Morning-after Pill Remains Prescription Only

In the continued financial stand-off between doctors and pharmacists, Korean women’s health and sexual freedom remain a low priority.
MV 010 - 2 - SBS Family's Honor (2008-2009) - This I Promise You(Source: withhyunbin; CC BY-NC 2.0)

Remember back in 2012, when the Korean FDA announced the monthly birth-control pill would become prescription only?

In isolation, there are many reasonable arguments for such a change. In the context of the criminalization of abortion though? Plus the slut-shaming that compels many women to rely on their male partners for contraception, combined with Korea’s woefully-inadequate sex education? Then that freedom of access was important.

What’s more, while the monthly pill was to become prescription only, the morning-after pill was to be made over the counter.

That made no sense, whatever one’s feelings about either pill. And indeed, there were no sudden new medical reasons provided to justify the changes. Instead, as I wrote this January:

…it was a transparent attempt to forge a compromise between the competing financial interests of the Korean Medical Association and the Korean Pharmaceutical Association. And a blunt demonstration that women’s health and sexual freedom were the least of the government’s concerns.

Fortunately though, it backed down in the face of outrage, and because the outgoing Lee Myung-bak Administration resolved it was not worth creating a political headache for Park Geun-hye’s presidential campaign. Also fortunately, Park Geun-hye hasn’t tried again since gaining power. A surprise, frankly, given her continuation of Lee Myung-bak’s equally bizarre and women-unfriendly policy of (re)criminalizing abortion in order to raise the birthrate. (And in practice, only serving to make abortion services much more expensive and difficult to find.)

Four years later, she still hasn’t. And it’s wonderful that the monthly pill remains over the counter.

Alas, that doesn’t mean the government hasn’t been busy. Earlier this week, it decided that the morning-after pill would remain prescription only. As the Korea Bizwire reports:

The Ministry of Food and Drug Safety revealed that after a comprehensive review of contraceptives’ actual usage statistics, side effects, and general public awareness, it would continue to categorize emergency contraceptives as ethical drugs.

Ethical drugs, also referred to in Korea as ETC drugs, are defined as drugs that require a doctor’s prescription for usage, and the Ministry of Food and Drug Safety revealed that the decision to keep emergency contraceptives under the category of ETC drugs was due to serious concern over the possible abuse of these contraceptives by the public.

On the other hand, the ministry will maintain its categorization of regular contraceptive pills, which are to be taken prior to sexual intercourse, as over-the-counter (OTC) drugs.

Recent trends show that the production and imports of emergency contraceptive pills are both increasing – growing from 2.8 billion won to 4.4 billion won in 2014 and then 4.2 billion won in 2015 – according to a study on contraceptives’ actual usage statistics, side effects, and general public awareness conducted between 2013 and 2015 by the Korea Institute of Drug Safety & Risk Management on 6,500 individuals of both genders between 15 and 59 years of age.

And yet, the study also found that only 44 percent of females in the study had accurate knowledge about emergency contraceptive pills, such as their side effects.

[Emergency contraceptive pills have] a high risk of side effects compared to regular OTC contraceptive pills in that the drastic hormonal change could be a considerable burden on the female body.

The Korea Herald adds that only “36 percent of female teenagers were accurately informed about the drug and its possible side effects” (as opposed to the 44% of women mentioned above). Unlike in 2012 though, now it appears that the Ministry has Korean women’s and teenagers’ health very much in mind.

I call bullshit.

This is dubious, retroactive justification of a decision made entirely on ideological grounds.

First, consider the track-record of the Park Geun-hye administration, which is unusually beholden to conservative vested interests. In the absence of (sufficient) political pressure from the Korean Pharmaceutical Association, and/or the ever-dwindling pool of young female voters, it would be extremely unlikely to ever make such a female-friendly, sexually-progressive move as increasing access to the morning-after pill.

Next, recall that under-18s aren’t actually allowed to access information about contraception on the internet, in which case that figure of 36 percent could even considered a positive. (Search on portal sites, and a social security number login will be required.)

(Update: It turns out, that login may only be required for information about condoms.)

Finally, and in particular, the Korean Medical Association has a long history of scaremongering about the pill, which likely plays a big role in why only 2.5% of Korean women actually use it. This makes me very, very wary of the Korean government’s claims about the dangers.

Sure enough, just this week Fusion offered a damming rebuttal of those, via an article on why US universities don’t offer the morning-after pill to students:

…Medication abortion is really, really safe. Since 2000, more than 1.5 million women in the U.S. have used it to terminate early pregnancies. While the pill can cause side effects such as nausea, fever, and cramping, it has an adverse effect rate of only 0.2 percent. That’s way less than adverse effect rate for the asthma inhaler Advair (27 percent), the antidepressant Wellbutrin (22.3 percent), the anti-anxiety drug Xanax (13.9 percent), and the cholesterol medication Lipitor (12.9 percent).

And just two months ago, the FDA revised its label of the abortion pill mifepristone to match the evidence-based protocols already being utilized by physicians nationwide—a protocol that allows for the drug to be given up to seventy days into a pregnancy, instead of forty-nine days and states that a smaller dose can be given to efficiently terminate a pregnancy.

But I’m clearly biased in favor of over the counter access, for just about every non-invasive/non-surgical contraception really, so please let me know what you think. Also, let me pass on the following video report for Korean speakers, although it doesn’t add much to the English articles already linked sorry (unless readers spot something I missed?):

Update:

Claire Lee at the Korea Herald has just penned a must-read on the angry response of Korean women and Korean women’s-rights groups, and the utter uselessness of visiting doctors for the morning-after pill. Not least, because of the frequent slut-shaming involved.

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(Still) Empowering Korean Women: Over-the-counter contraceptive pills

Increased access to the pill in the US provides a reminder of how good it’s always been in South Korea.

Korea Contraceptive Pill CommercialSource: YouTube

Have you heard? Women in Oregon can get hormonal contraceptives directly from pharmacies now, without having to go to a doctor for a prescription first. And in California, they’ll be able to do so from March, whatever their age.

Which is great news. But with health and reproductive rights being such a quagmire in the US, it will be a long time before that’s the case in the other 48 states. Indeed, some supporters think the new legislation will even slow down that extension of access, due to the lengthy FDA approval process required for converting prescription contraceptives to over-the-counter products.

Whatever happens, I was struck by the stark contrast to Korea, where the monthly contraceptive pill has been available over-the-counter for 48 years. As Jordan McCutcheon explains, in her recent article “12 ways Korea ruined me for the US” for Matador Network (my emphasis):

Before I left to go abroad, I was told my insurance wouldn’t cover a year’s worth of birth control at one time (shocker). In Korea, birth control is over the counter, and it’s cheap. I asked for the active ingredient in the medicine I took at home, and the pharmacist found a similar brand. So, for ₩8,000 ($7) I can buy as much as I want whenever I want because I’m a woman who knows what’s good for my body, and what it doesn’t need is another US male politician regulating my right to not reproduce.

That said, only 2.5 percent of Korean women actually use the pill. Probably, due to a combination of aggressive sterilization programs in the 1970s and ’80s, a knock-on tendency to leave contraception in men’s hands, and because of scaremongering by the Korean Medical Association.

Also, there were alarm bells in mid-2012, when the KFDA announced bizarre plans to make monthly pills require a prescription, but morning-after pills over-the-counter. (Basically, the opposite of the existing situation.) But there was no medical justification provided. Instead, it was a transparent attempt to forge a compromise between the competing financial interests of the Korean Medical Association and the Korean Pharmaceutical Association. And a blunt demonstration that women’s health and sexual freedom were the least of the government’s concerns.

Fortunately though, it backed down in the face of outrage, and because the outgoing Lee Myung-bak Administration resolved it was not worth creating a political headache for Park Geun-hye’s presidential campaign. Also fortunately, Park Geun-hye hasn’t tried again since gaining power. A surprise, frankly, given her continuation of Lee Myung-bak’s equally bizarre and women-unfriendly policy of (re)criminalizing abortion in order to raise the birthrate. (And in practice, only serving to make abortion services much more expensive and difficult to find.)

In the meantime then, Korea remains one of the few developed countries where the monthly pill is over-the-counter. Which makes we wonder: in terms of attitudes towards and use of the pill, in what other ways does Korea stand out?

With that in mind, I was struck by the emphasis on appearance in the following recent commercial.

The voiceover says “My body? ‘A.’ My personality? ‘A.’ My style? ‘A.’ [The reason for?] my success? Alesse contraceptive pills,” followed by the text also mentioning it’s a good treatment for acne.

Should women with “normal” bodies try something else then? What about those with only so-so fashion sense?

That can’t compare with the Koreanness of this next one though, with its mention of “bagel girls” and use of aegyo:

So much so, it may actually be a satire: its title is “Pill Ads These Days,” and I can’t find any mention of the company.* Either way, it stresses that even women who look great in a white one-piece, women on a diet, women with great bodies, and women who do aegyo with their boyfriends…all get mood swings and PMT. And all of which can be solved by rearranging their cycles with the pill.

Which I’m sure is indeed empowering. Yet, watching these, you could be forgiven for forgetting that the pill is sometimes used to prevent pregnancy too.

Or is that just me? Please let me know your own thoughts in the comments, about these commercials, how they compare to pill commercials overseas, and/or about contraceptives in Korea in general. And if I’ve been reading too much into these two examples too—no matter how much fun I’ve had doing so! ;)

Just in case though, I’m happy to point out that Mercilon’s commercials at least, do seem to acknowledge that they can be used for that thing called sex too (which is also fun):

Update 1: According to Stuff, there’s a strong possibility the pill is going to be made (more) over-the-counter in New Zealand also. Most commenters are supportive of the move, and question just how useful and necessary visits to GPs are. For instance, according to “BenzyY”:

In my experience, doctors tend not to provide any real advice or counselling about the use of the pill anyway. When you first start taking it they tell you to read the information leaflet. That is all. And once you’re on it, all they do is harass you about your weight and medical history, and when asked about spotting, imply that boyfriends/partners/husbands have been cheating and have given you an STI.

Bring on pharmacy visits.

Meanwhile, the author of Vintage Ads was stuck at “how condom ads [in Western countries] have changed from ‘prevent pregnancy’ to ‘prevent disease’ over the years.” I wonder then, if these Korean pill ads are so coy about their pregnancy prevention because of Korean sensibilities, or whether they’re more a reflection of recent, international trends in contraceptive advertising?

*Update 2, August 2019: “Pill Ads These Days” was the title of the original video, which has since been taken down from YouTube. The title of its replacement—매력적인 그녀의 하필 그날! 빵 터지는 이야기!—is (I think)”Attractive women getting THAT day! A story that bursts with a bang!”.

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If you reside in South Korea, you can donate via wire transfer: Turnbull James Edward (Kookmin Bank/국민은행, 563401-01-214324)

“Korean Women are Sexually Conservative”

korean-etude-advertisement-song-hye-gyo(Source: Naver)

As they say, first impressions last, and my own first introduction to Korean sexual politics came with a bang when the scandal over the Baek Ji-young (백지영) sex tape erupted in late-2000. The way she was treated by the Korean media was hypocritical and shocking, and confirmed what I’d learned at university: Korea was a deeply patriarchal and sexually-conservative society.

Or at least, as the “Korean Gender Guy,”™ that’s what I’d like to pretend informed my first year in Korea. The truth is, I barely noticed at the time, being rather more concerned with getting into my Korean girlfriend’s pants. But they also say that the best way to learn a new culture is to sleep with the locals, and what I learned about sexual politics that way was no less important for being so base: the books were simply wrong about how prudish Koreans were. I’ve been poking fun at the huge gap between image and reality ever since.

But with a nod of appreciation to the advice of this regular commenter, it’s high time to move on from that extremely simplistic conception of the subject.

Just like it is misguided to think of, say, all American voters as mere “conservatives” or “liberals,” the reality is that Korean society is both profoundly sexually-liberal in some instances and sexually-conservative in others. For instance: most Koreans have sex before marriage; Korea has one of the largest prostitution industries in the world; Korean teenagers increasingly dance extremely provocatively on television; Korean women are increasingly objectified in advertisements; and, overall, censorship of sexual content in movies is rapidly easing.

And yet that combination by no means implies that Korean men and women are equally able to express and enjoy their sexuality in 2009, let alone that, like almost a decade ago, a female celebrity secretly filmed while having sex with her boyfriend wouldn’t again be ostracized by the Korean media. Indeed, one can argue that to describe Korean society as simply “sexual-conservative” is merely to gloss over its profound double-standards.

One such double-standard is the need for sexually-active women to appear inexperienced and virginal to their partners, and in that vein, this survey of condom use and sexual activity in Korea – probably the most comprehensive of its kind – found that a majority of them did so to the extent that they regarded contraception as entirely men’s responsibility, as I discussed last December. Either they didn’t provide it themselves, they didn’t insist on their partners using condoms, and/or they would even feign complete ignorance of all contraceptive methods.

Again, that’s to be expected from a “sexually-conservative” society. But bear in mind the fact that love hotels are ubiquitous here, and – as that survey demonstrates – are well used. So while this particular double-standard is hardly confined to Korea, it is particularly severe in its effects on Korean women.

In light of that, the fact that rates of oral contraceptive pill usage are extremely low in Korea (3%) shouldn’t have been a surprise to me when I learned it from this recent Korean blog post, which I’ve translated below. But while I was certainly aware of the scare-tactics used – for various reasons – by Japanese medical authorities to dissuade women from using the pill there for instance, and which meant that it was only legalized as late as 1999 (see here, here and here), in hindsight perhaps I was too optimistic about Korean women’s reaction to similar tactics used here in January. So I was taken aback:

피임에 보수적인 여자들 – When it Comes to Contraception, Korean Women Are Conservative

Korean Pill Cartoon 1Mr Kang, reporter: “As women are actively making advances in Korean society, so too are women becoming more open and assertive about sexual matters.”

Korean Pill Cartoon 2a

Mr Kang: “Today, we are going to meet Ms. Kim, a cool, forward-thinking woman with free and open attitudes to love.”

Ms Kim, caption: “I have 900 intimate male-friends…but that’s what happens if you’re as pretty as I. It’s not a crime!”

Korean Pill Cartoon 3Mr Kang: “I will ask about modern women’s opinions on sex and love…Nice to meet you Ms Kim. Ms Kim, I heard that you have very liberal and open attitudes to love. Is that true?”

Ms Kim: ” Yes. I don’t care about men that leave me, and I don’t say no to men that approach me…I’m so cool!”

Korean Pill Cartoon 4Mr Kang: “Since you are old enough, I assume that you have sex with your boyfriends. Do you take the initiative and/or insist on using contraception?”

Ms Kim: “Contraception? Surely that is men’s responsibility, yes?”

Mr Kang (gray text): “I’m surprised that you’re so conservative.”

Ms. Kim (gray text): “It is totally men’s responsibility!”

Granted, a bizarre cartoon, and probably one that detracts from rather than evinces the following points made by the blogger:

이전보다 자유로와진 미혼남녀의 성생활이나 성 담론에 비해 아직도 피임에 대한 인식은 무척 보수적이죠. 게다가 아직까지 수많은 여성들은 ‘피임=남자의 책임’이라는 구시대적 사고방식을 가지고 있는 듯 합니다. 한국 여성 피임 인식 조사에 따르면, 여성의 60%는 성관계 시 피임을 하지 않는 것으로 나타났는데 이는 ‘설마~’와 ‘막연함’ 때문이라고 합니다.

“Compared to the past, people are much more sexually active these days, and talk about sexual matters much more openly. But they are still surprisingly conservative when it comes to using contraception. In particular, many women stick to the traditional line that it is entirely men’s responsibility. According to a survey by the WHO, 60% of Korean women don’t use any contraception at all, maintaining an “it won’t happen to me” attitude.”

International Rates of Pill Usage Korea

물론, 남자에게도 책임은 있겠지만 여성들 역시 능동적일 필요가 있다고 보는데요, 통계에 따르면 남자들의 피임 방식인 “CONDOM”은 피임에 성공할 확률이 85%에 지나지 않는다고 합니다. 반면에 여성들이 준비할 수 있는 ‘먹는 피임약’인 경우, 성공 확률이 무려 99%에 이른다고 하네요.

“Of course men also have a responsibility to use contraception, but it seems that women are not fulfilling theirs. According to statistics, whereas condoms are 85% effective in preventing pregnancy, the use of the oral contraceptive pill is done entirely by women and is as much as 99% effective.”

Korean Pill vs Condom Cartoon

더치페이의 나라 네덜란드에서는 피임에 대해서도 서로를 배려하기 위해 CONDOM과 피임약을 모두 사용하는 이른바 ‘더치피임’이 널리 퍼지고 있다고 합니다. 또한 요즘 나오는 먹는 피임약(야즈)은 피임 뿐만 아니라 여드름 및 월경전불쾌장애(심한 형태의 월경전 증후군)에도 치료 효과를 인정받았다고 하니 여성 스스로를 위해서라도 꼭 한번 고려해볼 수 있길 바랍니다.

“In the Netherlands, when it comes to contraception people combine condoms with the use of the pill in order to be safer, and this is known as “Dutch [Style] Contraception.” In addition, a  new form of the pill called “Yaz” is coming onto the market, which combines a contraceptive function with helping to prevent skin problems and PMT. Women should consider this new product as an option.”

Men Women Gender 50 50And I’m afraid that that is all, although it attracted a great many commenters, most of whom agree that contraception is also women’s responsibility. But they take issue with the blogger’s description of women that don’t use the pill as “conservative,” citing concerns about side-effects, to which my response would be to direct them to this comment.

Meanwhile, if you haven’t already read my earlier post on condom use and rates of sexual activity in Korea then I strongly recommend you do so to place this new information in context, and you may also be interested in the recent appointment of a minor Korean-American celebrity being named “goodwill ambassador for the Korean Association of Obstetricians and Gynecologists to promote a campaign teaching young Korean women about sex and reduce abortions.” This has many positives of course, but I’d echo Brian in Jeollanam-do’s concerns that this may be “a product of, and will contribute to the perpetuation of, the belief that Americans and Westerners alone can be open about sex,” to which I’d add the stereotype that Westerners and especially Caucasians are overall much “more sexual” than Koreans. Finally, for a very frank discussion from the front-line as it were (an American woman dating Korean men), make sure to check out Doing it Korean Style!

Update: Apologies for not mentioning Dating in Korea also.