N. Korea faces rare crisis: Low birthrate, deep poverty

North Korean leader Kim Jong-un is surrounded by children during his visit to a temporary shelter for flood victims in Pyongyang, in this Aug. 15, 2024, photo released by Rodong Sinmun. Yonhap

North Korea is quietly joining the ranks of low‑birthrate societies ― but without the economic prosperity that typically accompanies such a transition. Experts warn that this rare combination of deep poverty and shrinking families could leave the regime facing a serious demographic crisis within a generation.

Larger families are more common in countries as poor as North Korea, with total fertility rates of three or more children per woman. In contrast, data from the U.N. and South Korea suggest North Korean women have only about 1.6 to 1.8 children on average, far below the replacement level needed to keep a population stable and more in line with wealthier East Asian societies than low‑income states.

Almost all nations with similar gross domestic product per capita struggle with limited access to contraception and to clinics, but North Korea’s numbers look more like wealthy countries where women delay marriage and invest heavily in work and education. That gap has led some observers to question the data.

But experts contacted by The Korea Times say they think the figure is convincing, given what appears to be a genuine effort to boost the birth rate, seen through state-led campaigns like last month's Mother’s Day campaign, which promoted a “mother’s duty” to have children. Authorities have also intensified punishment for doctors who perform abortions and for contraceptive smuggling, with enforcement tightened in the 2010s and again in the 2020s.

“North Korea is changing in a way similar to South Korea,” Choi Jung‑hoon, a former North Korean doctor who defected to South Korea, said. He notes that people are marrying later than in the past, and more are choosing not to marry at all.

He added that cohabitation without marriage has become more common, especially among younger adults who want flexibility and less state interference. As these patterns spread, the old assumption that everyone will marry and have several children is weakening.

Abortions are also common, according to Choi. He recalls during his time as a physician that abortions, though unlawful, were frequent and formed a significant share of many doctors’ income there. “It is against the law, but there are many,” he said.

Despite its poverty, North Korea has more doctors and hospitals than many countries at a similar economic level ― a legacy of its socialist health care system. Experts say that the country’s relatively dense medical network, combined with strong demand for birth control, helps explain how fertility can fall sharply even in a poor nation.

According to experts, intrauterine devices (IUDs) are believed to be the most widely used contraceptive method inside North Korea. An analyst focused on North Korea at a state-funded think tank said Chinese condoms and pills have also been entering the North in increasing quantities in recent years.

Alongside these products, outside information has played a key role. “Because of information coming in from abroad, the culture of delaying marriage or not marrying at all has spread widely among the younger generation,” Kang Chae‑yeon, a professor at the Institute for Unification Education, said. This exposure reinforces the idea that women can shape their own lives rather than simply fulfilling a “duty” to produce children, she added.

North Korean authorities, alarmed by the drop in births, have framed the issue as a national crisis and stepped up efforts to boost the population. Experts believe the regime will keep rolling out policies to raise the birthrate, but doubt it can overturn deeper forces.

“The regime seems to see its low birthrate as a crisis and will likely continue such policies to reverse the trend,” the think tank analyst said. “But once a society moves into low fertility, history suggests it is very hard to reverse.”