Childcare holds key to higher birth rates

Despite policy initiatives to subsidize medical fees at birth, the overall birth rate dropped from 1.25 births per woman in 2005 to 1.24 in 2011, and more women in their 40s are having children. / Korea Times file

Increasing benefits at time of birth appears less effective

By Noh Hyun-gi

A policy shift to encourage more Koreans to have children is required, considering the overall birthrate is static despite increased welfare benefits given at the time of birth.

Moreover, the number of women giving birth after the age of 35 has increased steadily.

Putting the two factors together, it indicates that a lack of financial support for childcare, not childbirth, discourages people from having children.

“That conclusion is considered the truth in the field,” said Lee Ho-young from the policy review division of National Health Insurance (NHI).

In July, the cost of a cesarean delivery will be lowered by nearly 25 percent as part of the Diagnosis Related Group policy that will become effective.

This is one of the many benefits offered by the government to parents after the birth of a child. Since 2005, national health insurance provides full coverage for normal deliveries as well as analgesia for vaginal delivery. The Seoul Metropolitan government launched an extra subsidy program for parents with disabilities this year.

In 2011, 9,885 women between the age of 40 and 44 had children, a notable jump from 5,680 from 2007, according to the Ministry of Health and Welfare. Meanwhile, the number of births by women between 25 and 29 dropped from 127,641 to 92,324.

The overall birthrate dropped from 1.25 births per woman in 2005 to 1.24 in 2011.

Concerns over rising cesarean sections

Regardless, the government body is focusing on promoting normal births over cesarean sections for better physical and mental health outcomes and at lower cost to parents and the government. In a data analysis spanning 2007 through 2011, the rate of cesarean sections in 100,000 births rose by 0.2 percent. The official from NHI emphasized that the seemingly low number is significant given the cost difference. The cost of the surgery is nearly two times higher than the alternative and may incur more additional expenses such as fees for hospitalization and post-operative care. On average. A C-section require twice longer hospitalization than noraml delivery.

The cost related to normal delivery surged by 9 percent to 88,900 won (2011) from 63,200 won (2007). Similarly, average fees for cesarean births rose by 3.5 percent from 1.206 million won to 1.503 million won.

“What is notable here is that despite the full-coverage of normal labor (procedure and hospitalization fees in a room with four or more beds), the number of surgeries did not decrease,” Lee said.

Physicians emphasize the health benefits of non-invasive births. Lee San-hee, gynecologist from the National Heal Insurance Corporation Ilsan Hospital, said not undergoing surgery allows mothers to return to normal life easily. “The recovery time is significantly quicker, allowing women to go back to their daily business as soon as possible.”

Also, a mother can rejoice with their child right after natural birth compared to the two to three days recovery needed after a C-section. “This can positively affect the bond creation between the child and its mother.”

Though many fear the pain of natural birth, alternatives to surgery are available to eradicate the sensation. For example, under anesthetic for vaginal delivery, the patient’s lower body is numbed during birth.

“These methods need more promotion so that expectant mothers can make a more informed decision between the choices,” the doctor concluded.

Concerns over rising mothers’ age

More women are delaying having children to pursue academic or professional stability, meaning they have an increased need for medical attention. According to the Insurance Review and Assessment Service, the number of high-risk deliveries jumped four fold in 2011 (54,454) compared to 2006 (25,855).

“We usually consider 35 as the cut-off age for a statistically safe delivery,” said Lee Kyong-wook, assistant professor at the department of Obstetrics and Gynecology of Korea University Asan Hospital. While there is no age limit to having a child, pregnancy after 35 increases the risk of complications such as placental abruption, acute hypertension and diabetes and placenta previa. “Pregnancy related maladies like hypertension and diabetes affect not only the mothers but also the babies. And we have found that in many cases, the problems persist 10-years after,” the doctor said.

While a number of factors such as underlying medical conditions can put expectant mothers in the high-risk category, age also a significant role.

Lee explained that the probability of experiencing problems in the veins is two to four times higher for pregnant women in their 30s compared to those in their 20s. In serious cases, blood vessels contract blocking the blood flow and delivery of nutrition to the placenta. Therefore, monitoring blood pressure is crucial to high-risk mothers and keeping a protein-rich diet can help strengthen the vessels.

Also, diabetes during pregnancy can result in fetal macrosomia (newborns that weigh over 4 kilograms) or dystocia, abnormal labor. To avoid lasting complications such as hypoglycemia or dyspnea in their infant, expectant mothers over 35 should closely check glucose levels and take caution when eating snacks high in sugar.