Dr Susan Fan served The Family Planning Association of Hong Kong as executive director for 25 years, until her retirement in early 2021. We recently sat down with Dr Fan as she reflected on the evolving role of the organisation in her years of service. “The deferral in marriages and fertility decline in Hong Kong has required diversification of our services,” said Dr Fan, “but our mission has always been to advocate planned parenthood and sexual health.”

Established in 1950, the Association began its work as a charitable voluntary organisation via individual contacts in its early days. “Our volunteer doctors and nurses were pioneers in promoting birth control amid the traditional beliefs of expanding the family lineage,” said Dr Fan. Their efforts were later much amplified by the organisation’s successful “Two Is Enough” campaign in the 1970s. That decade also saw the gradual incorporation of the Association’s 32 birth control clinics into the Department of Health’s Maternal and Child Health Centres. Although the Association is best known for its contraceptive and abortion services, the Association’s very first clinic, established in 1956, also specialised in investigation and management of subfertility. “We did not tell people to simply avoid getting pregnant; we advised couples to plan their childbearing early and wisely. The same can be said today, as we see an upturn in demand for fertility treatment due to advanced parental age,” explained Dr Fan.

The Association’s scope differs from the conventional obstetrics and gynaecology specialty in that its services transcend genders and age-groups. The Association ran the only semen bank in Hong Kong before other technologies were developed for treating male factors in infertility. The organisation also runs a men’s health clinic and supports the exploration of sexuality in youth and LGBTQ communities with school-based education and a mobile classroom. Because sexual activity is still a relatively taboo topic in Chinese culture, discussions on youth sexuality must be conducted with sensitivity. “Pre-marital sex is often misconstrued as being synonymous with ‘promiscuity’. We had to work around prevalent social norms by calling sex education ‘family life education’, and using subtle language in educational television in order to introduce issues of sexual identity and orientation.“ Yet the Association also benefits from Hong Kong’s unique cultural milieu, as Dr Fan explained “Our community is very pragmatic. Unlike some countries and cultures where abortion remains highly divisive, our organisation has not faced outright opposition from conservative or religious sectors.”

When Dr Fan joined the Association in the 1990s, the issue of population ageing was gaining attention. In response, the Association began to introduce services for older members of society, such as opening the first menopause clinic in Hong Kong, offering hormone replacement therapy, and commencing an osteoporosis clinic for women and men. Through these health services, the Association aimed to prevent and reduce age-related conditions while enhancing the quality of life of Hong Kong’s ageing population.

Dr Fan stated that sexual health is an issue common to everyone in society, regardless of their background. She stressed that the Association’s services are entirely confidential and professional, and staff are not there to chastise or discipline people. Under Dr Fan’s leadership, the Association actively reached out to certain groups that are often overlooked; for example, male sexual and reproductive health is often neglected. In the past, men were simply advised to use condoms or get vasectomies. However, the Association not only emphasises the male role and responsibility in family planning, but also provides sexual health services for men including management of sexual dysfunction, erectile dysfunction, or premature ejaculation. To minimise patient embarrassment or reluctance, these services are usually delivered by male doctors, nurses and counsellors.

The Association also extended services to other under-served members of society, marginalised groups, and ethnic minorities. Despite the best intentions, these are not always successful, as Dr Fan illustrated by recounting efforts to run a mobile clinic for foreign domestic helpers, in public areas where helpers gather on Sundays. It turned out that parking the mobile van in an open public space was counterproductive, as helpers feared being noticed and stigmatised for visiting it. There have also been successes; the Association was entrusted to roll out a programme to provide free or subsidised human papillomavirus vaccines for more than 30 000 young girls from low-income families. Dr Fan reflected that there are always ways to improve the effectiveness and accessibility of these services, to dispel misconceptions and to reduce public hesitation to seek sexual health services, and to reach as many people as possible.

Youth sex education is another important focus for the Association. Dr Fan thanks the Hong Kong Jockey Club for their support in opening a Youth Zone for introducing sexual health to young people. The Association also runs three Youth Health Care Centres throughout the city. Dr Fan explained that the locations of these Centres in commercial buildings in busy districts were carefully selected so that they were readily accessible but also discreet. The Association<s dedication to empowering the youth is impressive; Dr Fan noted that 20% of their Council membership is comprised of youth representatives nominated from the Association<s youth volunteers by themselves. Furthermore, the Association<s longstanding efforts in sex education have contributed significantly at all levels of education in Hong Kong, nurturing a future generation that is more aware of their sexuality and sexual health.

Looking into the future, Dr Fan hopes that Hong Kong people, particularly young couples, will proactively plan their families earlier. She understands that factors such as the city’s demanding work culture and high living costs exacerbate people’s reluctance to have large families, but she hopes family planning will allow people to fulfil their dreams of parenthood, while avoiding problems caused by age-related effects on fertility. The Association offers pre-pregnancy check-ups, in which prospective parents can be screened for common hereditary conditions or to simply learn about preparing for childbearing. She also hopes to see more support for men playing a more active role in parenting.

Dr Fan looks back fondly on the past 25 years at the Association. She credits all her achievements to the incredible staff and the doctors who volunteer their time at the Association, without whom her ideas would simply be unattainable. She is also grateful to the government and many donors who have provided the Association with sufficient funding to allow it to provide affordable services to the Hong Kong population. “I found working with the Association immensely satisfying, and I sincerely hope my successor, Dr Mona Lam, will do so too”, remarked Dr Fan with a smile. The Association has tirelessly worked to improve the quality of life of families across Hong Kong, but Dr Fan acknowledges that challenges remain in social policy, community perception and cultural values, and notes that there is always room for improvement. The continued promotion of proper family planning and education in enhancing the overall sexual and reproductive health of all people in Hong Kong cannot be over-emphasised.