The sharp increase in South Korean caesareans--the rate has doubled since 1995 and tripled since 1990--has created a backlash from women's groups and a financially troubled government health insurance system faced with mounting medical costs.
Statistics due out in May are finally expected to show the rate leveling off. Still, experts don't foresee a dramatic drop any time soon because it's generally recommended in most countries that women who undergo caesareans do the same with their next child.
South Korean public health officials say the 43% figure is so high that they have been reluctant to report it to international research organizations. Recently, in an effort to reverse the trend, the government insurance corporation--part of a universal system funded by company and employee premiums--has dramatically reduced its reimbursement schedule for a caesarean, although the operation still generates more income for doctors than does a natural birth.
Doctors have bridled at suggestions that they sacrifice patient health for profits. Some have questioned the statistics, while others have accused insurers of interfering.
But the most common argument is the different ways the two procedures are treated in court. Under the assumption that a birth requiring a caesarean must be problematic by definition, the law saddles doctors performing caesareans with much less liability than in cases of natural birth. The fact that the law spurs more caesareans was an unintended consequence.
"The courts are always finding doctors guilty, so it's common sense they try and avoid natural childbirth," says Park Moon Il, professor of obstetrics at Seoul's Hanyang University.
The number of childbirth malpractice suits in South Korea remains tiny by U.S. standards--49 for the entire country in 1999 out of 616,000 births. But the Health Ministry plans to submit legal changes to the National Assembly this year that would equalize liability in caesarean and natural births.
Not all the blame, however, can be placed on doctors' shoulders. Women also play a role for some very unscientific reasons. One commonly held belief in Korean society is that women who undergo caesareans will be thinner and physically more attractive than those who give birth naturally. Another holds that the sex life of women who undergo caesareans will be better than that of their natural-birth peers because the birth canal will not have been distended.
