About two years ago, Jeong Yu-jin faced an unexpected predicament. After having unprotected sex on Saturday night, she decided to get morning-after pills -- also known as emergency contraception pills -- to prevent unwanted pregnancy the day after. 

“And then I realized it was Sunday,” the 31-year-old told The Korea Herald. “I couldn’t find any gynecologist clinics that were open because it was the weekend. Most pharmacies in my town were closed, too.”

Jeong ended up visiting a gynecologist on Monday, more than 35 hours after the incident. “I was really anxious as I knew the drug is most effective when taken as soon as possible,” she said, explaining that although she had been on birth control pills, she had sometimes forgotten to take them. “I thought the doctor would explain how the drug works and its possible side effects, but instead she only asked me two questions – when the intercourse took place and the date of my last period.”

And then the doctor scolded Jeong for asking for the drug. “She said I should’ve protected myself better. ... But I don’t think women should be shamed for it,” she said.
 
A growing number of Korean women, along with several women’s rights groups are stepping up their demands for access to morning-after pills without prescription, protesting the Ministry of Food and Drug Safety’s recent decision to continue disallowing over-the-counter sales of the drug at pharmacies. 

Currently, all women are required to have a prescription from a medical professional in order to obtain the drug, which is not covered by the national health insurance.

Since 2012, the ministry has been considering the option of designating the emergency contraception pills an over-the-counter drug. As the drug is known to be effective up to 72 hours after unprotected sex, the requirement of a doctor’s prescription may deter prompt access to the pills and reduce its effect, the ministry had said three years ago.

Yet after receiving fierce and continuous criticism from the nation’s gynecologists and religious groups, the government announced last week that the pills shall remain a prescription drug here indefinitely.

Debate has persisted with religious groups contending that the morning-after pills are equivalent to abortion, which they classify as murder, and that easy access would encourage unruly sexual relationships.

Citing its own study with gynecologists and pharmacists, the ministry argued that the drug’s overuse can be a health threat to women, especially young girls, and many are “not informed enough” on birth control in general. The ministry stated last week that it plans to come up with a proposal to better educate the public on the matter.

According to the ministry’s study, only 36 percent of young Korean girls aged 15-19 were accurately informed about morning-after pills and its possible side effects. Also, 47 percent of all surveyed women said they learn about birth control options, including oral contraceptives, from non-health care professionals.

As of 2014, only 39 percent of sexually active South Korean teenagers used birth control, while 66.1 percent of all teenagers who became pregnant had abortions. The nation’s sex education, which often discourages students from dating but does not provide enough information on birth control, is highlighted as one of the main reasons behind such statistics.

“I don’t think Korea is ready for it just yet,” said Lee Im-soon, a gynecologist and professor at Soon Chun Hyang University’s medical school. “Most people are ill-informed about birth control options, including morning-after pills,” said the professor, who also contributed to the decision made by the ministry.

“There is also a huge misconception about oral contraceptives, such as that it may cause infertility and increase the risk of cancer. Because of this, only about 3 percent of Korean use oral contraceptives, whereas about 30 to 40 percent of women in Europe and North American do the same. I think people need to be educated first on birth control (by visiting the clinics) before designating the drug an OTC drug.”

Yet Yoo Rim from the Center for Health and Social Change, a nongovernment think tank, said it is irresponsible for the government and physicians to point to the “ill-informed” public as one of the reasons for their decision not to designate morning-after pills as an OTC drug. “The government is the reason why people are not informed enough,” the researcher said. “They should make the drug more accessible and educate the public at the same time.”

Jeong Yu-jin said there was no benefit to her in visiting her gynecologist to obtain the drug, as the doctor gave no explanation on birth control as well as the pills. “It just cost me more time and more money,” she said. “With or without a prescription, it’s very hard for women to access accurate information about the drug and its effects. So why not just make it an OTC drug and at least allow us to access it as soon as possible?”

In order to avoid getting a “scolding” from doctors and unwanted attention from visitors and nurses, she visited different clinics every time she needed the drug, Jeong said.

“I think this notion of ‘unwed women are supposed to be sexually inactive,’ still prevails in Korea,” she said.

The Korean Society of Obstetrics and Gynecology, the biggest organization of obstetricians and gynecologists here, has been arguing that the overuse of morning-after pills can cause “serious side effects” to women, since 2012. There are currently a total of 13 morning-after pills available upon prescription in Korea, and among them, 12 of them are levonogestrel-only emergency contraceptive pills (LNG ECPs).

Contrary to the claims made by the largest body of Korean gynecologists, the LNG ECPs, made solely of levonogestrel -- a manufactured hormone used in a number of birth control methods -- are very safe and pose no risk of overdose, according to the World Health Organization.

“Levonogestrel is well tolerated, is not a known allergen,  leaves the body within a few days, is not addictive and has demonstrated no toxic reactions,” said a WHO report available online. “Its frequent use can result in increased side-effects, such as menstrual irregularities, although their repeated use poses no known health risks.”

The Korean Society of Obstetrics and Gynecology was unavailable to comment when reached by The Korea Herald.

Women’s groups said designating morning-after pills as OTC drug would help women save on costs for birth control. “Right now women have to pay doctors for prescription, and pay for the drug at the same time,” said Yeo Gyeong from an NGO named Womenlink. “The prescription alone costs about 10,000 won ($8.46) while the drug about 30,000 won. It costs more on weekends because emergency clinics charge you more.”

Bae Bok-ju, the head of an organization supporting women with disabilities, said disabled women as well as sexual violence victims also need easier access to the drug. “For many women with physical disabilities, oral contraceptives and morning-after pills are the most convenient birth control option,” she said. “Right now rape victims can get a prescription at emergency medical facilities, but it would be easier if they could just get it at pharmacies immediately.”

Professor Lee said while getting a prescription can require more time, especially on national holidays and weekends, people can easily find information on pharmacies and medical clinics that run 365 days a year online. “I think such clinics and pharmacies are not hard to find in Korea as it’s one of the most wired countries in the world,” she said. 

Yoon Jeong-won, a Seoul-based gynecologist, said although she agrees that the overuse of the drug can be harmful to a woman’s health, it is still better than the possible physical and emotional side effects from an abortion.

“I think the most important part of this debate is the lack of sex education in this country,” she said. “Most Korean women don’t know that the LNG ECPs are not effective at all if taken more than twice during their menstrual cycle – the length of time between the first day of one period and the first day of the next. If every woman knows this, no one’s going to ‘overuse’ the drug.”

By Claire Lee (dyc@heraldcorp.com)