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

  • 1Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. ohsymd@skku.edu


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.


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

MeSH Terms

Delivery of Health Care
Fees, Medical
Hospitals, Maternity
Maternal Age
Maternal Death
Maternal Health
Maternal Mortality
Medically Underserved Area
Obstetrics and Gynecology Department, Hospital
Postpartum Period
Pregnancy, High-Risk
Pregnancy, Multiple
Pregnant Women
Students, Medical
Tertiary Care Centers


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

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

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

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

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

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1. Statistics Korea. Complementary investigations on the infant, maternal, and perinatal mortality [Internet]. Daejeon: Statistics Korea;2014. cited 2016 March 10. Available from: http://kostat.go.kr.
2. Chung SH, Seol HJ, Choi YS, Oh SY, Kim A, Bae CW. Changes in the cesarean section rate in Korea (1982-2012) and a review of the associated factors. J Korean Med Sci. 2014; 29:1341–1352.
3. Kim JK. Fall of maternal health care system: as two OBGYN hospitals shut down as one opens. The Korean Doctor's Weakly. 2013. 10. 03. cited 2016 May 10. Available from: http://www.docdocdoc.co.kr/140425.
4. Korean Society of Obstetrics and Gynecology. The evaluation of supporting methods for reliable antenatal care and birth for pregnant women in obstetrically underserved area [Internet]. Seoul: Ministry of Health and Welfare;2013. cited 2016 March 10. Available from: http://www.prism.go.kr/homepage/entire/retrieveEntireDetail.do?pageIndex=1&research_id=1351000-201300210&leftMenuLevel=160&cond_research_name=%EB%B6%84%EB%A7%8C&cond_research_start_date=&cond_research_end_date=&pageUnit=10&cond_order=1.
6. Cho MK. The financial difficulty in hospitals in obstetrically underserved area supported by national supporting program. Kuki News. 2014. 10. 14. cited 2016 May 10. Available from: http://news.kukinews.com/article/view.asp?arcid=0008761634&code=46111201&cp=nv.
7. Choi JS, Seo K, Lee NH, Kim SY, Lee SU, Lee SU, Pu YK. Infant and maternal death survey report in 2007-2008. Seoul: Ministry of Health and Welfare;2010.
8. Sullivan SA, Hill EG, Newman RB, Menard MK. Maternal-fetal medicine specialist density is inversely associated with maternal mortality ratios. Am J Obstet Gynecol. 2005; 193(3 Pt 2):1083–1088.
9. National Health Insurance Service. Review records of delivery by provider type, 2012-2014 [Internet]. Wonju: Korean Statistical Information Service;2015. cited 2016 March 10. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_LEE_54&vw_cd=MT_ZTITLE&list_id=354_1_F&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=E1.
10. Health Insurance Review and Assessment Service. Cesarean section records by provider type of medical institutions, 2007-2012 [Internet]. Wonju: Korean Statistical Information Service;2014. cited 2016 March 10. Available from: http://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=TX_354_2009_H1012&vw_cd=MT_ZTITLE&list_id=354_35402&seqNo=&lang_mode=ko&language=kor&obj_var_id=&itm_id=&conn_path=E1.
11. Lee GY. Establishment of health care delivery system between the integrated center for high-risk pregnant women and neo-nates and the maternity care in the underserved area [Internet]. Sejong: Ministry of Health and Welfare;2015. cited 2016 March 10. Available from: http://www.prism.go.kr/homepage/theme/retrieveThemeDetail.do;jsessionid=7EC0F0966B138834D8579F682B438191.node02?cond_research_name=&cond_organ_id=&cond_research_year_start=&cond_research_year_end=&cond_brm_super_id=NB000120061201100060495&research_id=1351000-201500314&pageIndex=8&leftMenuLevel=110.
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