BY SUKRITI MOHAN
In a world where we often worry about overpopulation, there are certain nations struggling to stimulate higher numbers of births. Concern about declining fertility and birth rates has risen drastically during the last few decades, and many worry that the decreased number of young residents will weaken the future labor force and economy of their respective nations. In addition, the young are traditionally responsible for the care and well-being of elderly populations, so a low fertility rate leads to fear of a forgotten and unsupported aging population. Consequently, nations such as the Republic of Korea, Japan, and Singapore have embarked on a journey to establish political and health interventions aimed at reversing the decreasing fertility and birth rates. This piece will provide general background on the Republic of Korea’s healthcare system and family planning services, analyze the methods that Korea uses to stimulate its low fertility rate, and finally, pinpoint the barriers this nation continues to face. Methods that will be discussed are the limitation of abortions, pronatalist policies, more generous family leave policies, and more accessible maternal and child healthcare. Obstacles that discussed include workplace stigma, illegal abortions, and cultural norms.
Health services in the Republic of Korea are largely provided by the private sector; yet, they are financed by national health insurance, which covers 96.7% of the population. Consequently, this nationalist health insurance system provides healthcare for the vast majority of pregnant women, mothers, and children.1 In Korea, almost all children receive medical benefits through insurance and the healthcare system. This is in contrast with the United States, where many children still do not have access to medical insurance benefits, often because they are not enrolled in Medicaid nor do they have access to private insurance. One of the advantages of Korea’s national medical insurance system is the relative lack of racial discrimination, especially compared to the US, where the black population, for example, faces significantly higher rates of single motherhood, pre-term births, and infant deaths.2 Of course, Korea’s low levels of discrimination are aided by its predominantly homogenous ethnic population: The 2.8% of the population that identifies as non-Korean is mainly Chinese.1
After the population boom that followed the Korean War, the government worked to decrease the fertility rate through the Family Planning Project.4 Condoms and birth control pills were disseminated by the government.3 As in the US the use of contraceptives began to rise in the 1960s and continued well into the 1990s.5 Similarly to the Netherlands, Denmark, and the United States, rates of abortion in Korea rose in the 1960s and early 1970s, although it was and remains illegal. In the late 1970s, the rate of abortions peaked. During this time, the increase in both contraceptive use and abortion contributed to the drastic fall of the total fertility rate and family size.5 As of 2015, Korea’s fertility rate had dropped to a staggering 1.2 births per woman. Today, the elderly make up a considerable portion of Korea’s population, which has led to concerns over the low fertility rate and the future of Korea’s economy. In the last two decades, Korea’s low fertility rate has driven many social and economic policies targeted toward increasing family size. These include the decreased tolerance of abortion and the implementation of pronatalist policies. These policies also include positive incentives such as more generous family leave policies and an increased emphasis on maternal and child health.
As of 2012, approximately 440,000 childbirths were reported annually in Korea; yet, approximately 340,000 abortions are performed annually, despite national regulations that make 95.6% of these abortions illegal. According to Article 14 of the Mother Act, abortion is only legal in cases of genetic disease or disability, infectious disease, rape, incest, or danger to the pregnant woman. Although illegality of abortion has not changed significantly in the last half-century, there has been a change in the government’s treatment of abortion. In the 1960s and 1970s, while the government was attempting to decrease the fertility rate through the Family Planning Project, abortion, albeit illegal, was used as a demographic policy. With Korea’s fertility rate drastically lower today than just a few decades ago, abortion is now treated less as a family planning tool, and more as a crime.
The most important worries with regard to abortion policies are the following: First, each of the instances in which abortion is legal has been defined quite narrowly.4 Therefore, women seeking abortion often avoid safe facilities such as hospitals and clinics. This is exacerbated by the fact that the punishment for doctors aiding abortions is much graver than for women receiving them. As harsher punishments for medical personnel are implemented, the incidence of unsafe practice and its negative health consequences increase. Second, when abortion’s legality is dictated by demographics and population growth, the government’s emphasis on low family sizes can skew the sex ratio at birth. Females are disproportionately aborted and male children are disproportionately born due to male favoritism. Until the recent past, these social differences between the sexes were even legally codified—male children inherited the family register, greater inheritances than sisters and mothers, and the title of family head. Therefore, there is still a great deal of social pressure on women to bear male children.4
In addition to implementing more stringent punishments for those undergoing or aiding in abortions, Korea created many pronatalist policies in 2006. Called the First Basic Plan for Low Fertility and Aged Society, it worked to provide incentives for higher birth rates through the following methods:
- Decreasing the socioeconomic burden of childcare
- Expanding childcare infrastructure
- Expanding support for pregnancy and childbirth
- Increasing the compatibility between home and work
- Engendering family social culture emphasizing gender equality6
The government offers tax incentives for childcare, an untaxed allowance to aid in paying for childbirth and childcare, and baby bonuses. In the civil service, temporary employees are often hired to substitute for parents on leave, and new parents often have the option to work part-time.8 Unfortunately, it seems that these policies did not effectively encourage people to have more children — the number of births per woman has remained less than 1.5 since 2000. In 2013, President Geun-hye Park cited low fertility rates as one of the government’s significant concerns. Although since 2010, the federal government has not implemented a new set of pronatalist policies uniformly across Korea, fertility encouragement grants are provided at the borough level.6 Boxes of beef and baby clothes are disseminated to families with newborn children, and health workers buy newspaper ads to welcome the births.3
Along with the creation of pronatalist policies, Korea also revised family leave policies in the early 2000s in the following ways:
- In 2001, the Labor Standards Act was amended to increase maternity leave from 60 to 90 days.
- The Act on Equal Employment and Support for Work-Family Reconciliation was amended to allow an increase in wage replacement levels during leave, and termination during leave was prohibited.
- In 2001, the Employment Insurance Act was revised so that those on leave were eligible for wage replacement through the national employment insurance fund.
Additionally, in 2005, the Constitutional Court upheld penalties for violation of family leave laws, which include up to 5 years of jail and a maximum monetary penalty of $30,000 USD for employers who illegally terminate their employees on leave. Despite these changes, 48% of businesses were in violation of parental leave laws that year. It comes as no surprise that less than 20% of pregnant women take advantage of family leave. In a 2011 survey, 24.4% of women stated that they had signed a recommended resignation form under pressure after their use of leave. They cited fear of disrupting the workplace, guilt from fellow employees, policy inadequacy, fear of dismissal, and loss of salary and promotions as reasons for not taking maternity leave. Myunghwa Lee, who writes for the Asian American Law Journal at Berkeley Law, found that “Many women return from maternity leave to find that their desk is no longer in the office, that they are assigned to another team…or that they are transferred out of town.” Although modernization occurred quickly in Korean society, traditional values such as hierarchy in social structures have remained. Consequently, industry practices and business customs prevail, even at the expense of government policies. The preference for male employees, as well as low female workforce participation—only approximately 50% over the past two decades—hinders the effective implementation of family leave policies.8 Unfortunately, the rate of male participation in parental leave has remained less than 3% during the last decade. Many women argue that this increases the stigma of maternity leave and decreases the chances of women taking advantage of such policies.7 Therefore, neither male nor female parents are likely to take family leave, which makes it difficult to raise fertility rates.9
The last manner in which Korea has worked to increase fertility rates is through the positive incentive of high quality maternal and child healthcare. The Ministry of Health and Welfare is especially involved in the promotion of health and prevention of disease in mothers and children.2 In the last two decades, the Korean government has placed an increased emphasis on national programs to improve healthcare for pregnant women and children. Between 2000 and 2011, Korea also implemented programs to diagnose deafness early in life, prevent the blindness of preschoolers, prevent maternal hepatitis B infection, and support teenage mothers, as well as provide information on pregnancy, childcare, and breastfeeding.
These changes will hopefully have a twofold effect—the availability of social support may persuade more women to have children, and the increased health benefits may lead to better overall health for those new mothers and children. Future policy must focus on reconciling the roles of women as both mothers and members of the workforce, as well as decreasing the negative connotations associated with male parental leave.9 Similarly, efforts must be made to diminish the negative effects of preference for male children. An unbalanced sex ratio nationwide may lead to a fewer number of female residents, who would therefore have even fewer children, aggravating the current situation. Hopefully, with various economic and social initiatives, the Republic of Korea will soon be able to simultaneously minimize stigma associated with female children and employees, increase the fertility rate, and improve the quality of life and health outcomes of Korean mothers and children.
Sukriti Mohan is a senior in Silliman College who is majoring in History of Science, Medicine & Public Health and is in the 5-year accelerated BA/MPH program. She can be contacted at firstname.lastname@example.org.
- WHO and Ministry of Health and Welfare, Republic of Korea. (2012). Health service delivery profile, Republic of Korea, 2012. World Health Organization: Western Pacific Region. Retrieved from http://www.wpro.who.int/health_services/service_delivery_profile_republic_of_korea.pdf.
- Chang, J., Lee, K.S., & Bae, C (2011). Decreasing trends of neonatal and infant mortality rates in Korea: Compared with Japan, USA, and OECD nations. Journal of Korean Medical Science, 26(9), 1115–1123.
- Sang-hun, C. (2015) Korean county achieves its goal: Less birth control, more babies. The New York Times. Retrieved from http://www.nytimes.com/2015/12/01/world/asia/korean-county-achieves-its-goal-less-birth-control-more-babies.html?_r=0.
- Sung, W.K. (2012). Abortion in South Korea: The law and the reality. International Journal of Law, Policy and the Family, 26(3), 278-305.
- Marston, C & Cleland, J. (2003). Relationships between contraception and abortion: A review of the evidence. International Family Planning Perspectives, 29(1), 6-13.
- Kim, W. (2013). Will pronatalist policy work? The case of South Korea. Brown University Department of Economics. Retrieved from https://www.brown.edu/academics/economics/sites/brown.edu.academics.economics/files/uploads/wookin%20Kim%20thesis.pdf.
- Westley, S.B., Choe, M.K., & Retherford, R.D. (2010). Very low fertility in Asia: Is there a problem? Can it be solved? Asia Pacific Issues, 94.
- Lee, M. (2015). Legislative initiative for work-family reconciliation in South Korea: A comparative analysis of the South Korean, American, French, and German family leave policies. Asian American Law Journal, 22(1), 45-104.
- Jones, G.W. (2009). United Nations expert group meeting on recent and future trends in fertility. Recent fertility trends, policy responses and fertility prospects in low fertility countries of East and Southeast Asia. United Nations. Retrieved from http://www.un.org/esa/population/meetings/EGM-Fertility2009/P05_Jones.pdf.