Korea has emergency contraception in name only

Ministry's inaction forces women to have "illegal-yet-common" abortion

By Lee Kyung-min

A Nepalese woman in her 20s had an abortion a couple of months ago. The foreign worker who works at a farm in Nonsan, South Chungcheong Province, paid 2 million won ($1,870) to terminate the pregnancy at an obstetrics and gynecology clinic (ob/gyn) in the region. "I had no choice but to pay the cost that was much higher than my monthly wage," said the woman who makes 1.4 million won per month. She and her Nepalese boyfriend who also works at the farm paid 1 million won each.

"After I had an unprotected sex with my boyfriend, I got worried and went to a pharmacy to buy emergency contraception. But the pharmacist kept saying that the pill was sold only with doctor's prescription. There was nothing I could do." It was Friday evening and there were no ob/gyn clinics near where she worked. Levonorgestrel-based emergency contraceptives can be taken within 72 hours of having unprotected sex, but its effectiveness decreases if taken more than 12 hours later.

It wasn't until the following Monday evening when she finally made it to the clinic as she could not ask her employer for time off to go to a clinic. "I was not covered by the National Health Insurance Service so I paid 40,000 won to see the doctor, and I paid 100,000 won extra to get the emergency contraception." Many other tests that she couldn't refuse cost her more money.

About two months later she realized she had missed a period and went to the clinic again only to find out she was pregnant. She had no choice but to have an abortion as she was not ready to have the baby. Word traveled fast among the small community. Women with similar stories came to her for help, and she recommended the doctor to three others including women from her home country and Sri Lanka.

"If only I had the pill, that whole experience could have been avoided."

She is among many women living in Korea, a country where abortion is illegal but common. Women who have abortions here are subject to a prison term of up to one year or a fine of up to 2 million won. Abortion-performing doctors in theory could face up to two years in prison, but they usually get a 1 to 2 million won fine or a suspended prison sentence. Exceptions include cases of rape, incest, or when a severe hereditary defect is found in the fetus or the woman's health could be in danger.

Ministry of Health and Welfare 2010 data estimated that about 168,000 abortions are carried out a year, but doctors say the number was at least 500,000 and possibly up to 800,000.

Women in "advanced" Korea denied easy access to emergency contraception

In May 2016, the Ministry of Food and Drug Safety failed to revise a guideline on emergency contraception, saying the pill should be available only with a doctor's prescription, drawing fierce opposition from women's groups that called the decision "a further restriction on women's right to reproductive health."

Citing its own commissioned report of 6,500 men and women aged between 15 and 59 between 2013 and 2015, the ministry said in a statement that the guidelines should be left unchanged citing a lack of social consensus due to concerns over possible misuse or overuse of the pill. That would, the ministry added, follow a socially more accepting attitude toward sexual activities expected after the pill became available over the counter. It also cited a lack of public knowledge about oral contraceptives in general and possible side effects. Despite mounting calls to disclose the report in which the ministry maintained the much-criticized guidelines, it failed to make it public.

However, in the 728-page report reviewed by The Korea Times, data from the European Consortium for Emergency Contraception (ECEC) showed pills containing up to 1.5 milligrams of levonorgestrel are available without a doctor's prescription in the U.S., the U.K., Canada, France and Germany, as well as many other "advanced" countries.

That is in stark contrast to the situation in Korea, which claims to be advanced in all other aspects otherwise.

According to data from the Korea Institute of Drug Safety & Risk Management, a ministry-supervised organization, out of 14 emergency contraceptive pills currently available on the market, six have only 0.75 milligrams of levonorgestrel per pill and seven have 1.5 milligrams per pill, all of which are impossible to purchase without a doctor's prescription. Even for ellaOne 30, containing 30 milligrams of ulipristal acetate per pill, the intake of which requires more caution, a committee for medicinal products for human use under the European Medicines Agency advised that it "can be used safely and effectively without medical prescription" in 2014.

Meanwhile, unlike the claimed "high and constant risk" of the pills' side effects, data cited in the ministry statement showed no significant ones were reported in 2014 and 2015, with three cases reported in 2013. The Korea Times requested details on the specific side effects but the ministry official declined to answer saying it would take a few weeks.

The ministry fears women would seek new prescriptions within a month of taking the pill, which it said was an example of overuse. However, women's rights groups countered that saying it disregarded the possibility of them vomiting up the pill, in which case another dose should be taken immediately. Vomiting, dizziness, breast tenderness or headaches are common side effects exhibited by women who took the pill.

Ministry rebuffs WHO guidelines

The World Health Organization recommends provision of emergency contraception. "All women and girls at risk of an unintended pregnancy have a right to access emergency contraception and these methods should be routinely included within all national family planning programs," it says. "There are no absolute medical contraindications to the use of emergency contraception. There are no age limits for the use of emergency contraception."

The side effects from the use of the emergency contraceptive pills, it added, include nausea and vomiting, slight irregular vaginal bleeding, and fatigue. "Side effects are not common, they are mild, and will normally resolve without further medications. Frequent use of emergency contraception can result in increased side effects, such as menstrual irregularities, although their repeated use poses no known health risks."

When asked by The Korea Times whether the current measure goes against the WHO recommendation, the ministry official said, "Regardless of the WHO recommendation, each country maintains the discretion to implement healthcare policies it deems fit. The ministry's stance is the same as 2016."

When asked about the pills sold online for around 100,000 won, the ministry official said, "We simply cannot be held accountable for that because we cannot prevent the sellers from opening up a website. There's nothing much we can do other than referring the websites that get reported to us to the Korea Communications Commission."