Forced abortions in developing South Korea?

South Korea, with its ultra-low fertility rate (well below replacement level) and its lingering gender imbalance, was once a high-fertility society where families would routinely have four, five, six, even seven or more kids, often continuing to produce new children until they produced a male heir.

When the government put in place family planning — contraception information and contraceptive devices, sterilization, and widespread abortion — it took hold with a vengeance.

Part of this is addressed in a Foreign Policy piece that asks why 160 million girls are missing from East Asia. Here is the section that deals with South Korea specifically:

In South Korea, Western money enabled the creation of a fleet of mobile clinics -- reconditioned U.S. Army ambulances donated by USAID and staffed by poorly trained workers and volunteers. Fieldworkers employed by the health ministry's Bureau of Public Health were paid based on how many people they brought in for sterilizations and intrauterine device insertions, and some allege Korea's mobile clinics later became the site of abortions as well. By the 1970s, recalls gynecologist Cho Young-youl, who was a medical student at the time, "there were agents going around the countryside to small towns and bringing women into the [mobile] clinics. That counted toward their pay. They brought the women regardless of whether they were pregnant." Non-pregnant women were sterilized. A pregnant woman met a worse fate, Cho says: "The agent would have her abort and then undergo tubal ligation." As Korea's abortion rate skyrocketed, Sung-bong Hong and Christopher Tietze detailed its rise in the Population Council journal Studies in Family Planning. By 1977, they determined, doctors in Seoul were performing 2.75 abortions for every birth -- the highest documented abortion rate in human history. Were it not for this history, Korean sociologist Heeran Chun recently told me, "I don't think sex-selective abortion would have become so popular."

I wonder how accurate this characterization is. That is, this description makes it sound like sterilizations were coerced and abortions were forced, criticisms that in the 1980s and beyond would be leveled at Mainland China and their One Child Policy, and one wonders if it was generally true, true in some areas, or rarely the case at all.

On the other hand, the astronomical prevalence of abortion, from what I've heard, well-known and documented. But I have no first-hand knowledge or insight into cases prior to the 1990s (I knew several ob/gyns and medical students who discussed such matters, though often in vague terms) to know if these were anything other than the voluntary abortions that have been the norm in the 1990s and 2000s.

Ultrasound and abortion:America and Korea and their opposite cases

Exhibit #437 that the US and South Korea are (often) each other's Bizarro World. In the New York Times today we have an article on how ultrasound is being used in a weapon in the battle for abortion:

The technician told Laura she was at 11 weeks. “Do you want to see your ultrasound?” she asked. “I’d rather not,” Laura answered promptly.

Laura, who asked that her last name not be used, had come to the New Woman All Women Health Care clinic in Birmingham with her mind set on having an abortion. And she felt that seeing the image of her bean-size fetus would only unleash her already hormonal emotions, without changing her mind.

“It just would have added to the pain of what is already a difficult decision,” she said later.

Over the last decade, ultrasound has quietly become a new front in the grinding state-by-state battle over abortion. With backing from anti-abortion groups, which argue that sonograms can help persuade women to preserve pregnancies, 20 states have enacted laws that encourage or require the use of ultrasound.

Alabama is one of three states, along with Louisiana and Mississippi, that require abortion providers to conduct an ultrasound and offer women a chance to peer inside the womb.

Late last month, Oklahoma went a step further. Overriding a veto by Gov. Brad Henry, a Democrat, the Republican-controlled Legislature enacted a law mandating that women be presented with an ultrasound image and with a detailed oral description of the embryo or fetus.

Contrast that with South Korea, where abuse of the ultrasound procedure and other sex-determining technologies were seen as causing a higher abortion rate (and in a country where such rampant pregnancy termination is nominally illegal, allowing it to be used as a key tool in reducing the fertility rate). Abortions were  not uncommon when would-be parents who learn of their fetus's sex might be more apt to abort the pregnancy if it's not the sex they wanted. This was usually son-preferring families aborting female fetuses, which led to a disproportionate gender ratio.

Of course, ultrasounds are an important part of maintaining the health of the mother and the fetus, so the solution was to outlaw the reporting of the fetus's sex to the prospective parents (and for the life of me, I'm having trouble finding a link... even if I include "Korea" in the search parameters, I end up with stories about China or India). [Edit: Oh, here's one from the WHO!]

Like many laws on the books in Korea, however, the enforcement of this legislation was lax. Doctors and parents got around it by thinly veiled statements intended to reveal the information indirectly: "Oh, looks like you're going to be decorating your baby room in blue," "Ah, your kid will make a fine soccer player some day," or even, "I think your in-laws will be very pleased." Silence from the doctor was also a form of code.

Of course, growing opportunities for women, as well as their expanding value in a society where marriage-age females are scarcer and scarcer, have meant that there are fewer and fewer families who would abort a child simply over its sex, but they're still out there. Such sex-determinant abortions may in fact have been only a small portion of overall pregnancies and even overall abortions, but they were enough to cause a gender imbalance that South Korean society will be paying for for sometime.