[Chatham House Roundtable] "Concerns Over Unlimited Age and Attempts in Infertility Policy... Importance of Preventive Messaging"

"'Unlimited' Infertility Policy Requires Caution...
Focus Should Be on 'National Support for Infertility Prevention'

Does Infertility Support Help Solve Low Birthrate?
'No Help' VS 'Effective Response' Divided Opinions

Editor's Note As social advancement and marriage are delayed, the number of infertility patients nationwide facing difficulties with pregnancy and childbirth has surpassed 250,000. The government and local governments are pouring in huge budgets to support various infertility policies, including financial aid for infertility treatments. Asia Economy held a Chatham House roundtable under the theme "In the era of low birth rates, is the current infertility policy adequate?" The purpose was to establish the right policy direction at a time when the number of infertility patients is increasing. The roundtable included Kim Dong-sik, Senior Research Fellow at the Korea Women's Development Institute; Kim Myung-hee, President of the Korea Infertility Families Association; Jung So-jin, Director of the Seoul Metropolitan Government Health Management Division; and Choi Anna, Spokesperson for the Korean Medical Association (former Director of the National Medical Center Infertility Center). Experts gave differing answers on whether existing infertility support policies can be a solution to the low birth rate problem. However, they unanimously expressed concern that unrestricted support for infertility treatments sends a wrong policy message that "it's okay to delay pregnancy" and could harm women's health. The roundtable followed the Chatham House rule, disclosing the list of participants but anonymizing each speaker's remarks.

Experts attending the Chatham House roundtable held at Asia Economy in Jung-gu, Seoul on the 21st are sharing their opinions on infertility policies in the era of low birth rates. From the left: Anna Choi, spokesperson for the Korean Medical Association (former director of the National Medical Center Infertility Center), Myunghee Kim, president of the Korea Infertility Family Association, Kangnyeong Baek, managing editor of digital content at Asia Economy, Sojin Jung, director of the Seoul Metropolitan Health Management Division, and Dongsik Kim, senior research fellow at the Korean Women's Development Institute. Photo by Dongju Yoon

▶ Social Affairs = Baek Gang-nyeong, Digital Content Managing Editor

As solving the low birth rate problem emerges as an urgent task, interest in infertility policies is rising. Do you think current infertility policies help address the low birth rate issue?

A: Infertility is not a physiological disease. It is a result created by social phenomena. The biggest misconception in infertility policy is claiming that the number of children born through assisted reproductive technology (ART) has increased significantly due to infertility support through health insurance. In Korea, children born through ART account for about 10%. The proportion has increased because the total number of births has decreased, but it is difficult to say the absolute number has increased. Policies have been developed to create an environment where ART can be performed indefinitely, but this does not help solve the low birth rate problem.

B: Since the infertility policy implemented in 2006, only infertility treatments have increased. What matters is not the increase in children born through infertility treatments but the increase in total births. The policy direction should be "Infertility is difficult; get pregnant before being diagnosed with infertility. The state fully supports infertility prevention." The current policy tone sends a message that "even if you become infertile, the government will continue to support you, so keep trying until menopause." Both women and men should focus on infertility prevention.

Senior Research Fellow Dong-sik Kim, Korea Women's Development Institute. Photo by Dong-joo Yoon

C: Looking at the infertility policies announced by the government, it seems they emphasize only quantitative achievements. When the birth rate drops sharply, if the number of children born through ART increases, the infertility policy may appear successful immediately. However, if after abolishing all age and income criteria and continuously expanding the current infertility policy there is still no achievement, how will that be explained? That raises questions.

D: I have a somewhat different view. Infertility support is certainly one of the measures against low birth rates. It is difficult to change all causes of low birth rates at once. The most effective response is to support couples who want to have children. Although excessive support may harm women's health and send a policy message that "you can have children later," efforts to change perceptions should be combined while supporting couples who want to conceive.

Do you think infertility policies are heading in the right direction?

B: Current infertility policies dance to complaints rather than expert opinions. They neither help women nor achieve national goals. In the past, infertility treatments were non-reimbursable and mainly performed in private clinics. Support began when the birth rate started to drop significantly in the 2000s. The problem is that when health insurance coverage for infertility treatments was introduced in 2017, non-reimbursable items were left out. Patients still bear 30% of the cost outside of insurance coverage. The government and local governments run support programs, creating a structure where money flows in twice. As technology improves, more non-reimbursable items keep emerging. No other country in the world has such a policy.

A: Policies should be based on scientific evidence to determine their effectiveness and direction. Consistency is necessary, but neither infertility nor low birth rate policies have proper evidence. Even existing statistics are not properly utilized. That is the biggest problem. Policies should be developed and implemented based on data, but since policies are made in other directions, only side effects occur and desired effects do not materialize. Money is spent, and support continues like pouring water into a leaky bucket.

Kim Myung-hee, President of the Korean Infertility Family Association. Photo by Yoon Dong-joo

C: It is concerning that infertility policies are too closely linked to low birth rates, trying to create a social narrative that infertility policy is a breakthrough and achievement to increase birth rates. We need to identify structural problems explaining why our society inevitably faces low birth rates. The average age of first marriage for women is 31-32, and it takes about 1.5 years until the first childbirth. As a result, the first child is born at about 33-34 years old, which is a high-risk situation at age 35. The state needs to examine this deeply. Current infertility policies make people think that delaying pregnancy by one or two years is acceptable because the government will support ART.

How far should infertility support go?

B: Priority should be supporting pregnancy before infertility occurs. Medically, women's fertility declines after age 30. For women over 40, natural miscarriage rates rise to 70-80%, and maternal mortality rates increase during pregnancy. Considering women's health, the target age for infertility support should be lowered. The principle should be not just achieving pregnancy but ensuring "safe childbirth and parenting." For women under 40, insurance coverage should be provided, and for those over 40, a voucher system with certain restrictions should be introduced.

C: When interviewing women who have undergone multiple infertility treatments, couples agree on limits for the number of treatments and age. They plan to try treatments until a certain point and stop if unsuccessful. However, the government offering unlimited support leads to pressure from both sets of parents to try one more time. In this respect, the policy message can impose significant pressure on the individuals involved. Such reactions from the surroundings are side effects of the policy.

One of the representative infertility policies is infertility leave. How do you evaluate this system for those undergoing infertility treatments while working?

C: Looking at infertility leave usage rates, public institutions and large companies are doing okay. Small and medium enterprises drop sharply, and micro-enterprises hardly use it at all. Many female workers do not work in public institutions or large companies. In this structure, is increasing infertility leave by a day or two really important? Attention should be paid to the fact that many cannot take infertility leave at all.

Even if infertility leave is extended to six days, it may still be insufficient during treatment attempts. This can lead to women having to interrupt their careers for treatment. They may have to give up infertility treatments to recover labor rights.

Jung So-jin, Director of Health Management Division, Seoul Metropolitan Government. Photo by Yoon Dong-joo

B: Another problem with infertility leave is that regardless of the number of days, disclosing the fact of infertility treatment to the company when applying for leave is an issue. Infertility leave should not be separate; employees of reproductive age should be able to visit obstetrics, gynecology, or urology clinics freely without concern. Also, the issue of out-of-pocket expenses must be resolved.

D: The system is well established, but there is a culture of underutilization. However, I think it has been stabilizing rapidly recently. In the past, infertility leave did not exist, and even parental leave was taken with hesitation. In Seoul, employees who return after infertility or parental leave receive additional points for promotion.

Some infertility support policies were transferred to local governments in 2022. There are opinions that the central government should take them back. What do you think?

C: The transfer of infertility policies to local governments can be positive because the central government provides overall guidelines. It grants autonomy for local governments to set budgets and plans according to demographic characteristics and industrial structures. However, Seoul is becoming the standard. Seoul has incomparable budgets and personnel compared to other local governments. Local governments just starting support feel burdened. They say if they provide less support, complaints arise. This situation may cause fierce competition and problems that local governments cannot handle.

A: It is the biggest mistake for the government to leave policy-making to local governments with populations of 100,000 or 10 million like Seoul on such a critical national issue as low birth rates. It is irresponsible. Local governments vary in scale. Small local governments may struggle to set policies and achieve goals. Moreover, the government's infertility treatment support policy is too complicated and labor-intensive. Statistics are also poorly generated.

D: From the local government perspective, the Ministry of Health and Welfare gives infertility policy guidelines and then leaves the rest to local governments, causing administrative waste as social security consultations must be obtained for each project. It is desirable for the central government to cover certain parts of infertility treatments through insurance, and for local governments to handle the rest. The Ministry of Health and Welfare should also provide clear or unified standards. Most local governments request this from the ministry.

What do you think is important in infertility policy?

Anna Choi, spokesperson for the Korean Medical Association (former head of the National Medical Center Infertility Clinic). Photo by Dongju Yoon

B: Fertility testing should be available regardless of marital status or cohabitation, starting from teenagers. Out-of-pocket costs should be zero. This encourages young people to care about reproductive health even if they are not planning pregnancy immediately. Reproductive health peaks from puberty to early twenties. Policy messages should emphasize avoiding harm to reproductive health during this period and prompt consultation with experts if problems arise. Infertility treatment technology is medically designed to treat those who cannot conceive. However, Korea socially and economically promotes infertility. Approaching social and economic infertility issues only medically does not solve the problem.

C: Data should be standardized and well collected through government-designated infertility treatment hospitals. This allows accurate assessment of people who have undergone multiple treatments, the condition of children born, and mothers' health, enabling review of policy directions. Women undergoing infertility treatments range from late twenties to mid-to-late forties; their health status as middle-aged and elderly should also be monitored.

A: As important as childbirth is giving birth to a "healthy" child. Infertility policies should focus not only on childbirth itself but also on the condition of children born through infertility treatments.

D: In Seoul, preparing for healthy pregnancy alongside infertility is also considered important. When treatments fail, counseling and mentoring for overcoming emotional challenges are crucial.