謝醫生自動 she recovered. “In the first couple of weeks, she was 請纓加入沙士病房。蘇醫生說：「因為她是呼吸系統 doing okay, and then it started to deteriorate,” So says. 科醫生，所以認為自己有責任應對這方面的疾病，理 “She looked at her own lung scans and knew it was 應要加入沙士病房照顧患者。」 getting worse.” 謝醫生在搶救一名沙士患者（這名病人後來終告 According to a media report by Ming Pao, a nurse 不治）期間受到感染，開始出現了高燒等症狀。起初 testified in Tse’s death inquiry that the hospital had 她仍保持樂觀，甚至向家人保證，康復出院後會和他 been reusing N95 masks and isolation gowns at the 們一起慶祝生日。蘇醫生說：「最初幾個星期她的情 time, but stopped after Tse and 況還算不錯，然後突然急轉 other medical professionals 直下。她看了自己的肺部X光 contracted SARS. 片，也知道情況正在惡化。」 Forty days later, Tse passed 根據《明報》的報導， away from the disease on 13 有護士在謝醫生的死因研訊 May 2003. When the media 中指出，在謝醫生與另一名 praised her actions, it prompted 醫護人員感染沙士之後，醫 an outpouring of grief across 院才停止重用 N95口罩和保 Hong Kong that culminated 護衣，讓醫護人員得到更妥 in her emotional funeral. The 善的保護。 community honoured Tse in 不到40天之後，謝醫生於 many ways. That same year, 2003年5月13日在醫院搶救無 the Hong Kong government 效而逝世。當媒體披露這個 awarded her posthumously 不幸的消息，並對她無私奉 with a Gold Medal for Bravery. 獻的犧牲精神大力讚揚時， In 2004, the CUHK Medical 所有香港人都悲慟不已，紛 Alumni Association established 紛前往她的葬禮致敬。 the Dr Tse Yuen Man Memorial 全港各界亦以各種方式 Scholarship, which is awarded 向她致敬：香港政府在她離 to two medical students and 世一個多月後為她追授金英 – So Wing-yee 蘇詠儀 one nursing student each year. 勇勳章；2004年，香港中文 Her story was also made into a 大學醫學院校友會設立「聯 movie, The Miracle Box, which 合書院謝婉雯醫生紀念獎學 focused on her marriage and work. Today, the Fighting 金」，每年頒發給兩名醫學院學生及一名護理學院 SARS Memorial Architectural Scene at Hong Kong Park 學生。同年，她的故事被拍成電影《天作之盒》， features seven statues to honour the medics, including 講述她的婚姻故事及獻身沙士病房的英勇事蹟。如 Tse, who died fighting the SARS epidemic. 今，設於香港公園內的「弘揚抗疫精神建築景觀」 Her brother Steven, however, says Tse wouldn’t 樹立了七座因沙士殉職的前線醫護人員銅像，包括 want to be praised for doing her job. He hopes her 謝婉雯醫生。 legacy can be viewed from a different perspective. For 然而，謝卓智表示，妹妹不會希望因為做了自己 the family, Tse is an inspiring example of Hong Kong’s 應做的事而受到讚揚。他希望大家從不同角度來看待 famous “lion rock spirit,” displaying perseverance and 她的事蹟。對其家人而言，謝婉雯代表了香港人引以 solidarity in the face of challenges. 為傲的「獅子山精神」，象徵香港人勇敢面對挑戰、 “As a doctor, she did what she had to do,” Steven says. 堅持不懈、互相團結的價值觀。 “I want to show her spirit to people, her spirit of carrying 謝卓智說：「作為醫生，她已盡了自己的責任。 out your responsibilities.”  我希望大家效法她盡忠職守的精神。」 

“Some people loudly declared they wanted to be heroes. She wasn’t like that.”

「有些人喜歡大肆宣揚自己想成為英雄，但她絕非那樣。」

148

生育權 | arianalife.com

HONG KONG’S DAUGHTER

香港女兒

arianalife.com | REPRODUCTIVE RIGHTS

LAST WORD 流芳之語

生育權 | arianalife.com

Ariana #05 Reproductive Rights

Articles inside

Hong Kong’s Daughter

Under the Sky

Breaking the Cycle

Life Studies

My Child-Free Choice

Tomorrow's Harvest

The Surrogates

Out of Step

Invisible Tolls

Let's Talk About Sex?

Equal Opportunities

Live and Learn

Reproductive Health

Right at Home

Dogged Pursuits

World of Change