Women's Health, Sexual & Reproductive Rights in Korea

Hwa-Joong, Kim
President, Korean Nurses Association 

1. Background

Women's sexual and reproductive role has been largely determined by their social status and economic opportunities. It has shaped their view of themselves and their sense of personal empowerment, yet they have received little support or care  in fulfilling it. For many women in most societies, their reproductive role has been simultaneously over-valued and under-supported.
According to the WHO's definition of health, as a state of complete physical, mental and social well-being, and not merely the absence of diseases or infirmity, reproductive health addresses the reproductive processes, functions, and relevant system at all stages of life. Reproductive health therefore implies that people are able to have a responsible, satisfying, and safe sex life, and that they have not only the capability to reproduce but also the freedom to decide of, when, and how often to do so. Implicit in this last condition are the rights of men and women to be informed of and to have access to safe, effective, affordable, and acceptable methods of fertility regulation of their choice. Furthermore this entails the right of access to appropriate health services that will enable women to safely go through pregnancy and child birth and will provide couples with the best chance of having a health infant. 
Policies and programs related to women's health in the Republic of Korea have focused mainly on family planning, which was initiated in 1962 by the government as part of its Five-Year Economic Development Plan for the purpose of controlling fertility, and the broader picture of women' health was not considered over the last three decades. The government started providing 
free contraceptive  services with assumption that availability of contraceptives would  help the motivation for family  planning. The mid-1970's were highlighted by the introduction of social support policy measures with numerous incentive schemes, such as reduction in child delivery charges for sterilization acceptors and income tax deduction for up to two children. Owing to this kind of strong government population control measures, Korea was able to achieve its outstanding result for population control within a relatively short period of time and has reached below-replacement fertility. 
In response to these changes the government has been adjusting its direction from contraceptive supply for birth control to developing quality oriented programs, such as sex education for the youth, prevention of induced abortion, and other maternal health programs. 

2. Reproductive Health 
Contraception 
According to the 1997 National Fertility and Family Health Survey, 80.5% of all married women aged 15-44 practiced contraception. This means that most married women, with the exception of those experiencing menopause, naturally sterile, and temporarily separated from their husbands, practice family planning. 
Generally, most Korean couples employ female contraceptive measures rather than male ones. In 1997, the use of contraception by women was 52.7% compared to only 27.8% by men. Female sterilization was the most common form of contraception, although it is an unfavorable method due to possible side effects. In addition, tubaligation is chosen more frequently in rural areas than urban areas; 22.8% of women in urban areas and 30.8% in rural areas. On the other hand, condoms are more frequently used in urban than in rural areas. The comparatively low rate of contraceptive use by men in Korea reflects social attitudes which place the responsibility to control reproduction and giving birth to women.
Induced Abortion
Induced abortions are not allowed in principle under the Maternal and Child Law in Korea. However, pregnancies due to contraceptive failure remained high and also resulted in a highinduced abortion rate despite the regulations in Korea. Induced abortion experience rate among married women was 44 % in 1997, which was decreased from 54 % in 1991. This high rate can be traced to unwanted pregnancies among married women due to contraceptive failure and to prenatal sex selection because of desire to have son. According to a study in a medium-sized city in 1990, unmarried women accounted for 32.9 % of all induced abortions performed. One of the reasons for this may be increased sexual activities among youths and unmarried. 
Sexually Transmitted Diseases & HIV/AIDS
Sexually Transmitted Diseases are still a major public health problem. Cumulative totals of treatment cases of gonorrhea and syphilis in the public sector were 43,000 in 1990 and  38,000 in 1994. 
By 1996, a total of 527 HIV cases has been reported and most of them were males. However, the major route of HIV transmission was sexual contact among Korean in 1992. A total of 41 AIDS cases has been reported by 1996 and only 5 of them were female. 

Complications of Pregnancy 
It is reported that the maternal mortality ratio per 100,000 live births fell from 88 in 1965 to 20 in 1996.  Results of some hospital studies indicated that toxemia was the most common cause of death from 1961 to 1966, and it accounted for 51.8 % of all maternal deaths. Post partum hemorrhage was the most common cause of death during the period 1982-1986, accounting for 60.0 % of all maternal deaths. This problem stems from a failure in the prenatal emergency care system, specifically lack of transport and inadequate referral system between primary/secondary and tertiary care facilities. 

3.Reproductive Health Services

Integrated Health Programs
Maternal and child health services in Korea can be relatively considered to intergrate curative and preventive activities. Some special hospitals for women and general hospitals have recently opened comprehensive women's health clinics or health promotion centers with life-cycle approach. These clinics and enters provide screening services for early disease detection and services for counseling, health and nutritional education, information, obesity, exercise, and menopause. However, while the need of these services is increasing, they are only accessible to the rich because such services are not covered by medical insurance. 

Medical Service Utilization 
In terms of gender differences, hospital admission rates are lower for women than men in every age group. The average length of stay is 18.2 days for men and 10.5 days for women. Despite the increased accessibility to health services, Korean women visit hospitals far less frequently than Korean men do. 

Prenatal Care, Attended Births
The proportion of pregnant women receiving prenatal care rose to 99.2 % in 1994 from 57.2 % in 1977, corresponding to a fifteen-year period from initial start to the achievement of universal coverage of the national medical insurance system. Similarly, 99.7 % of all deliveries took place at medical institutions in 1997. Among those deliveries, 98.3  % occurred at hospitals and clinics, while 1.1 % were at midwifery clinics and 0.3 % at maternal and child health centers. 

Choice of Family Planning Methods 
Government policy for distribution of concerning contraceptive measures has changed recently. A self-pay system was introduced, but support for lower income class has been consistently made. Current government family planning program is centered on lower income class. Sterilization and IUD services can also be obtained through medical insurance, while condoms and spermicide are sold through commercial pharmacies. Recently, condoms also started being sold in vending machines. More than 70 % of all married women received government support services in 1994. 

4. Conclusion 
Despite the improving status of women's health in Korea for the past 30 years, we conclude that no specific objectives related to quality assurance for reproductive health has been set. To solve the problems related to women's health, several policy recommendations are suggested. The government has to strengthen preventive reproductive health policies and health education to establish an information system for women' s health based on cooperation between women's organizations and scholars.