A very low fertility rate in Hong Kong: Challenges and Opportunities

Paul Yip Department of Statistics and Actuarial ScienceThe University of Hong Kong

Outline

An overview of the fertility pattern A critical review of dependence ratioImplication on health care deliveryOpportunities and challenges

Population size refers to the mid-point of the respective years

0

1

2

3

4

5

6

7

8

1971 1976 1981 1986 1991 1996 2001 2004

Million

0.84 2001 - 04

0.94 1996 - 01

1.80 1991 - 96

0.62 1986 - 91

1.53 1981 - 86

3.23 1976 - 81

2.34 1971 - 76

Average annual growth rate

Population pyramid of Hong Kong 1976, 2003 and 2033

Replacement level (2.1)

0

0.5

1

1.5

2

2.5

3

3.5

4

1971 1976 1981 1986 1991 1996 2001Year

Live

birt

hs p

er w

oman

Total fertility rates of Hong Kong SAR, 1971 - 2005

Change in TFR, Italy, France, Japan, Singapore, Hong Kong from 1950 to 2000, prospects to 2050

0

1

2

3

4

5

6

7

1950-1955 1960-1965 1970-1975 1980-1985 1990-1995 2000-2005 2010-2015 2020-2025 2030-2035 2040-2045

ItalyFranceJapanSingaporeHong Kong

Total fert ility rate, HKSAR and other low fert ility

economies, 1971-2000

0

0.5

1

1.5

2

2.5

3

3.5

4

1971 1976 1981 1986 1991 1996Year

per w

oman

HK

Singapore

Finland

Total fertility rates of Hong Kong andselected low fertility economies, 1995 – 2002

2.011.341.641.731.751.731.751.651.321.370.962002

2.031.351.631.751.731.711.781.571.331.410.932001

2.061.381.641.771.761.721.851.551.361.61.022000

2.011.361.691.741.761.651.851.51.341.470.971999

21.361.721.721.761.631.811.51.381.470.991998

1.971.371.721.751.781.561.861.521.391.611.11997

1.981.321.731.751.81.531.891.611.431.661.171996

1.981.251.711.811.831.531.871.741.421.671.31995

USGermany UK Denmark Australia Netherlands Norway Sweden Japan Singapore Hong Kong

Non-Asian economiesAsian economiesYear

Reasons for decline of TFR

Reduction on marital fertility rate (44%)

Change in marital structure: (56%)Increasing spinsters and late marriagesIncreasing Cross-boundary marriages

(China and Hong Kong) Increasing age difference in marriage

Decomposition method for TFR

Definition

Pi : Proportion of marriage in age group i

AMFRi : Age-specific marital fertility rate in age group

i i i ii

TFR AMFR p p AMFR⎡ ⎤∆ = ×∆ + ×∆⎣ ⎦∑

Results for decomposition of the change in TFR

1004456Total

<0.5<0.5<0.545–49

33<0.540–44

84435–39

189930–34

42222025–29

2571820–24

4-1515–19

TotalAMFRAge group

Proportion (%) of decline in the TFR attributable to change in

ip

A new measure - WTMFR

A Weighted Total Marital Fertility Rate (WTMFR)

Wi : Percentage of women get married in age group i to all married women

TMFRi : Total marital fertility rate for women get married in age group i

∑=

×=7

1.

iii TMFRwWTMFR ∑

=

×=7

1.

iii TMFRwWTMFR

7

1.i i

iWTMFR w TMFR

=

= ×∑

A new measure - WTMFR

Comparison of TMFR and WTMFRTMFR: assumes that all women get

married at age twenty.WTMFR: take the marriage percentage as

weights, hence avoids the over-general assumption and has the same trend as TFR (birth outside wedlock is constant (7%) in HK )

0%

1%

2%

3%

4%

5%

6%

7%

8%

1981 1986 1991 1996 2001

Prop

ortio

n of

live

birt

hs

Proportion of live births in Hong Kong by cohabitating parents, 1981-2003

Comparison of TFR, TMFR and WTMFR

Trends of WTMFR,TFR and TMFR1976-2001

0

1000

2000

3000

4000

5000

6000

7000

1976 1981 1986 1991 1996 2001Year

WTMFRTFRTMFR

Decomposition Results for WTMFR

1004852Total

<0.5<0.5<0.545–49

<0.5<0.5<0.540–44

-1<0.5-135–39

-52-730–34

216-1425–29

73274620–24

3132815–19

TotalTMFiW_iAge group

Proportion (%) of decline in the WTMFR attributable to change in

Reasons for decline of TFR

Reduction on marital fertility rate (44%)

Change in marital structure: (56%)Increasing spinsters and Late marriagesIncreasing Cross-boundary marriagesIncreasing age difference in marriage

Age-specific fertility rates of Hong Kong, 1971-2004

0

50

100

150

200

250

300

15-19 20-24 25-29 30-34 35-39 40-44 45-49

Live

birh

ts p

er 1

,000

wom

en

19711976198119861991199620012004

Mean age of mothers by live birth order, 1981-2003

24

26

28

30

32

34

36

1981 1986 1991 1996 2001

Mea

n ag

e at

bir

th

1st parity2nd parity3rd parity4th parity

For the same age group 15-49 Never married men > Never married women (７６８５０ｖｓ892100 ）

However, due to the preference of gloom age pattern we estimate there will be about 135,000 women at marriage age can’t find the partner in Hong Kong.

Increase in Spinster

A of never married Kaplan-Meier curve: Probability

Kaplan-Meier curves for females

00.10.20.30.40.50.60.70.80.9

1

15 20 25 30 35 40 45Age

Pro

babi

lity

of N

ever

mar

ried

200119961991

Median Age at First Marriage 1971-2004

20

22

24

26

28

30

32

1971 1976 1981 1986 1991 1996 2001 2004

year

age

malefemale

Increase Cross-boundary Marriage

Cross-boundary marriage in 2004, (HK Male and HK Female: 61.37%)(HK Male and Mainland Female: 33.77%)590 cases to 13126 cases in 2004(HK Female and Mainland Male: 4.8690 cases in 1991 to 1888 in 2004

Marriages composition 1991-2004

0

10 000

20 000

30 000

40 000

50 000

1991 1996 2001 2004year

NO. of marriage

MMvsMFMMvsHKMHkMvsHKFHKMvsMF

13126200418882004

516920017232001

221519962691996

5901991901991

HK Men and Mainland

womenYear

Increased by

nearly 21 times

for1991-2004

HK Women and Mainland Men

Year

Increasing age difference in marriage

2

2.5

3

3.5

4

4.5

5

5.5

6

1991 1996 2001 2004year

age

diffe

renc

e be

twee

n m

ales

and

fe

mal

es

23853Total Number of Cases

7443281271189650187050+

54618731401401194313045-49

151475623348948720536140-44

37083321208091698894146635-39

80461747393350835635121530-34Groom

7668011779860530413575025-29Age of

1531002434286104615920-24

96000003316216-19

Number ofGroom 50+45-4940-4435-3930-3425-2920-2416-19

Age of Bride

P(Age of Groom<Age of Bride)Number of Marriages

MythsAgeing is no big deal:

Speed and magnitude and 80% growth is from migrants.A smaller population size to Hong Kong is good:

Yes it is only true if we can choose who is going to stay.Increasing fertility measures in overseas countries is useless:

The reduction of the TFR in other countries has levelled off around 1.3 but not in Hong Kong

Hong Kong can have unlimited supply of people from China, it is a city The supply is unstable and unreliable. Hong Kong has become less attractive in attracting migrants

Silver Hair MarketIt might be true twenty years later but not now

Fertility is going to rebound soon. NOT YET about 1/3 from non-Hong Kong residents in 2005

Tempo effect versus Quantum effect

Not tempo. But real Quantum effect.

In 2001, Total Marital Fertility Rate (TMFR) was still around 2.2.

It is the speed and the magnitude of the reduction of the fertility rate,

Proportion of live births born in Hong Kong, 2001-2004

0%

20%

40%

60%

80%

100%

1991 1993 1995 1997 1999 2001 2003

BHKROutside HKBnotHKRBSHKR

Demographic Ratio (DR)

Dependence Ratio

Dependency ratios for Hong Kong population, 1976 - 2031

0

100

200

300

400

500

600

1976 1986 1996 2006 2016 2026Year

Children Elderly Total

This positive “population effect” eases the pressure on countries to provide for the young and elderly and enabling more investment in economic and social development such as health, family planning, and education, in addition to providing women with more opportunities (United Nations, 2002, 2004)

Demographic window

Benchmark: 1 dependent to 2 independents

Total dependency ratio (TDR)=0.5

When the population’s TDR shifts below 0.5, it gives a golden opportunity for the community to improve the quality rather than the quantify of the population.

Window closes earlier when the age truncating for total dependency ratio changed

Source: United Nations World Population Prospects: The 2002 Revision

0.0

0.5

1.0

1.5

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

YR<15TDR(0-14+60+/15-59)AR 60+

Change in young ratio <15, ageing ratio 65+ & total dependency ratio in Hong Kong, from 1950 to 2000, prospects to 2050

Source: United Nations World Population Prospects: The 2002 Revision

0.0

0.5

1.0

1.5

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

YR<15AR 65+TDR

Change in labour participation rate, by age and sex, Hong Kong, from 1985 to 2001 and prospects up to 2019

Source: General Household Survey 1985-2001, Hong Kong Census and Statistics Department

0

20

40

60

80

100

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

19852001200220102019

Males

0

20

40

60

80

100

15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+

19852001200220102019

Females

Implications: Health

Figure 4: Hospital patient days needs index, HKSAR, 2000-2029

0

25

50

75

100

125

150

175

200

2000 2004 2008 2012 2016 2020 2024 2028Year

Inde

x

Health (continue)Age distribution of of patient days utilisation, HKSAR,

2000-2029 (Yip and Law, 2003)

0%

20%

40%

60%

80%

100%

2000 2004 2009 2014 2019 2024 2029Year

0-1415-6465+

Fig. 4.2: Projected patient days, population at working ages and patient days to adult ratios, HKSAR, 2001 - 2031 (Yip

and Law, 2003)

02468

101214161820

2001 2006 2011 2016 2021 2026 2031Year

Pop

ulat

ion/

Pat

ient

da

ys (m

illio

n)

012345678910

Pat

ient

day

s pe

r per

son

at w

orki

ng a

ge

Patient days per adultsPopulation (15 - 64)Patient days

Health Care implications

Sources of Support:Family members support: decreasingGovernment support: IncreasingHealth Care Protection account: The existing cohort of those aged 40 or above might not have enough.

Migration: slow down ageing

The difference between the proposed

and the official projectionComparison of official projection and new projection,

HKSAR, 2000-2029

6500

7000

7500

8000

8500

9000

2000 2005 2010 2015 2020 2025Year (mid)

(thou

sand

peo

ple)

Off icial

New

Three-fold challengesHow to revert the low fertility:

Replacement Migration:

Healthy Population:

Low fertility

About 60% reduction is due to change of marital distribution rather than the reduction of marital fertility.Promoting fertility, CS suggested to have three. However the married one on average have 2 already.Engage the newborns from Mainland born mothers in Hong Kong Family friendly work practice: including longer maternal or paternal leave for parents, child care facilities, tax reduction and shortening of working hours.

Replacement migration

About more than 80% of the population growth from migration.The new comers rejuvenate and inject new blood into the community.They are not coming and not very stable (38100 one-way permit holders in 2004; 55,000 in 2005).Impact on the labour force: postponement of the retirement age.Successful experience in Shanghai about 30% are newly migrants

Healthy Population

Life-long health promotion and practiceHealthy life style.Prevention: to prevent unnecessary health cost: for example, abortion, smoking and attempted or completed suicides

LAW, C.K. and YIP, P.S.F. (2002). Acute care service utilization and the possible impacts of a user-fee policy in Hong Kong. Hong Kong Medical Journal, 8, 348-353.LAW, C.K. and YIP, P.S.F. (2002). Healthy Adjusted Life Years of Hong Kong, SAR. International Journal of Public Health, 81, 1-7.LAW, C.K. and YIP, P.S.F. (2002). Viability of the health protection account in Hong Kong. Hong Kong Medical Journal, 8, 262-8. YIP, P.S.F. and LAW, C.K. (2002). Assessment of the future resources and needs for hospitalization in Hong Kong SAR. The International Journal of Health Planning and Management, 17, 113-122.

YIP, P.S.F. and LEE, J. (2002). The impact of the changing marital structure on the fertility rate of Hong Kong SAR. Social Science and Medicine, 55, 2159-2169.CHEUNG, Y.B. and YIP, P.S.F. (2001). Social patterns of birth weight in Hong Kong, 1984-1997. Social Science and Medicine, 52, 1135-1141.YIP, P.S.F., LEE, J, CHAN, B. and AU, J. (2001). A study of demographic changes under sustained below -replacement fertility in Hong Kong SAR. Social Science and Medicine, 53, 1003-1009.