Understanding Elective Egg Freezing (EEF) and Motherhood Ideals Among Nulliparous Chinese Women in Hong Kong: A Collaborative Focus Group Study

Background and Purpose: Regions in East Asia, including Hong Kong, have some of the world’s lowest fertility rates. While declining fertility rates reflect women’s changing preferences for having children, the rate of decline varies by age group, with younger cohorts experiencing sharp declines and older cohorts experiencing more modest declines. This trend suggests shifts in women’s timing preferences for childbearing and may be influenced by advances in assisted reproductive technologies. Elective egg freezing (EEF) as a fertility preservation method allows healthy women to extend their childbearing years beyond the natural reproductive lifespan, complicating fertility choices and timing. However, research on EEF and women’s changing fertility preferences is limited, particularly in the Asian context, and qualitative in nature. This study aims to address this gap by exploring women’s perceptions and attitudes toward EEF and childbearing in Hong Kong.

Methods: The study employed an innovative qualitative method called Collaborative Focus Group Analysis (CFGA). A reflecting team composed of medical practitioners, social workers, and researchers in nursing, counseling and law joined 36 nulliparous Chinese women in Hong Kong for three focus groups (ages 18–22, 23–31, and 32–40; 12 participants each). Participants were recruited through social media and community networks. Each focus group began with a 90-minute moderated focus group discussion among the participants while the reflecting team observed via Zoom from an adjacent room. In the following 30-minute session, the roles reversed: the reflecting team discussed the observed themes and concepts from the first session while the participants observed online. In the final 30-minute session, the participants responded to the reflecting team’s analysis with clarifications or reinterpretations. Each CFGA ended with a brief joint meeting of the participants and the reflecting team. All sessions were video-recorded and transcribed verbatim. The transcripts were coded thematically and a narrative approach was used for the analysis.

Findings: Data from the three focus groups revealed that women of different ages shared similar normative and gendered ideologies about motherhood, emphasizing the need for financial and career stability before having children. Despite this shared perspective, each participant navigated unique struggles and compromises in their childbearing decisions. Regarding EEF, participants expressed curiosity but were hesitant to pursue the procedure due to limited knowledge, potential stigma, and other systemic barriers. As a result, EEF was viewed primarily as a theoretical option rather than a practical choice.

Conclusion and Implications: CFGA not only increased transparency in the data analysis process, but it also facilitated collaborative knowledge creation between participants and the reflecting team. The comparison of narratives within each participant, between participants, and across age groups provided a nuanced understanding of women’s experiences and attitudes toward EEF and childbearing. This collaborative and inclusive method can be used in future research aimed at empowering the participants. On the other hand, the findings of this study also call for structural changes to help women fulfill their unmet fertility desires so that they can have greater reproductive autonomy.