J Korean Med Assoc.  2016 Jun;59(6):417-423. 10.5124/jkma.2016.59.6.417.

The collapse of infrastructure for childbirth: causes and consequences

• Oh SY

• KMID: 2305541
• DOI: http://doi.org/10.5124/jkma.2016.59.6.417

Abstract

Despite low childbirth rate in Korea, the number of women with high-risk pregnancies is steadily increasing, mostly due to increased maternal age, multiple pregnancies, and obesity. In fact, one out of five Korean women is above 35 years old at childbirth. It is well known that high risk pregnancy is closely related with increased maternal mortality, either by direct or indirect causes. Despite such problems, however, Korea's health care infrastructure for childbirth has deteriorated, leaving approximately 20% of the geographic area of the country medically underserved with regard to optimal maternity care. Such a collapse has been caused by the decrease in the number of maternity hospitals and their financial difficulties due to medical fee reimbursement for childbirth being too low. The problem is aggravated by a lack of obstetricians who can provide skilled attendance at childbirth. In addition, extensive legal pressure has dissuaded talented medical students from pursuing obstetrics and gynecology, thereby resulting in aging and severe gender imbalance in such professions. The direct consequence of the collapse in infrastructure for childbirth is an increased maternal mortality ratio, especially in underserved areas. Moreover, increased maternal death caused by postpartum bleeding reflects an obvious sign of danger in the maternal health care system. Furthermore, the number of tertiary hospitals that can provide optimal care to high risk pregnant women has decreased to two-thirds of what it once was, and the training of competent obstetricians for the mothers of the future continues to be a difficulty.

Keyword

Parturition; Medically underserved area; Maternal mortality ratio; Obstetrics and gynecology department, hospital; Korea

MeSH Terms

Aging
Aptitude
Delivery of Health Care
Fees, Medical
Female
Gynecology
Hemorrhage
Hospitals, Maternity
Humans
Korea
Maternal Age
Maternal Death
Maternal Health
Maternal Mortality
Medically Underserved Area
Mothers
Obesity
Obstetrics
Obstetrics and Gynecology Department, Hospital
Parturition*
Postpartum Period
Pregnancy
Pregnancy, High-Risk
Pregnancy, Multiple
Pregnant Women
Students, Medical
Tertiary Care Centers

Figure

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  Figure 1 Maternal mortality ratio according to maternal age at delivery (2012 to 2014).

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  Figure 2 The annual number of doctors newly qualified as obstetrics and gynecology specialists (2000 to 2016).

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  Figure 3 The annual number of doctors newly qualified as obstetrics and gynecology specialists according to gender (2006 to 2015).

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  Figure 4 Comparison of maternal mortality ratio by district in Korea in 2007 to 2008 (A) versus 2012 to 2013 (B).

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  Figure 5 The change in cause of maternal mortality in Korea (2012 to 2014).

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