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.

(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.**

Source: 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.

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 Gender Reader

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Some good news and bad news: after announcing earlier this year that monthly birth-control and morning-after pills were to be reclassified as prescription-only and over-the-counter respectively (i.e., the opposite of the current situation), the KDFA has just postponed its decision for 3 years.

Officially, the reason is because “there has to be careful consideration when overturning a classification system that has been retained for decades,” and because the extra time will allow the KDFA to “carefully monitor” the (supposed) side effects of the morning-after pills and also (unnecessarily) better educate the public on the side-effects and correct usage of monthly birth-control ones. But the more likely explanation is that the government was unnerved by the opposition to the reclassification of the month birth-control pill in particular, especially just before the election. In contrast, the opposition to the morning-after pill is mainly by religious conservatives, who would be very unlikely to vote for a different party.

One interpretation of such a long postponement is, of course, that the proposal will be quietly shelved in 3 years, although a negative of that would be a continued lack of access to the morning-after pill. But the realist in me thinks otherwise: as I explain in this Busan Haps article, the curious proposed simultaneous restriction and liberation of access to contraception has nothing to do with any dangers or women’s own needs or concerns, and everything to do with financial pressures within and between the Korean medical and pharmaceutical industries as Korea’s demographic crunch begins to bite. Those are not going to go away any time soon, particularly if the present conservative administration is reelected under Park Geun-hye — recall that her predecessor’s biggest solution to the declining birth rate and women’s inability to combine careers and children was simply to (re)criminalize abortion.

The conservative media’s framing of the contraception debate supports this pessimistic view: this article in the Korean Joongang Daily, for instance, explains that if reelected the government will continue to stress the opposition of “government officials, doctors, experts, women’s rights activists, religious groups and other civic organizations” to making the morning-after pill OTC, while simultaneously downplaying the far greater support for the status quo with the monthly birth-control pill. (And, possibly, support for making the morning-after pill over-the-counter too; I am unsure how much that has sorry.)

In sum, the combination of the (re)criminalization of abortion and now the proposed restriction of the monthly contraceptive-pill points to a “War on Women” every bit as real as the GOP’s one in the US, and which deserves to be far more widely known outside of Korea. Although, admittedly, I don’t know Park Geun-hye’s own personal beliefs on women’s reproductive rights, I do have genuine concerns that the Korean election of 2012 will be a eerie parallel of that of my native UK in 1979, when, to paraphrase my mother, “Millions of women voted for her simply because she was a woman, who then proceeded to crap all over them.” Certainly, her mere nomination as presidential candidate is already being widely described in feminist, empowering, and riding the crest of a wave of “women rising to the top” type terms, whereas I say that remains to be seen.

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Meanwhile apologies for the lack of posts, but my first week of the new semester proved to be much busier than expected. Usually, I try to have at least 2 posts in between each Korean Gender Reader, but I decided I’d rather post (hopefully) much better quality ones next week than rush them this time!

Update: By coincidence, the birth control pill ad I used to open this post with is for the Mercilon brand, which is several readers’ favorite, and which they were stocking up on because it is unavailable in the US. But of course every woman is different, so if Mercilon is not for you then please see The Wanderlust Diary and/or Kimchiowner’s Blog for a list of available brands, and the process of buying them.

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