Wandering through Seoul in 2020, I spotted a woman and her baby in a café. This was a rare sight, as having a baby has turned into a sign of extreme wealth in South Korea – the country with the lowest fertility rate in the world. Parents are eager to show their children off, while other baby-feverish South Koreans admire the little miracle. Only 3 months prior, I was living in Norway, where children wander around town in their winter overalls, like ants in a summer picnic, making me wonder how one could have so many children. South Korea was the complete opposite.

These days, the socioeconomic context in South Korea presents a barrier to traditional, nuclear family units. High housing prices are a deterrent to stable housing for young people and couples. In addition, cultural attitudes towards women’s role in society, particularly their role as housewives after marriage, act as deterrents to marriage. Single motherhood is stigmatized culturally –  in 2021, most people were not in favor of unmarried women  bearing and raising children.

These factors have contributed to a constant drop in fertility rates over the last few decades. Anti-natalist policies were implemented in the 60s (when the total fertility rate was around 6.0) and 70s, as a means of population control. In combination with some of the abovementioned factors, fertility rates dropped rather drastically.  Since 2005, the South Korean government thus changed tack, among others via pronatalist policies, including in the form of financial incentives.  Not to much avail  so far – the fertility rate has further decreased over the past years, reaching 0.78  in 2022.

Interestingly, based on my personal interactions with South Korean society, most of my friends seem to be sexually active, but almost none of them use contraception. Data seem to confirm this. In 2021, only 36.3% of the people aged between 19 and 49 claimed to always use contraception and 19.3% to mostly use contraception, while the average age of sexual activity onset was 14.1 years old  (data sourced from the Korean Statistical Information Services (KOSIS)).

And this brings us to the role of abortion (and access to it).

Part of the answer for South Korea’s  ultra-low fertility rate indeed also seems to lie in the (still lingering) use of abortion as a means of family planning. This is perhaps a remnant from the 60s and 70s government policy, when abortion was considered as such –  it was called a ‘menstrual adjustment procedure’ back then.  Abortion was widely conducted in the family planning clinics, even if technically illegal. From the early 2000s onwards, however, the constant drop in fertility rates led the government to revive and endorse the anti-abortion laws put in place in 1953, limiting the access to safe abortions which, although illegal, had been widely accessible previously.

In 2019, however, the constitutional court found the ban on abortion unconstitutional, setting a deadline for the revision of the law until the end of 2020, but the revision never took place. Thus, since 2021, abortion has been decriminalized, but no new law was put in place, leaving abortion in a legal grey area.

A pre-2021 abortion “access” anecdote

Before 2021, when I was living in South Korea, a friend found out she was pregnant and opted to terminate the pregnancy – at a time when abortion was still illegal. Interestingly, she succeeded, giving me some insight into the issue of illegal abortions in South Korea.

My friend’s pregnancy took place during the COVID-19 pandemic – implying that travelling overseas for an abortion was not an option. She checked in with numerous existing health facilities, until one agreed to perform a surgical abortion, for a shockingly high price of 3 million Won (around 2,100 Euros) in cash. The appointment was scheduled on a Post-it® note and there was no post-procedure care – she was asked to leave as soon as the procedure was completed. Groggy, with a diaper to contain bleeding, my friend made her way home. Despite this unpleasant experience, she was one of the lucky ones, as she didn’t have any post-abortion complications. Although this clinic was part of the healthcare system, the fact that abortion was criminalized did not allow the system to provide patients with financial protection or quality assurance of the procedure, making this an unsafe abortion, which can lead to life-long injuries, severe disability, heavy bleeding, and infertility, not to mention mental health issues.

The criminalization of abortion before 2021 didn’t prevent the termination of pregnancies, as over 35% of pregnancies between 2015 and 2019 ended in abortion.

The picture since 2021

Little has changed since 2021. Abortion is still not covered under the national health insurance service, constituting an unspecified medical practice, meaning that doctors can be penalized for offering them. Therefore, the experiences of many South Korean women who opt for abortion remain similar to that of my friend’s (pre-2021).

Official statistics and doctor’s testimonials indicate a fall in surgical abortion rates in recent years, but at the same time we see an increase in stories of women with adverse effects after taking unsupervised abortion pills  – already between 2018 and 2019, there was a slight increase in the use of abortion pills from 8,3% to 9,8% among women between 15 and 40. This increase in the uptake of abortion pills seems to be due to the high price of abortion surgery compared to pills, but also due to stigma associated with abortion. Therefore, abortions may not be decreasing, but becoming less safe in some cases. Quite some South Korean women also still seem to go abroad (to places such as Thailand and Vietnam) for abortion.

In sum, the decriminalization of abortion in South Korea in 2021 was a big step, but there is still a need for appropriate regulation to offer women a safe environment to exercise their reproductive rights. Concerns about the low fertility rate are legitimate, but a change in the country’s cultural attitudes on the role of women and the acceptance of single mothers, alongside supportive strategies like financial incentives throughout the child’s upbringing, and offering paternity leave to combat gender norms, may be ways to encourage younger people to have children. Conversely, making abortion difficult  increase the chances of unsafe abortions, thus negatively impacting women’s health. It is not the answer to preventing abortions or the use of abortion as a family planning tool.