2024-25
Mitra FAMILY GRANT Recipient
Missing the Forest for the Family Tree: How Cultural Misalignment Undermined South Korea’s Family Planning Program
Sahngwie Yim
Missing the Forest for the Family Tree: How Cultural Misalignment Undermined South Korea’s Family Planning Program
Sahngwie Yim
2025 Mitra Family Scholar
Mentors: Mr. Clifford Hull and Ms. Meredith Cranston
April 14, 2025
In 1961, the South Korean government launched a nationwide family planning program, or kajok kyehoek, with the primary goal of spurring economic development by curbing population growth through any means necessary.1 Over the next three decades until its termination in the 1990s, the program successfully reduced birth rates and reshaped societal attitudes toward contraception, family structure, and gender roles. However, its implementation also raised ethical concerns, as coercive measures and low-quality medical practices were frequently employed.2
Despite these controversial methods, family planning played a pivotal role in transforming South Korean society. By the 1980s, increasing access to education, urbanization, and policy measures to enhance equality further reinforced the shift in reproductive choices.3 Yet, this transformation did not occur in isolation; family planning faced challenges in its implementation and effectiveness, particularly in disseminating information to a wide audience and encouraging family planning measures in rural communities, which lacked sufficient awareness. At the root of the tension caused by family planning, however, was the misalignment between family planning policies and cultural values.
For family planning to find true success, popular attitudes had to fundamentally shift away from the cultural mindset that placed high importance on lineage. This shift occurred gradually, manifesting as a broad societal change stemming from localized transformations within individual communities. The relationship between family planning and Korean cultural
1 Jae-Mo Yang, “Family Planning Program in Korea,” Yonsei Medical Journal 18, no. 1 (1977): 64.
2 John P. DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!): Family Planning and Nation-Building in South Korea, 1961–1968,” East Asian Science, Technology and Society: An International Journal 2, no. 3 (September 1, 2008): 365–66.
3 Yang, “Family Planning Program in Korea,” 65.
values underscores the complex interplay between public health initiatives and cultural and societal norms. The mixed consequences of these policies were not solely a result of their direct implementation but also reflected deeper cultural tensions. Their challenges were exacerbated by the prioritization of economic growth over well-being, excessive foreign influence by the United States, and a discrepancy in education and technological progress, all rooted in a fundamental lack of cultural sensitivity. Only as attitudes gradually evolved did the program ultimately align with broader social changes that redefined family life and gender roles in South Korea.
Although South Korea’s early family planning policies accelerated economic development, their implementation failed to address deeply rooted Confucian values, resulting in coercive, harmful policies and reduced effectiveness, even leading to unintended consequences. Government attempts to forcibly combat cultural values ultimately worsened demographic challenges, whereas natural social changes including urbanization and education proved effective, highlighting the necessity for public health policies to align with cultural and social realities for lasting success.
Post-War Context and Policy Origins
After the Korean War’s end in 1953, South Korea experienced slow economic growth, ineffective and authoritarian government rule, and continued heavy foreign involvement and aid, especially from the United States.4 Additionally, disproportionate population growth compared to the available resources created resource shortages and poverty.5 The census data revealed
4 Michael J Seth, “An Unpromising Recovery: South Korea’s Post-Korean War Economic Development: 19531961,” Association for Asian Studies, Education About Asia, 18, no. 3 (2013): 42–45.
5 Jae-Mo Yang, “An Overview of Family Planning Korea (1961-1978),” Yonsei Medical Journal 20, no. 2 (1979): 184–97.
unchecked population growth of thirty per thousand per year, which had a strong correlation to economic decline.6 In 1960, the Total Fertility Rate (TFR), the average number of children a woman is expected to have during her childbearing years, reached 6.0, mainly due to the baby boom and high level of infant mortality after the Korean War.7 According to surveys conducted by the Knowledge, Attitude, and Practice (KAP) and the National Forensic Service, South Korea was one of the poorest countries in the world, with an annual per capita income of between $7080, and most crowded, with families of six regularly living in houses meant for one or two people.8 In rural areas, 35 percent of families had six or more children. Poverty and a lack of education dominated the landscape; children were often found abandoned on the streets, their parents unable to provide for them. Further, popular attitudes in Korea supported high population growth. While in Europe, the reported ideal number of children was two or three, in Korea, the average answer was four, one of the highest answers given among thirty surveys conducted in fourteen countries.9
In the midst of economic turmoil, Park Chung-Hee seized power of the South Korean government through a military coup in 1961, after Syngman Rhee stepped down in 1960, faced with widespread opposition due to the poor state of the economy and claims of election fraud. As a senior officer, Major General Park Chung-Hee was at the forefront of the military coup that sought to prevent popular unrest from growing too large. Influenced by Japanese doctrines of 6 Yang.
7 Namhoon Cho, “Achievements and Challenges of the Population Policy Development in Korea,” Seoul : Korea Institute for Health and Social Affairs, January 1996, 3, https://kihasa.re.kr/.
8 Yang, “An Overview of Family Planning Korea (1961-1978),” 184–85.
9 Sook-Bang, Man-Gap Lee, and Jae-Mo Yang, “A Survey of Fertility and Attitude Toward Family Planning in Rural Korea,” Yonsei Medical Journal 4, no. 1 (1963): 90
strong nationalism and state involvement in the economy, he hoped to improve Korea’s might.10
To improve South Korea’s economy, Park devised a Five Year Economic Development Plan, which aimed for a 5 percent annual growth rate.11 As a part of his Five Year Plan, he established the Planned Parenthood Federation of Korea (PPFK) to support a family planning program. The program successfully reduced the population growth rate and improved economic development until 1996, when the government abolished population control policies as birth rates fell too low.12 Park also cultivated a strong relationship with international actors, including the United States. In line with the United States’ goal of increasing influence in East Asia, international actors established various scientific and technical projects to conduct population surveys and demography, funded by the Foreign Operations Administration and International Cooperation Administration (predecessor to USAID).
13
Confucian Foundations
Confucianism shaped Korean society for over 500 years as the hegemonic ideology, embedding deeply patriarchal structures within legal and familial institutions.14 During the Joseon dynasty from 1392 to 1910, the government sought to replace Buddhism, whose values of individual self-realization detracted from familial and state loyalty, with neo-Confucianism,
10 Edward Graham, “The Miracle with a Dark Side: Korean Economic Development under Park Chung-Hee,” in Reforming Korea’s Industrial Conglomerates, 2003, 14–15, https://www.piie.com.
11 Graham, “The Miracle with a Dark Side: Korean Economic Development under Park Chung-Hee”; Yang, “An Overview of Family Planning Korea (1961-1978).”
12 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 3.
13 DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!).”
14 Uchang Kim, “Confucianism, Democracy, and the Individual in Korean Modernization,” in Transformations in Twentieth Century Korea, 2006, 221–44.
creating a structured system to promote stability and loyalty to the family and the state through strict relations and rituals.15 The family became a representation of social organization, with the wife in the domestic sphere, as subordinate to the public sphere, where the father and son participated.16
Confucianism particularly emphasized the idea of filial piety, or familial loyalty, especially between a son and a father. Filial piety highlighted that sons should take care of their fathers, both materially by caring for them in old age and spiritually by carrying on the family lineage. The importance of a continued connection and respect for ancestors and elders by descendants continued emphasizing ancestor worship and other rituals for filial piety. For example, after the head of the house died, the men in the extended family dressed themselves with hemp cloth, women let down their hair, and relatives fasted or ate fewer meals to express their sadness.17 However, only men participated in carrying out funeral processions. Married daughters did not take part in these rituals because by marrying, they had effectively become part of a different family and separated from their initial family.18 Family line and ancestral prestige were critical to economic, social, and even political success; the more prominent and long-lasting one’s lineage was, the more authority and respect one would have.19 Members of the same lineage often held joint property, conducted rituals together, and provided social services for
15 Woojin Chung and Monica Das Gupta, “The Decline of Son Preference in South Korea: The Roles of Development and Public Policy,” Population and Development Review 33, no. 4 (2007): 760.
16 Martina Deuchler, The Confucian Transformation of Korea: A Study of Society and Ideology, vol. 36, HarvardYenching Institute Monograph Series, 1992, https://www.jstor.org/stable/j.ctt1dnn8zj.
17 Seong-hi Yim, “Changing Patterns in Korean Family Structure,” Korea Journal, August 1, 1966, 5.
18 Yim, 5.
19 Deuchler, The Confucian Transformation of Korea: A Study of Society and Ideology, 36:6–14.
each other.20 With a strong motivation to bolster one’s lineage, having a son, to provide a male heir, was paramount.
Further, Confucian beliefs of ancestor worship manifested in the legal sphere. Family law and the patriarchal family structure continued the broader Confucian ideology of lineage culture.21 In particular, the patrilineal kinship structure, which was prevalent in both legal doctrines and family law, codified beliefs of son preference. Son preference refers to both the beliefs themselves that favor having sons and the behaviors, including economic and legal attitudes (such as wage rates and dowries) that manifest from those values.22 In 1958, the Korean Civil Code, also known as the Family Law, included policies to enhance lineage strength and state and filial piety. Specifically, Article 789 codified the idea of head-of-family, or hoju, giving male figures utmost authority in the house.23 This Confucian system emphasized that family law preserved valuable cultural assets, including familial roots and important traditional values.24 Family law, “the stipulation of the age-old tradition and custom” according to the Minister of Justice in 1984, presented an especially important bulwark against Western values, protecting Korean morals by preserving ancestral legacies and securing generational succession.25 The
20 Woojin Chung and Monica Das Gupta, “Why Is Son Preference Declining in South Korea?,” The World Bank, Policy Research Working Papers, October 2007, 3–4, https://openknowledge.worldbank.org
21 Deuchler, The Confucian Transformation of Korea: A Study of Society and Ideology, 36:6–14.
22 Seik Kim and Sam-Ho Lee, “Son Preference and Fertility Decisions: Evidence From Spatiotemporal Variation in Korea,” Demography 57, no. 3 (June 2020): 928–29.
23 Hyunah Yang, “Gender Equality vs. ‘Tradition’ in Korean Family Law: Toward a Postcolonial Feminist Jurisprudence,” The Review of Korean Studies 6, no. 2 (2003): 88–89.
24 Sanghui Nam, “The Women’s Movement and the Transformation of the Family Law in South Korea. Interactions Between Local, National and Global Structures.,” European Journal of East Asian Studies 9, no. 1 (March 1, 2010): 69–70, https://doi.org/10.1163/156805810X517670.
25 Yang, “Gender Equality vs. ‘Tradition’ in Korean Family Law: Toward a Postcolonial Feminist Jurisprudence,” 101–2.
framework institutionalized women’s economic dependence on male family members, as it required productive assets to be passed through male family members, while women were limited to moveable goods such as dowries or inheritance.26 Confucianism’s deeply rooted influence codified son preference and patriarchy, shaping legal and familial structures accordingly. The primary source of resistance to family planning stemmed from these foundations, undermining family planning’s effectiveness.
Initial Establishment and Key Objectives (1961-1970)
The development of the family planning campaign occurred in a few main stages, categorized by the aspects and themes the program emphasized at different points in time, including economic development, maternal and child health, social welfare, and population growth control.27 In its early stages, family planning prioritized raising awareness about the necessity of the campaign, using extensive media campaigns and emphasizing economic development.28
The South Korean government set ambitious targets for family planning. The Ministry of Health and Social Affairs’ main objective for family planning was to reduce the natural population increase rate of 3 percent in 1961 to 2.5 percent by the end of 1966, 2 percent by
26 Monica Das Gupta et al., “Why Is Son Preference so Persistent in East and South Asia? A Cross-Country Study of China, India and the Republic of Korea.,” Journal of Development Studies 40, no. 2 (December 1, 2003): 160, https://doi.org/10.1080/00220380412331293807.
27 “Population and Family Planning in the Republic of Korea” (Seoul, Korea: Korean Institute for Family Planning, 1974), 199; “Population and Family Planning in Korea” (Korea Institute for Population and Health, August 1986), 17, https://kihasa.re.kr/
28 “Population and Family Planning in the Republic of Korea,” 199.
1971, and 1.5 percent by 1976.29 Family planning indeed proved to be incredibly effective in terms of achieving numerical targets: the Total Fertility Rate steadily decreased, lowering drastically to 1.6 by 1988 (see fig. 1).
Figure 1. Changes in Total Fertility Rate by Area, “Population and Family Planning in Korea,” Chan Moo Park, 1986.
Before the 1950s, few abortions were induced. However, after the implementation of family planning policies in 1962, the number of married women who had at least one induced abortion increased from 7 to 54 percent from 1964 to 1991.31 Contraceptive use also surged. According to a survey by the Korea Institute for Health and Social Affairs (KIHASA), the National Fertility and Family Health Survey Reports, the number of women who used contraceptives greatly increased from 9 percent in 1964 to 79 percent in 1991.32 Examining the
29 Jae-Mo Yang, “Family Planning Programs During Last One Decade in Korea,” Yonsei Medical Journal 12, no. 1 (1971): 56, https://doi.org/10.3349/ymj.1971.12.1.55.
30 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 3.
31 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 3.
32 Nam-Hoon Cho and Hyun-Oak Kim, “An Overview of National Family Planning Program in Korea” (Korea Institute for Health and Social Affairs, May 1992), 12, https://kihasa.re.kr/
33
usage rates of various contraceptive methods reveals a move toward more extreme measures, as the percentage of female and male sterilization more than doubled from 1979 to 1991 (see fig. 2).
Figure 2. Contraception Practice Rate by Method, “Population and Family Planning in Korea,” Chan Moo Park, 1986.
Beyond increased contraceptive use, family planning yielded some economic and social benefits. Capital savings from family planning were estimated to be around $36 billion won from 1964 to 1969, and the total cost of the program was around $14,055,000. The cost of family planning per person, $13, was only one-ninth as much as the financial benefits per person of $115, revealing that economic benefits far outweighed the financial costs of family planning.
34
According to studies done by the Economic Planning Board, which Park established to lead his Five Year Development Plan, Korea Statistical Yearbook, and National Statistical Office, IMR
33 Cho and Kim, 13.
34 Rae Young Park, “Impact of Population Growth on Korean Economy,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 64.
decreased sharply from 55.6 per thousand births in 1960 to 12.8 in 1990, which contributed to the reduction of the birth rate and added to the changing narrative of maintaining a smaller family.
35 Jae-Mo Yang, a member of the Supreme Council of National Reconstruction of Korea, even argued that family planning laid the groundwork for national maternal and child health initiatives, enabling those with lower socioeconomic status to participate in national development efforts.36 These key metrics demonstrate the program’s tangible impact, illustrating the overall effectiveness of South Korea’s family planning policies.
Foreign Involvement
Foreign actors, particularly the United States, provided important resources for family planning, but also overlooked important cultural context, which negatively affected people’s well-being. In fact, American influence began reshaping Korea’s medical system even before family planning was implemented. The Minnesota Project, also known as The Seoul National University Cooperative Project, an educational aid and exchange program between the Seoul National University College of Medicine and the University of Minnesota that aimed to improve medical education and research in Korea, marked a key point in American influence on Korean medical systems. From 1954 to 1961, advisors and faculty members from the University of Minnesota visited South Korea to serve as advisors in medical research and hospital administration, including providing new medical knowledge and equipment for laboratories and hospitals.37 The majority of Seoul National University College of Medicine staff members from a
35 Cho and Kim, “An Overview of National Family Planning Program in Korea,” 18.
36 Yang, “An Overview of Family Planning Korea (1961-1978),” 190.
37 Ock-Joo Kim and Sang-Ik Hwang, “The Minnesota Project: The Influence of American Medicine on the Development of Medical Education and Medical Research in Post-War Korea,” Korean Journal of Medical History 9, no. 1 (July 2000): 114–15.
variety of departments, including clinical medicine and medical sciences, brought back new approaches to medical practice and research from their time studying abroad at the University of Minnesota.38 Despite the largely positive influence of improved techniques and knowledge, cultural differences presented a challenge. Advisors from the Minnesota Project faced difficulties in making quick progress and resistance from older generations.39 Educated in American medicine, some Korean physicians struggled to provide culturally nuanced care for Korean patients, especially as many left for America rather than staying in Korea.40 While the Minnesota Project did not directly influence the implementation of family planning, the vestiges of American influence and failure to focus on the Korean people, by both American and Korean actors, remained.
In addition to initiatives like the Minnesota Project, Western nations encouraged population control programs for economic growth. After World War II, expert consensus and popular opinion viewed high birth rates as obstacles to development. The idea of using family planning to decrease birth rates was particularly prevalent among Western nations, which sparked the creation of the International Planned Parenthood Federation (IPPF), including countries like India, the United Kingdom, the United States, the Netherlands, and Sweden.41 By the 1960s, family planning gained significant momentum, particularly as a method for developed countries to aid developing countries. Accordingly, international organizations, such as the United Nations Declaration on Population, and international donor agencies such as the
38 Kim and Hwang, 116–17.
39 Kim and Hwang, 118.
40 Kim and Hwang, 121.
41 P. J. Donaldson and A. O. Tsui, “The International Family Planning Movement,” Population Bulletin 45, no. 3 (November 1990): 9–10.
Population Council, IPPF, and Swedish International Development Authority recommended and assisted with family planning activities, particularly to various Third World countries and governments, of which a major recipient was Korea.42 In Korea, the IPPF provided 44.5 percent of the PPFK’s funds in exchange for PPFK leadership’s support at international seminars and encouragement of family planning in other countries.43 The greater the success of South Korea’s family planning program, the more it would bolster the legitimacy of the international population control regime and gain support from the West. Adopting a national family planning policy grew to be a symbol of alliance with international organizations and a way to gain more funding.
During John F. Kennedy’s presidency, Robert Barnett was appointed as population advisor in 1961. In a message to the Secretary of State Dean Rusk, Barnett argued for “maximum support to activities in the population field by the UN,” particularly in “countries like Formosa or Korea where a problem is known to exist, the government is known to be willing to act, and where foreign assistance has already been sought.”44 Internal pressure for the United States to become more involved in family planning manifested through organizations including the United States Agency for International Development (USAID). USAID spearheaded international population control efforts, widely promoting and funding large-scale, government-sponsored family planning programs to increase contraceptive use, spending a total of $3.9 billion, the largest single donation to population aid, over the course of two decades on family planning
42 Deborah Barrett and Amy Ong Tsui, “Policy as Symbolic Statement: International Response to National Population Policies,” Social Forces 78, no. 1 (September 1999): 215–16, https://doi.org/10.2307/3005795; “Population and Family Planning in Korea,” 3.
43 Yang, “Family Planning Program in Korea,” 69.
44 Peter J. Donaldson, “On the Origins of the United States Government’s International Population Policy,” Population Studies 44, no. 3 (November 1, 1990): 389, https://doi.org/10.1080/0032472031000144816.
programs.45 A study conducted on 114 countries from 1973 to 1993 found that adopting family planning policies increased the chance of receiving foreign aid and the amount received.46 In fact, population policy was the most significant predictor of receiving aid; adopting a policy led to an average increase of $1.7 million in funding from the USAID.47 While foreign aid provided important resources, such as supplies, information, education, and even promotional materials, this external involvement reinforced a top-down approach that overlooked and failed to account for cultural attitudes and local needs, revealing the broader tension between foreign-driven policy goals and Korean cultural values.48 The desire to meet foreign actors’ demands of reduced population growth and establish international credibility exacerbated policies that promoted widespread sterilization without considering the cultural implications and resistance they might face, especially within Korea’s patriarchal society. The mixed consequences of the program were shaped by the lack of cultural sensitivity in the foreign-driven framework that underpinned them.
Implementation in Rural Areas
The South Korean government demonstrated unwavering commitment to family planning, making it one of the earliest (the third) to have a national planning program among developing Asian countries. Park repealed regulations prohibiting domestic production of contraceptives, created a family planning advisory committee, and established a robust family
45 Donaldson and Tsui, “The International Family Planning Movement,” 10.
46 Barrett and Tsui, “Policy as Symbolic Statement: International Response to National Population Policies,” 228.
47 Barrett and Tsui, 228–29.
48 Warren C. Robinson, ed., “The Korean Breakthrough,” in The Global Family Planning Revolution: Three Decades of Population Policies and Programs, n.d., 182, https://openknowledge.worldbank.org/
planning taskforce, starting in 1962 with 183 country health centers, 366 family planning workers, 3400 vasectomies, and 230,000 couples registered.49
As an initial testing ground, rural areas served as the ideal pilot sites, as birth rates were high, and over 70 percent of the total population resided in rural locations.50 In particular, the research program conducted in Koyang, headed by Dr. Jae-Mo Yang, became a blueprint for expanding family planning campaigns to the rest of the country for years to come. Koyang tested various means of communication for health campaigns, including techniques like using new radio advertisements and other media.51 Despite effectively achieving qualitative goals of family planning, implementation ended up being coercive, exacerbated by the lack of industrialization and socioeconomic development. Even attempts to mitigate those effects through integrating family planning smoothly into the community proved ultimately ineffective.
Efforts in Koyang proved effective: the family planning practice rate increased to 38 percent in 1964, more than four times higher than the national average.52 Based on these results, Dr. Yang suggested that fundamental social changes were not necessary for family planning to be effective. He explained that family planning programs could find success even in areas without major industrialization or high levels of socioeconomic development, a key concern in family planning’s effectiveness 53 Contraception control did prove effective in other rural areas as well, as evidenced by a significant increase in the number of people who participated in 49 Yang, 187.
50 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 5.
51 DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!).”
52 Yang, “Family Planning Program in Korea,” 66.
53 Yang, 66.
family planning; the number more than quadrupled in Wondang and nearly doubled in Kimpo within only a year (see fig. 3).54 The primary motivation for adopting family planning was the economic and financial strain of raising children, with around 74 percent of 45 percent of initial participants remaining engaged in family planning.55 Notably, acceptance was high (44.7 percent) for women with two sons and those with three or more children.56
However, this interpretation of Koyang fails to capture the true picture of the process of implementation. The family planning campaign faced challenges in its implementation due to the government’s focus on rapid economic growth rather than well-being. The program emphasized quantity over quality, seeking to garner high rates of initial acceptance of a contraceptive method, or increase the percentage of “acceptors” to appear successful at creating a more developed nation.57 This desire for rapid success led the government to integrate family planning hastily without proper precautions.
The implementation of the Lippes Loop, a type of intrauterine device (IUD), from 1964 to 1968, exemplified the prioritization of reaching numerical targets, leading to harsh family planning policies. Despite having just been developed in the United States in 1962 and testing being incomplete, officials strongly pushed the IUD program, aiming to reach 300,000 women by 1969 and a total of 1.8 million from 1961 to 1971.58 With the Loop being aggressively
54 Jae-Mo Yang et al., “Fertility and Family Planning in Rural Korea,” Population Studies 18, no. 3 (1965): 246, https://doi.org/10.2307/2173286.
55 Yang et al., 250.
56 Yang et al., 250.
57 DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!),” 371–72.
58 John A. Ross et al., “Korea/Taiwan 1969: Report on the National Family Planning Programs,” in Population and Family Planning in the Republic of Korea, vol. 2, Studies in Family Planning, 1970, 87.
promoted while less intrusive means were discouraged, citing the excuse that they were more difficult to implement, the program exceeded its targets.59 By 1973, 2.8 million women, called “acceptors,” had received the Loop.60 Although seemingly effective, hasty and low-quality implementation undermined the program’s effectiveness. Maternal and child health services were underdeveloped, and in the rush to implement family planning as fast as possible, officials appointed under qualified doctors, nurses, and administrators, resulting in the procedure being often performed by trainees and without proper health care facilities.61 According to Cho, the president of a Mother’s Club in the Jeonbuk region and registered nurse, the lack of diverse Lippes Loop sizes, access to hospital transportation, and trained professional doctors led to both harmful side effects for the women and less effective implementation rates, lowering people’s trust in family planning.62 Negative experiences contributed to lack of sustainable implementation, reflected by the low continuation rate. Starting in 1964, 1.9 million Lippes Loops were inserted, but only about 500,000 women continued using them until 1970.63 The high average termination rate of 43 percent after one year and 59 percent after a year and a half of the IUD shows many women did not continue using the IUD, undermining the effectiveness of the IUD campaign because women did not fully support the program.
59 Eun Kyoung Bae, “Gajokgyehoeng saeopgwa yeoseongui mom: 1960~70 nyeondae chulsanjojeol bogeum gwajeongeul tonghae bon yeoseonggwa ‘geundae’” [Family Planning and the Women’s Body: Women and ‘Modernity’ as Seen Through Birth Control Distribution in the 1960s and 70s]. Sahoewayeoksa(gu hanguksahoesahakoenonmunjip) [Society and History (formerly Journal of the Korean Society of Social History)] 67 (2005): 79–81.
60 Bae, 79–81.
61 Yang, “Family Planning Programs During Last One Decade in Korea,” 58–59.
62 Bae, “Gajokgyehoeng saeopgwa yeoseongui mom: 1960~70 nyeondae chulsanjojeol bogeum gwajeongeul tonghae bon yeoseonggwa ‘geundae’” [Family Planning and the Women’s Body: Women and ‘Modernity’ as Seen Through Birth Control Distribution in the 1960s and 70s], 282.
63 George Worth et al., “Korea/Taiwan 1970: Report on the National Family Planning Programs,” in Population and Family Planning in the Republic of Korea, vol. 2, Studies in Family Planning, 1971, 98.
The lack of knowledge women had about contraception compounded the negative effects of family planning implementation. Nearly 80 percent of women surveyed in 1973 wanted to know more about contraception, as their primary sources of information (namely magazines and schools) were inadequate.64 In other rural regions like Wondang and Gimpo in 1962, only 7.9 and 11.7 percent of couples, respectively, most of whom were well-off and educated, had practiced family planning.65 More than half of the wives and about one-third of the husbands in both areas had never even heard of any birth control methods before.66 The lack of knowledge meant it was much easier for people to be coerced and convinced into getting extreme practices done without fully knowing its implications and long-term consequences.
National Mobilization Efforts
To address concerns about cultural misalignment, but still primarily motivated by a desire to expand the reach of family planning to achieve more goals, the government devoted significant resources to a strong on-the-ground presence, hoping to establish a direct connection with many people. Information, Education, and Communication (IEC) efforts aimed to spread awareness about family planning through a public information campaign and cultivate positive popular sentiment.67 As a part of IEC, mobile teams and vans were dispatched to rural and urban areas all over the country. Each unit included a physician, a nurse-midwife, and volunteers, along with the necessary supplies to carry out procedures. Field workers received recruitment quotas
64 Kun Yong Song, “Attitudes Toward Family Planning, Marriage, and Family Size Among Unmarried Women in Korea,” Studies in Family Planning 6, no. 10 (1975): 374–75, https://doi.org/10.2307/1964918.
65 Yang et al., “Fertility and Family Planning in Rural Korea,” 243.
66 Yang et al., 243.
67 “Population and Family Planning in Korea,” 14.
for family planning, which served as an effective baseline. Field workers’ payment was determined by the number of and type of procedures they performed, incentivizing them to complete as many procedures as possible. For example, a vasectomy earned a worker thirty-six cents and an IUD insertion earned them half that amount.68 Building on the initial support provided by external countries, Koyang also received significant assistance from foreign actors, including the United States Peace Corps volunteers for education; the Population Council, a research organization created by John D. Rockefeller III; USAID; and the Swedish International Development Agency, which donated mobile vans to utilize as clinics.69
Workers used various outreach strategies to facilitate acceptance of medical procedures in order to meet their goals.70 Koyang Project leaders determined that using existing local infrastructure to create a network of workers, carried out by both medical workers and volunteers, was best.71 In 1968, the PPFK started organizing Mothers’ Clubs in rural villages, aiming to foster community-led advocacy for family planning. Mothers’ Clubs, led by Korean women in their respective villages, built upon existing frameworks of women organizations by training women in leadership roles and giving them a role in village life.72 If trusted community leaders promoted family planning, citizens would more easily be convinced of the safety and importance of family planning, especially unfamiliar medical procedures. These clubs sought to
68 Mara Hvistendahl, Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men (PublicAffairs, 2011), 131.
69 DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!),” 369, 371.
70 S. K. Ahn, “The Korean National Family Planning Program,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 75.
71 DiMoia, “(Let’s Have the Proper Number of Children and Raise Them Well!).”
72 J. M. Yang and G. C. Worth, “Mothers’ Clubs in Korea,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 237–38.
integrate family planning into local networks by encouraging contraceptive practice, expanding reach to greater communities, promoting family planning information and contraceptive supplies, and supporting broader community development efforts.73 A 1962 study by Yonsei University found that Mothers’ Clubs were effective at improving acceptance levels of IUDs by increasing trust in villages that fell below target goals.74 By 1976, Mothers’ Clubs had grown to over 740,000 members, playing a crucial role in spreading the family planning movement by providing contraception to over 19,000 villages.75 Propaganda and promotional slogans used at various points in family planning reveal the government’s focus on particular themes and the changing political attitudes toward family planning over time. When family planning was first adopted in 1961, the PPFK adopted the slogan, “Have few children and bring them up well.”76 The slogan supported the PPFK’s economic development goals, connecting the need for population control to individual benefit.77
Media Outreach Tactics
The media played a central role in promoting family planning, with extensive efforts aimed at shifting public attitudes and informing people of family planning. In a survey conducted on rural families, 48.3 percent of respondents had heard of family planning or birth control from
73 Yang, “An Overview of Family Planning Korea (1961-1978).”
74 Yang and Worth, “Mothers’ Clubs in Korea,” 238.
75 Robinson, “The Korean Breakthrough,” 181.
76 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 9.
77 Tae Ryong Kim, “The Evolution of Family Planning Themes, Slogans, and Non-Verbal Designs in Korea,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 194.
mass communication media, with nearly 15 percent being from radio.78 Government agencies, including the Korean Broadcasting System (KBS) under the Ministry of Culture and Public Information, and even leading figures including the president and prime minister supported family planning.79 In 1969, during April, designated Family Planning Month, KBS aired a 20minute drama series advocating for reduced family sizes.80 IEC media efforts attempted to dismantle traditional attitudes of son preference by touting the benefits of daughters and improved women’s status in movies and magazines.81 Beyond media, workers distributed an extensive range of promotional and educational materials to reinforce these messages. Field workers distributed posters, pamphlets, custom magazines, restaurant counter cards, cartoons, exhibition materials, and more.82 The campaign published 50 articles, 37 professional papers, and 50,000 copies of a booklet on human physiology, and placed advertisements in the top ten monthly magazines, emphasizing family planning’s achievements, available services, and the need for continued public support.83 A two-month exhibit in a popular Seoul park showed a Walt Disney film on family planning, reaching around 114,000 viewers.84
A particularly notable aspect of the campaign was the evaluation of middle and secondary school textbooks by health educators from the PPFK to align with family planning
78 Bang, Lee, and Yang, “A Survey of Fertility and Attitude Toward Family Planning in Rural Korea,” 95.
79 Bang, Lee, and Yang, 95.
80 Ross et al., “Korea/Taiwan 1969: Report on the National Family Planning Programs,” 91.
81 Ross et al., 92.
82 Ahn, “The Korean National Family Planning Program,” 78.
83 Ross et al., “Korea/Taiwan 1969: Report on the National Family Planning Programs,” 91–92.
84 Ross et al., 92.
goals. As the 1969 report by The Population Council notes, the PPFK selected and approved, with the Ministry of Education, 913 texts. The majority of these texts emphasized the necessity for family planning, and elementary school materials, while not explicitly promoting family planning, removed references that supported large families and sons as blessings.85 The revision reflects a widespread, coordinated effort to cultivate public support and reshape societal attitudes toward reproductive practices.
Figure 3. Prevalence of conception control by year in Wondang and Kimpo, “Mothers’ Clubs in Korea,” Yang et al., 1974.
However, despite family planning’s comprehensive efforts, from regular group meetings, leaflets and visual aids, individual consultations, and over a hundred home calls a month, resistance lingered, reflected in high failure rates to continue participating after initial enrollment in family planning services. The desire for additional sons emerged as the most significant reason for not participating in family planning, underscoring the enduring strength of traditional Confucian values that created cultural conflict with family planning. The campaign failed to meaningfully address the deeply entrenched preference for sons one of the key factors driving high birth rates in the first place. Shifting such a fundamental cultural norm required more than media campaigns and textbooks reforms; it demanded a deeper transformation of economic, social, and legal structures. While these initial policies made a valiant effort, they further
85 Ross et al., 91–92.
revealed a critical disconnect between policy objectives and cultural attitudes, limiting the program’s overall effectiveness.
Program Expansion and Reform (1971-1980)
Toward the end of the 1970s, economic growth began slowing down as the unsustainable economic practices started exposing themselves. Korea entered a period of economic downturn once more, faced with the Energy Crisis Recession, high levels of debt and inflation, and crop failure.86 In response, the government sought to further curb population growth through various financial incentives. These included income tax exemptions for families with two children and corporate tax exemptions in 1977, priority in public housing in 1978, and even monetary subsidies provided to low-income sterilization acceptors, free medical services for children, and tax exemption on education in 1982.87 While these incentives successfully encouraged widespread participation in the program, they also had unintended consequences that reinforced the government’s emphasis on achieving quantitative goals rather than addressing holistic wellbeing. These extreme policies, paired with limited access to comprehensive information and healthcare infrastructure, led many to take drastic measures, including permanent sterilization, without fully understanding the long-term effects.
The year 1976 marked the introduction of an important new development in the national family planning program: female sterilization.88 The number of female sterilizations sharply increased: Between 1982 and 1987, over 2 million women were sterilized, leading to significant
86 Kwan S Kim, “The Korean Miracle (1962-1980) Revisited,” Kellogg Institute, November 1991, https://kellogg.nd.edu/.
87 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 9.
88 Cho and Kim, “An Overview of National Family Planning Program in Korea,” 3.
reductions in the fertility rate (see fig. 4).89 Further, field workers were incentivized to promote and expand the sterilization program, with recruitment incentives and payments for physicians and field workers tripling in 1972.90 Mobile clinics often took extreme measures to achieve family planning goals, even allegedly providing illegal payments for women to get abortions.91 Field workers aimed to bring as many women as possible into mobile clinics, as the women they brought counted toward their pay. Sterilization, mostly coercive, was widespread: if a woman was not pregnant, she would be pressured to undergo tubal ligation, and if a woman was pregnant, she would be persuaded to have an abortion followed by a sterilization.92 The increase in more severe family planning policies was correlated with foreign funding; foreign funding peaked in 1974 with the UNFPA pledging $6 million for a five-year grant, contributing to the rapid increase of nearly 3,000 field workers and sharp reduction in the birth rate.93
89 Seungsook Moon, Militarized Modernity and Gendered Citizenship in South Korea (Duke University Press, 2005), https://www.dukeupress.edu/militarized-modernity-and-gendered-citizenship-in-south-korea; “Population and Family Planning in Korea,” 20–21.
90 Ahn, “The Korean National Family Planning Program,” 77.
91 Hvistendahl, Unnatural Selection, 131–32.
92 Hvistendahl, 132.
93 Kyung Shik Chang, George C. Worth, and Peter H. Michael, “Korea (South),” Studies in Family Planning 5 5 (May 1974): 153.
Figure 4. Government Contraceptive Services (1962 1985), “Population and Family Planning in Korea,” Chan Moo Park, 1986.
The Effect of Son Preference
Alongside sterilization efforts, initiatives aimed to reshape societal attitudes towards family size. The most significant barrier to achieving the stated population goals was son preference, which a classified United States National Security Council brief emphasized: “The most serious is the persistently high cultural value placed on sons. … Koreans resist birth control until they have a son.”94 Accordingly, the government introduced policies seeking to make daughters more desirable. One widely promoted idea was the “three children” guideline, encapsulated in the slogan: “Have three children, spaced three years apart, and stop before the age of 35 (“3-3-35”)”, emphasizing smaller families as the key to happiness, wealth, and a better future.95 In 1971, the government introduced a new slogan, “Stop at two regardless of sex,” to
94 National Security Council Bureau of Intelligence and Research, “Republic of Korea: Intensified Drive to Curb Population Growth” (Executive Secretariat, NSC Records, February 9, 1984).
95 Kim, “The Evolution of Family Planning Themes, Slogans, and Non-Verbal Designs in Korea,” 195.
reinforce the urgency of lowering birth rates and directly challenge son preference (see fig. 5).96
This marked a shift in the government's strategy, as it recognized the need to reshape cultural attitudes that prioritized having multiple children to ensure a male heir.97 In fact, some slogans even actively attempted to promote having girls, like the 1978 slogan, “a well-raised girl surpasses ten boys.”98
Figure 5. Population Reference Bureau poster (“Sons or daughters, let’s have two children and raise them well.”), 1974.
However, the movement to mitigate son preference faced opposition, particularly in rural areas. In a February 1972 survey, 53 percent of respondents disagreed with the slogan while only
96 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 10.
97 Yang, “Family Planning Program in Korea,” 65.
98 Cho, “Achievements and Challenges of the Population Policy Development in Korea,” 11.
33 percent agreed.99 Another 1972 survey found that acceptance of the new slogan “stop at two regardless of sex” varied by region, with 29 percent in Central Seoul agreeing with the poster while significantly less, only 2 percent, agreed in rural villages (see fig. 6).100 The most commonly cited reason, at 63 percent, for disagreeing with the slogan was the need for a male heir.101
Location
Stop-at-two
Females
Proportions willing to
Ideal # boys
Males Central Seoul
(1.9)
(1.8) Rural Areas
(2.0)
(1.9)
Figure 6. Proportion of people in various areas who agree with the “Stop-at-two” slogan, “A Study of the Effectiveness of Family Planning Communications,” S/K Marketing Research Company, 1972.
Son preference, strengthened by patriarchal family systems and low female autonomy, persisted in most Korean families, as they believed that sons played an irreplaceable role in preserving family lineage and hosting rituals.102 Despite concerted efforts, son preference proved to be a difficult underlying cultural factor to combat. Dr. Yang, the president of the PPFK, stated
99 Song, “Attitudes Toward Family Planning, Marriage, and Family Size Among Unmarried Women in Korea,” 373.
100 S/K Marketing Research Company, “A Study of the Effectiveness of Family Planning Communications,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1972), 211.
101 S/K Marketing Research Company, 211.
102 Das Gupta et al., “Why Is Son Preference so Persistent in East and South Asia?”; Yim, “Changing Patterns in Korean Family Structure,” 6.
in the opening address of the PPFK’s 10th anniversary ceremony that, family planning “needs extensive educational campaigns directed toward a smaller family size norm and toward changing the preference for male children, which means a change in social values, something very difficult to accomplish.”
103 Numerical studies confirm anecdotal evidence of son preference: Families with two daughters were over 30 percentage points more likely to have a third child in an attempt to have a son, which 59 percent of married women in a 1973 survey agreed with, and 55 percent wanted their first child to be a boy.104 Researchers found that the places in which people grew up influenced their decisions regarding family size and gender of their children most strongly, indicating attitudes toward son preference developed from early on.
105 In 1971, a survey conducted by the Korea Institute for Research in Behavioral Science found that 50 percent of Korean women surveyed agreed that their husband should have a concubine if his wife could not give birth to a boy.
106 Son preference and an affinity toward larger families held especially strongly in rural areas, where the ideal number of children was largely influenced by traditional values. Although the percentage of women who viewed three children as ideal increased in both regions, the proportion of women desiring four or five children declined only slightly in rural areas, highlighting the persistence of these traditional preferences (see fig. 7).107 A study conducted by The Korean Institute for Research in the
103 “Population and Family Planning in the Republic of Korea,” 182.
104 Kim and Lee, “Son Preference and Fertility Decisions: Evidence From Spatiotemporal Variation in Korea,” 942–44; Song, “Attitudes Toward Family Planning, Marriage, and Family Size Among Unmarried Women in Korea,” 373.
105 Kim and Lee, “Son Preference and Fertility Decisions: Evidence From Spatiotemporal Variation in Korea,” 948–49.
106 Yang, “Family Planning Program in Korea,” 72.
107 Hyun-Sang Moon, Seung-Hyun Han, and Soon Choi, “Recent Trends in Ideal Family Size,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 286.
Behavioral Sciences in 1971 found a slight decrease in the ideal number of sons and overall preferred family size.108 By 1971, the average ideal number of children fell by 0.3 children from 3.9 in 1967 and 1968 to 3.6, including a decrease in the ideal number of sons from 2.4 to 2.2.109
3 children 4 or 5 children
Figure 7. Change in the percentage of women desiring four or five children when comparing 1971 Fertility Survey and 1971 KIRBS Survey results with those from the 1965 KAP Survey, “Population and Family Planning in the Republic of Korea,” 1974.
Cultural and Social Changes (1981-1985)
The availability of abortions both reduced fertility and proved a mechanism for prenatal sex selection, skewing demographic trends. Despite extensive family planning efforts, overall social change in popular attitudes occurred slowly. New technology, particularly for sex determination, mainly used to determine whether to abort a baby, proved the fastest way to reduce the birth rate despite son preference. Despite the illegality of abortions, prohibited by the Criminal Act since 1953, they were widely practiced and recommended by the government, as revealed by a rise in induced abortions in the 1970s 110 Abortions became a type of contraception, whether it was chosen or forced, informed or uninformed. Abortions were critical in reducing the population rate, especially because efforts to reach targets for condom and birth
108 S. M. Keeny, ed., “East Asia Review, 1971,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1972), 103.
109 Keeny, 103.
110 Sunhye Kim, Na Young, and Yurim Lee, “The Role of Reproductive Justice Movements in Challenging South Korea’s Abortion Ban,” Health and Human Rights Journal 21, no. 2 (2019): 98–99.
control pill acceptance fell short.111 By the 1970s, 26 percent of all women aged 15 to 49 had had an induced abortion.112 Coupled with a lack of knowledge and trust, 42 percent of people surveyed thought abortion was legal and 71 percent said abortion was unsafe, with only 9 percent saying it was safe, confirming that most believed that implementation methods were dangerous.113
Figure 8. Family planning campaign posters. (“Even two children are too many!” “Korea’s population has already exceeded 40 million.”), PPFK, 1980s.
Government measures were seemingly effective at changing popular sentiment. The 1985 national survey showed that 24.3 percent of those who practiced family planning had only one child, and about 43.3 percent of respondents said one child was enough, indicating that the social support policy and IEC activities for a one child family facilitated adoption and changing social
111 John A. Ross, “Korea and Taiwan: Review of Progress in 1968,” Studies in Family Planning, April 1969, 1.
112 Hyun-Sang Moon, Seung-Hyun Han, and Soon Choi, “Use of Induced Abortion,” in Population and Family Planning in the Republic of Korea, vol. 2 (Korean Institute for Family Planning, 1974), 350.
113 Moon, Han, and Choi, 353–54.
norms.114 Posters reinforced the push to curb population growth, becoming more forceful over time, dissuading families from having even two children (see fig. 8). As slogans grew increasingly adamant about discouraging son preference, the TFR continued falling, reflecting the effectiveness of the government’s media campaign on lowering birth rates (see fig. 9).115
Year TFR
1961 6.0
1971 4.7
Family Planning Slogan
Have few children and bring them up well.
Stop at two regardless of sex.
1978 2.7 A well-raised girl surpasses ten boys.
1984 2.1 Even two are too many.
1989 1.6 Less children, better mother health. Figure 9. Changes in Family Planning Slogans, Cho and Kim, 1992.
Despite lower levels of son preference, the significantly skewed sex ratio at birth (SRB) in the 1980s reveals the negative consequences of change that conflicts with social beliefs. Instead of fundamentally shifting cultural values, the combination of new technology and heavily enforced family planning in the 1980s led to a sudden surge in sex-selective abortions, distorting the SRB 116 The SRB became particularly worrisome in 1984, when the SRB reached 108.7, meaning there were 108.7 male births for every 100 female births, and peaked at 116.5.117 The increased prevalence of ultrasound machines and other new prenatal sex determination
114 “Population and Family Planning in Korea,” 36.
115 Cho and Kim, “An Overview of National Family Planning Program in Korea,” 10.
116 Ridhi Kashyap and Francisco Villavicencio, “The Dynamics of Son Preference, Technology Diffusion, and Fertility Decline Underlying Distorted Sex Ratios at Birth: A Simulation Approach,” Demography 53, no. 5 (2016): 1278.; Seik Kim and Sam-Ho Lee, “Son Preference and Fertility Decisions: Evidence From Spatiotemporal Variation in Korea,” Demography 57, no. 3 (June 2020): 930.
117 Kim and Lee, 930–31.
technology coupled with persisting Confucian values of the need for a strong family lineage led to this effect. Son preference appeared lower not because popular opinion had entirely shifted away from prioritizing sons, but because people simply had less children overall, creating a greater long-term demographic crisis of inadequate population growth
Gradual but meaningful economic and social shifts emphasize the effectiveness of natural changes that challenged these entrenched values over time. Detachment from Confucian trends due to urbanization and public campaigns that aimed to decrease bias contributed to these shifts.118 From 1966 to 1986, the urbanization and education of parents increased (see fig. 10).
The percentage of people living in or near cities doubled from 33 to 67 percent. From 1960 to 1966, boundary changes where five new areas gained shi, or city, status led to a net population increase in urban areas by 260,000 people, and internal migration contributed to urbanization, with rates in Seoul particularly increasing. The increase in urbanization fundamentally altered societal expectations surrounding gender roles. In particular, urban environments lessened the historical emphasis on having sons to continue the family line as economic and social opportunities expanded beyond traditional roles. Urban areas provided greater networks of support for women, both in the public sphere through churches and temples and more diverse communities in apartments and offices rather than remaining limited to their direct family.119 Additionally, the reduced dependence on sons for ancestral rites reduced the cultural preference for sons, gradually bridging the gap between sons and daughters.120 In legal settings, family law underwent changes that improved women’s legal standing. The third revision in 1989, while not
118 Das Gupta et al., “Why Is Son Preference so Persistent in East and South Asia?”
119 Chung and Gupta, “The Decline of Son Preference in South Korea,” 764.
120 Monica Das Gupta, “Return of the Missing Daughters,” Scientific American 317, no. 3 (September 2017): 80–85, https://doi.org/10.1038/scientificamerican0917-80.
abolishing the family-head system, gave daughters the right to claim equal inheritance and legally ended gender discrimination against women in property succession and gave women much more authority, such as requiring mutual consent to determine place of living and turning living expenses into joint responsibilities.121
labor force participation rate (%)
Figure 10. “Changes in level of education and urbanization, South Korea, 1975-2000,” Korea National Statistical Office, 2006.
However, slogans fell short at addressing the structural reasons behind son preference, proven by son preference continuing to persist. For example, according to 1991 KIHASA survey
121 Hyunah Yang, “A Journey of Family Law Reform in Korea: Tradition, Equality, and Social Change,” Journal of Korean Law 8 (December 2008): 82–84.
findings, the rate of couples with one or two sons who practiced contraception was significantly higher than the rate of couples with one or two daughters who practiced contraception, suggesting many families without a son still preferred to have a son.122 When fertility levels fell, some pressure was still heightened to reduce the number of daughters.123 As South Korea developed further, even becoming officially categorized as a developed country by the Organization for Economic Cooperation and Development (OECD) in the mid1990s, surprisingly, sex ratios at birth continued to rise.124 As shown in Figure 8, women’s education and the female labor force participation rate steadily rose, with the number of women who completed college nearly quadrupling from 1975 to 1990.125 Despite this, son preference persisted, presenting a unique trend, as improvements in women’s education and job attainment were usually expected to decrease gender inequalities and sex ratios at birth.126
Examining the key factors behind the changes in women’s education and job reveals the reason for this abnormal pattern. The government prioritized economic development through high investment and exports. To facilitate this, the government reduced funding from social welfare and instead, encouraged family members to care for older people, effectively placing the burden of caring for the family on women. Additionally, the government encouraged women to enter the labor force, but in a manner that befitted the house and the government, leaving work when they married and returning when the house needed them less.127 Part of the effort for economic
122 Cho and Kim, “An Overview of National Family Planning Program in Korea,” 27.
123 Das Gupta et al., “Why Is Son Preference so Persistent in East and South Asia?,” 159.
124 Chung and Gupta, “The Decline of Son Preference in South Korea,” 757–59.
125 Chung and Gupta, 758.
126 Chung and Gupta, 758–59.
127 Chung and Gupta, 762–63.
development among women included Mothers’ Clubs, revealing the true intent of family planning programs as not for the well-being of the women, but rather for the industrial development of and political loyalty to the state.
Only later on, with natural economic and social changes, did son preference meaningfully weaken in Korea overall, as the gender gap in economic and non-economic returns provided by sons and daughters decreased significantly.128 Using data from the Korea National Fertility and Family Health Surveys from 1985 to 2003, researchers found a consistent downward trend of women who reported they “must have a son” (see fig. 11).129 Specifically, gender differences in parental treatment declined, such as financial support for education and number of hours worked by the mother after giving birth.130 An analysis conducted by Woojin Chung and Monica Das Gupta corroborates the idea that son preference among South Korean women declined significantly over time, with younger birth cohorts showing a steady decrease in the belief that they “must have a son.” In 1991, two-thirds of the oldest women interviewed expressed strong son preference, whereas fewer than 30 percent of the youngest did. This decline accelerated after 1991, spreading rapidly through the population. Women with similar characteristics also exhibited lower son preference in 2003 than in 1991, with each birth cohort showing approximately half the level of son preference over this period. While increases in education and urbanization contributed to this shift, they accounted for only 27 percent of the decline, whereas 73 percent resulted from changing social norms. These findings indicate that evolving societal
128 Eleanor Jawon Choi and Jisoo Hwang, “Transition of Son Preference: Evidence From South Korea,” Demography 57, no. 2 (2020): 647.
129 Chung and Gupta, “The Decline of Son Preference in South Korea,” 769.
130 Choi and Hwang, “Transition of Son Preference,” 648.
values, rather than demographic changes alone, played the primary role in reducing son preference in South Korea.
Figure . Trend in the intensity of son preference (percent of women reporting “must have a son”), 1985-2003.
Post-Family Planning
While initial family planning policies focused heavily on achieving economic growth by drastically lowering population growth, excessive decline of population growth and skewed sex ratios at birth led the government to rethink family planning’s implementation. To combat the deeply rooted cultural value of son preference forcibly through law, the government outlawed sex selective abortions in 1990, trying to restore the SRB. Yet the SRB remained above normal until 2007, underscoring the enduring influence of cultural norms 132
To address the problems that family planning caused, the government realized that social support policies that improved women’s status and equality to create a balanced sex ratio were
131 Chung and Gupta, “Why Is Son Preference Declining in South Korea?,” 8–9.
132 Andrea den Boer and Valerie Hudson, “Patrilineality, Son Preference, and Sex Selection in South Korea and Vietnam,” Population and Development Review 43, no. 1 (2017): 128.
necessary.133 Accordingly, in 1996, the government abolished the initial population control policy and instead adopted a new population policy focusing on the quality of life and welfare of Korean citizens. The objectives of the new population policy in 1996 were: (1) to keep the rates of fertility and mortality at levels required for sustainable socioeconomic development; (2) to promote family health and welfare; (3) to balance the sex ratio at birth; (4) to promote women’s labor force participation and welfare; (5) to promote the health and welfare of the elderly population; and (6) to achieve a balanced distribution of the population across the country.
Integrating family planning not only for population control but as a part of Maternal and Child Health Programs (MCH) is important.134 Despite this change, the TFR continued decreasing, even lowering to 1.08 in 2005, the lowest in the world. This trend was mainly due to changes in people’s views on marriage, the heavy economic and financial burden of children, and increasing participation of women in the workforce, all underscored by cultural preferences of the past.
Lingering Legacies
South Korea’s family planning program reveals the intricate tensions between public health initiatives and deeply rooted cultural traditions. While the policies successfully achieved their economic goals of lowering birth rates and increasing contraceptive use, they often led to adverse consequences, such as unsafe implementation. Despite impressive metrics of reducing the TFR significantly and reaching millions of families, aggressive IUD campaigns, financial incentives for sterilization, and forced, uninformed abortions reflect a quantitative obsession that often overlooked the individual, human consequences. Rural communities, like in Koyang,
133 Cho and Kim, “An Overview of National Family Planning Program in Korea,” 31.
134 “Population and Family Planning in Korea,” 36.
experienced this tension most acutely, as the government heavily promoted family planning in rural areas. The Lippes Loop exemplifies the negative side effects of hasty implementation: poor educational awareness and inadequate medical infrastructure and staff contributed to side effects and high discontinuation rates, ultimately undermining family planning’s effectiveness.
The root of the program’s controversial implementation rested in its clash with longstanding cultural values, particularly Confucian beliefs like son preference, an effect that a prioritization of reaching quantitative goals and heavy international involvement exacerbated. Although aid from foreign actors like USAID and IPPF provided key resources and legitimacy, it also prioritized birth control as a tool for development, overlooking the need to ground policies in culture. In response to family planning rates being lower than expected, the government both increased the magnitude of their programs and attempted to shift the very cultural norms that created the most opposition by using various forms of media and a ban on sex selection at birth to counteract these dynamics. Despite these efforts, they proved ineffective, as son preference persisted, and the policies even inadvertently reinforced these norms, inadvertently contributing to the rise of sex-selective abortions in the 1980s.
The policy’s broader positive effects and change in attitudes regarding sons were not solely a result of policy enforcement, but rather shaped by broader social transformations. As urbanization accelerated, women’s education levels rose. Legal reforms increased female autonomy by creating more equal family structures. Ultimately, social changes that occurred naturally and slowly were able to meaningfully shift gender expectations and family structures that supported the program and changing policies.
The case of South Korea highlights the dangers of imposing policies that conflict with cultural beliefs without providing sufficient public education or long-term support, revealing the
necessity of balancing rapid goal achievement with sustainable, holistic progress. Sustainable public health efforts must engage with, not override, the beliefs and lived experiences of the communities they serve to truly foster healthy change.
Bibliography
Ahn, S. K. “The Korean National Family Planning Program.” In Population and Family Planning in the Republic of Korea, 2:73–85. Korean Institute for Family Planning, 1974.
Bae, Eun Kyoung. “Gajokgyehoeng saeopgwa yeoseongui mom: 1960~70 nyeondae chulsanjojeol bogeum gwajeongeul tonghae bon yeoseonggwa ‘geundae’” 가족계획 사업과 여성의 몸: 1960~70년대 출산조절 보급 과정을 통해 본 여성과 ‘근대’ [Family Planning and the Women’s Body: Women and ‘Modernity’ as Seen Through Birth Control Distribution in the 1960s and 70s]. Sahoewayeoksa(gu hanguksahoesahakoenonmunjip) 사회와역사(구 한국사회사학회논문집) [Society and History (formerly Journal of the Korean Society of Social History)] 67 (2005): 260–99.
Bang, Sook, Man Gap Lee, and Jae Mo Yang. “A Survey of Fertility and Attitude Toward Family Planning in Rural Korea.” Yonsei Medical Journal 4, no. 1 (1963): 77. https://doi.org/10.3349/ymj.1963.4.1.77.
Barrett, Deborah, and Amy Ong Tsui. “Policy as Symbolic Statement: International Response to National Population Policies.” Social Forces 78, no. 1 (September 1999): 213–33. https://doi.org/10.2307/3005795.
Boer, Andrea den, and Valerie Hudson. “Patrilineality, Son Preference, and Sex Selection in South Korea and Vietnam.” Population and Development Review 43, no. 1 (2017): 119–47.
Chang, Kyung Shik, George C. Worth, and Peter H. Michael. “Korea (South).” Studies in Family Planning 5 5 (May 1974): 153.
Cho, Namhoon. “Achievements and Challenges of the Population Policy Development in Korea.” Seoul : Korea Institute for Health and Social Affairs, January 1996. https://www.kihasa.re.kr/.
Cho, Nam-Hoon, and Hyun-Oak Kim. “An Overview of National Family Planning Program in Korea.” Korea Institute for Health and Social Affairs, May 1992. https://www.kihasa.re.kr/.
Choi, Eleanor Jawon, and Jisoo Hwang. “Transition of Son Preference: Evidence From South Korea.” Demography 57, no. 2 (2020): 627–52.
Chung, Woojin, and Monica Das Gupta. “The Decline of Son Preference in South Korea: The Roles of Development and Public Policy.” Population and Development Review 33, no. 4 (2007): 757–83.
. “Why Is Son Preference Declining in South Korea?” The World Bank, Policy Research Working Papers, October 2007. https://openknowledge.worldbank.org/.
Das Gupta, Monica, Jiang Zhenghua, Li Bohua, Xie Zhenming, Woojin Chung, and Bae HwaOk. “Why Is Son Preference so Persistent in East and South Asia? A Cross-Country Study of China, India and the Republic of Korea.” Journal of Development Studies 40, no. 2 (December 1, 2003): 153–87. https://doi.org/10.1080/00220380412331293807.
Deuchler, Martina. The Confucian Transformation of Korea: A Study of Society and Ideology. Vol. 36. Harvard-Yenching Institute Monograph Series, 1992. https://www.jstor.org/stable/j.ctt1dnn8zj.
DiMoia, John P. “(Let’s Have the Proper Number of Children and Raise Them Well!): Family Planning and Nation-Building in South Korea, 1961–1968.” East Asian Science, Technology and Society: An International Journal 2, no. 3 (September 1, 2008): 361–79. https://doi.org/10.1215/s12280-008-9054-5.
Donaldson, Peter J., and A. O. Tsui. “The International Family Planning Movement.” Population Bulletin 45, no. 3 (November 1990): 1–46.
. “On the Origins of the United States Government’s International Population Policy.” Population Studies 44, no. 3 (November 1, 1990): 385–99. https://doi.org/10.1080/0032472031000144816.
Graham, Edward. “The Miracle with a Dark Side: Korean Economic Development under Park Chung-Hee.” In Reforming Korea’s Industrial Conglomerates, 11–50, 2003. https://www.piie.com/publications/chapters_preview/341/2iie3373.pdf.
Gupta, Monica Das. “Return of the Missing Daughters.” Scientific American 317, no. 3 (September 2017): 80–85. https://doi.org/10.1038/scientificamerican0917-80.
Hvistendahl, Mara. Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men. PublicAffairs, 2011.
Kashyap, Ridhi, and Francisco Villavicencio. “The Dynamics of Son Preference, Technology Diffusion, and Fertility Decline Underlying Distorted Sex Ratios at Birth: A Simulation Approach.” Demography 53, no. 5 (2016): 1261–81.
Keeny, S. M., ed. “East Asia Review, 1971.” In Population and Family Planning in the Republic of Korea, 2:101–4. Korean Institute for Family Planning, 1972.
Kim, Kwan S. “The Korean Miracle (1962-1980) Revisited.” Kellogg Institute, November 1991. https://kellogg.nd.edu/.
Kim, Ock- Joo, and Sang-Ik Hwang. “The Minnesota Project: The Influence of American Medicine on the Development of Medical Education and Medical Research in Post-War Korea.” Korean Journal of Medical History 9, no. 1 (July 2000): 112–22.
Kim, Seik, and Sam-Ho Lee. “Son Preference and Fertility Decisions: Evidence From
Spatiotemporal Variation in Korea.” Demography 57, no. 3 (June 2020): 927–51.
Kim, Sunhye, Na Young, and Yurim Lee. “The Role of Reproductive Justice Movements in Challenging South Korea’s Abortion Ban.” Health and Human Rights Journal 21, no. 2 (2019): 97–107.
Kim, Tae Ryong. “The Evolution of Family Planning Themes, Slogans, and Non-Verbal Designs in Korea.” In Population and Family Planning in the Republic of Korea, 2:192–203. Korean Institute for Family Planning, 1974.
Kim, Uchang. “Confucianism, Democracy, and the Individual in Korean Modernization.” In Transformations in Twentieth Century Korea, 221–44, 2006. https://www.taylorfrancis.com/chapters/oa-edit/10.4324/978020396827713/confucianism-democracy-individual-korean-modernization-uchang-kim.
Moon, Hyun-Sang, Seung-Hyun Han, and Soon Choi. “Recent Trends in Ideal Family Size.” In Population and Family Planning in the Republic of Korea, 2:281–93. Korean Institute for Family Planning, 1974.
. “Use of Induced Abortion.” In Population and Family Planning in the Republic of Korea, 2:349–59. Korean Institute for Family Planning, 1974.
Moon, Seungsook. Militarized Modernity and Gendered Citizenship in South Korea. Duke University Press, 2005. https://www.dukeupress.edu/militarized-modernity-andgendered-citizenship-in-south-korea.
Nam, Sanghui. “The Women’s Movement and the Transformation of the Family Law in South Korea. Interactions Between Local, National and Global Structures.” European Journal of East Asian Studies 9, no. 1 (March 1, 2010): 67–86. https://doi.org/10.1163/156805810X517670.
National Security Council Bureau of Intelligence and Research. “Republic of Korea: Intensified Drive to Curb Population Growth.” Executive Secretariat, NSC Records, February 9, 1984.
Park, Rae Young. “Impact of Population Growth on Korean Economy.” In Population and Family Planning in the Republic of Korea, 2:61–72. Korean Institute for Family Planning, 1974.
“Population and Family Planning in Korea.” Korea Institute for Population and Health, August 1986. https://www.kihasa.re.kr/.
“Population and Family Planning in the Republic of Korea.” Seoul, Korea: Korean Institute for Family Planning, 1974.
Robinson, Warren C., ed. “The Korean Breakthrough.” In The Global Family Planning
Revolution: Three Decades of Population Policies and Programs, 177–92, n.d. https://www.openknowledge.worldbank.org/.
Ross, John A. “Korea and Taiwan: Review of Progress in 1968.” Studies in Family Planning, April 1969.
Ross, John A., Dae Woo Han, S. M. Keeny, George P. Cernada, T. C Hsu, and T. H Sun. “Korea/Taiwan 1969: Report on the National Family Planning Programs.” In Population and Family Planning in the Republic of Korea, 2:86–93. Studies in Family Planning, 1970.
Seth, Michael J. “An Unpromising Recovery: South Korea’s Post-Korean War Economic Development: 1953-1961.” Association for Asian Studies, Education About Asia, 18, no. 3 (2013): 42–45.
S/K Marketing Research Company. “A Study of the Effectiveness of Family Planning Communications.” In Population and Family Planning in the Republic of Korea, 2:208–14. Korean Institute for Family Planning, 1972.
Song, Kun Yong. “Attitudes Toward Family Planning, Marriage, and Family Size Among Unmarried Women in Korea.” Studies in Family Planning 6, no. 10 (1975): 372–75. https://doi.org/10.2307/1964918.
Worth, George, Walter B. Watson, Dae Woo Han, O.D. Finnigan, S. M. Keeny, T. H Sun, and H.C. Chen. “Korea/Taiwan 1970: Report on the National Family Planning Programs.” In Population and Family Planning in the Republic of Korea, 2:94–100. Studies in Family Planning, 1971.
Yang, Hyunah. “A Journey of Family Law Reform in Korea: Tradition, Equality, and Social Change.” Journal of Korean Law 8 (December 2008): 77–94.
. “Gender Equality vs. ‘Tradition’ in Korean Family Law: Toward a Postcolonial Feminist Jurisprudence.” The Review of Korean Studies 6, no. 2 (2003): 85–118.
Yang, Jae-Mo, and G. C. Worth. “Mothers’ Clubs in Korea.” In Population and Family Planning in the Republic of Korea, 2:237–47. Korean Institute for Family Planning, 1974.
. “Family Planning Programs During Last One Decade in Korea.” Yonsei Medical Journal 12, no. 1 (1971): 55. https://doi.org/10.3349/ymj.1971.12.1.55.
, Sook Bang, Myung Ho Kim, and Man Gap Lee. “Fertility and Family Planning in Rural Korea.” Population Studies 18, no. 3 (1965): 237–50. https://doi.org/10.2307/2173286.
. “An Overview of Family Planning Korea (1961-1978).” Yonsei Medical Journal 20, no. 2 (1979): 184–97.
. “Family Planning Program in Korea.” Yonsei Medical Journal 18, no. 1 (1977): 64–74. Yim, Seong-hi. “Changing Patterns in Korean Family Structure.” Korea Journal, August 1, 1966, 4–15.