History of Maternal Health in
North Korea
North Korea Census Reveals Poor Demographic and Health Conditions
:Carl Haub
"(December 2010) The Democratic People's Republic of North Korea, one of the few remaining Communist countries, has demographic similarities and disparities with wealthier, democratic South Korea. North Korea has conducted two population censuses—one in 1993 and another in 2008. The 2008 Census only became known to the Western media in 2010 and the published results were surprisingly frank regarding the poor demographic and health situation in the country, given its statistical veil of secrecy in the past.
Comparisons with South Korea are inevitable, particularly in light of current tensions. The two countries are technically still at war, having signed an armistice ending the Korean War in 1953 but not a peace treaty. North Korea's 2008 Census counted a population of 24.1 million. South Korea's 2010 estimate, in comparison, is 48.9 million. North Korea's area is 46,720 sq. miles, about the same size as Cuba (with a population of 11.2 million) or the U.S. state of Pennsylvania (12.6 million). South Korea's somewhat smaller area of 38,580 sq. miles is about the same as the Netherlands (16.6 million) or the U.S. state of Indiana (6.4 million) but its population gives it a density of 1,267 persons per sq. mile, one of the world's highest. One of South Korea's security concerns is the location of Seoul, the capital, which contains just over half the country's population. Central Seoul is located just 30 miles from the border with North Korea.
The 2008 Census showed setbacks in health and nutrition since the early 1990s, largely due to a series of famines believed to have caused from 600,000 to 1 million deaths from 1995 to 2000.1 The 2008 Census suggested that life expectancy at birth had declined since the early 1990s to 65.6 years for males and 72.7 years for females, both about 11 years less than in South Korea. The infant mortality rate stood at 19.3 infant deaths per 1,000 live births and the maternal mortality ratio was 77.2 maternal deaths per 100,000 live births. Both indicators have increased since the early 1990s but are also lower than estimated previously by other organizations, such as the United Nations and the U.S. Census Bureau. And both are far worse than in South Korea.
Contrasts in Fertility and Birth RatesOne sharp difference between North Korea and South Korea is the total fertility rate (TFR).2 North Korea's TFR is 2.0 children per woman, about what it is believed to have been in the early 1990s and just below "replacement" level. TFRs calculated from the 2008 Census data indicate a TFR of 1.89 in urban areas and 2.19 in rural areas (the definition of "urban" is not given in the census report). The sex ratio at birth as reported in the census was 104.2 male births per 100 female births, indicating no particular preference for sons over daughters. South Korea, on the other hand, has an extremely low TFR at 1.15 children per woman in 2009. From a purely demographic standpoint, North Korea has fewer concerns than its southern neighbor in supporting an aging population. Two-thirds of households in North Korea consist of extended families, suggesting that family support makes a significant contribution to support of the elderly. The low North Korean TFR seems to contradict Kim Jong-il's expressed wish to have a larger population than his adversary to the south through a higher birth rate, in line with the government's long-standing declaration of the country as a Juche (self-reliant) society.3
The figure below shows wide swings in North Korea's birth rate over the past 30 years. In the late 1970s and early 1980s, the government encouraged only one or two children per couple, reflected in the pyramid at ages 20 through 34. In more recent years, poor economic conditions seem to be discouraging births. Note also the large deficit of males in the upper-age groups, a likely consequence of the 1950-1953 Korean War.
Population of North Korea by Age and Sex, 2008
Source: North Korea Central Bureau of Statistics, 2008 Census.
High Levels of Marriage and Education, Poor NutritionMarriage is virtually universal in North Korea. In 2008, 25 percent of females ages 25 to 29 had never been married, but the figure dropped to only 4 percent for women ages 30 to 34. Of ever-married women ages 30 to 34, 48 percent had first been married at age 24 or later. Divorce is extremely rare. Only 1.7 percent of women ages 40 to 44 are listed as "separated" in the census. Virtually the entire population is listed as "literate" in the census, even up to the age group 80 and over. Educational attainment is relatively high, with 77 percent of males ages 30 to 34 and 79 percent of females having finished secondary school. Among that same group, 12 percent of males and 11 percent of females had completed college. In the labor force, 30 percent of males and 38 percent of females are engaged in agriculture.
Housing is free in North Korea but often cramped and lacking amenities. Extended families average 4.4 persons while most households live in two-room units. Comparatively small apartments in Asia are certainly not limited to North Korea, however. Eighty-five percent of North Korean households have piped water but flush toilets are available to only 58 percent with pit latrines used by most others. The main cooking fuels are coal in the urban areas (63 percent) and wood (28 percent). In rural areas, those proportions are roughly reversed. Very few use electricity for heating or cooking. Twenty-one percent of households live in apartment buildings but, of those, only 4 percent have central heating. The vast majority use coal or wood for heating in a briquette or wood hole in the dwelling.
North Korea's policy of "self-reliance" has contributed to its chronic food shortages; its rugged land and relatively harsh climate are not conducive to productive farming. The collapse of the Soviet Union in 1991, along with bureaucratic mismanagement and natural disasters in North Korea, began a series of agricultural crises that lasted for much of the 1990s and continue today. North Korea has typically been reluctant to ask for food aid from international organizations but it did receive support from the World Food Programme in the mid-2000s. A 2002 nutrition study found that 39 percent of North Koreans were stunted (low height for age), an indicator of chronic malnutrition; the situation had barely improved several years later.4
Nonetheless, North Korea's willingness to conduct and publish nutrition surveys with assistance from UNICEF and the World Food Programme since 1998 and to publish its 2008 Census has not only been surprising, but has revealed many of its internal problems. In 2009, a Multiple Indicator Cluster Survey-4 was conducted with the assistance of UNICEF. The results will be enlightening.
Carl Haub is senior demographer at the Population Reference Bureau."
Source: http://www.prb.org/Publications/Articles/2010/northkorea-population.aspx
Comparisons with South Korea are inevitable, particularly in light of current tensions. The two countries are technically still at war, having signed an armistice ending the Korean War in 1953 but not a peace treaty. North Korea's 2008 Census counted a population of 24.1 million. South Korea's 2010 estimate, in comparison, is 48.9 million. North Korea's area is 46,720 sq. miles, about the same size as Cuba (with a population of 11.2 million) or the U.S. state of Pennsylvania (12.6 million). South Korea's somewhat smaller area of 38,580 sq. miles is about the same as the Netherlands (16.6 million) or the U.S. state of Indiana (6.4 million) but its population gives it a density of 1,267 persons per sq. mile, one of the world's highest. One of South Korea's security concerns is the location of Seoul, the capital, which contains just over half the country's population. Central Seoul is located just 30 miles from the border with North Korea.
The 2008 Census showed setbacks in health and nutrition since the early 1990s, largely due to a series of famines believed to have caused from 600,000 to 1 million deaths from 1995 to 2000.1 The 2008 Census suggested that life expectancy at birth had declined since the early 1990s to 65.6 years for males and 72.7 years for females, both about 11 years less than in South Korea. The infant mortality rate stood at 19.3 infant deaths per 1,000 live births and the maternal mortality ratio was 77.2 maternal deaths per 100,000 live births. Both indicators have increased since the early 1990s but are also lower than estimated previously by other organizations, such as the United Nations and the U.S. Census Bureau. And both are far worse than in South Korea.
Contrasts in Fertility and Birth RatesOne sharp difference between North Korea and South Korea is the total fertility rate (TFR).2 North Korea's TFR is 2.0 children per woman, about what it is believed to have been in the early 1990s and just below "replacement" level. TFRs calculated from the 2008 Census data indicate a TFR of 1.89 in urban areas and 2.19 in rural areas (the definition of "urban" is not given in the census report). The sex ratio at birth as reported in the census was 104.2 male births per 100 female births, indicating no particular preference for sons over daughters. South Korea, on the other hand, has an extremely low TFR at 1.15 children per woman in 2009. From a purely demographic standpoint, North Korea has fewer concerns than its southern neighbor in supporting an aging population. Two-thirds of households in North Korea consist of extended families, suggesting that family support makes a significant contribution to support of the elderly. The low North Korean TFR seems to contradict Kim Jong-il's expressed wish to have a larger population than his adversary to the south through a higher birth rate, in line with the government's long-standing declaration of the country as a Juche (self-reliant) society.3
The figure below shows wide swings in North Korea's birth rate over the past 30 years. In the late 1970s and early 1980s, the government encouraged only one or two children per couple, reflected in the pyramid at ages 20 through 34. In more recent years, poor economic conditions seem to be discouraging births. Note also the large deficit of males in the upper-age groups, a likely consequence of the 1950-1953 Korean War.
Population of North Korea by Age and Sex, 2008
Source: North Korea Central Bureau of Statistics, 2008 Census.
High Levels of Marriage and Education, Poor NutritionMarriage is virtually universal in North Korea. In 2008, 25 percent of females ages 25 to 29 had never been married, but the figure dropped to only 4 percent for women ages 30 to 34. Of ever-married women ages 30 to 34, 48 percent had first been married at age 24 or later. Divorce is extremely rare. Only 1.7 percent of women ages 40 to 44 are listed as "separated" in the census. Virtually the entire population is listed as "literate" in the census, even up to the age group 80 and over. Educational attainment is relatively high, with 77 percent of males ages 30 to 34 and 79 percent of females having finished secondary school. Among that same group, 12 percent of males and 11 percent of females had completed college. In the labor force, 30 percent of males and 38 percent of females are engaged in agriculture.
Housing is free in North Korea but often cramped and lacking amenities. Extended families average 4.4 persons while most households live in two-room units. Comparatively small apartments in Asia are certainly not limited to North Korea, however. Eighty-five percent of North Korean households have piped water but flush toilets are available to only 58 percent with pit latrines used by most others. The main cooking fuels are coal in the urban areas (63 percent) and wood (28 percent). In rural areas, those proportions are roughly reversed. Very few use electricity for heating or cooking. Twenty-one percent of households live in apartment buildings but, of those, only 4 percent have central heating. The vast majority use coal or wood for heating in a briquette or wood hole in the dwelling.
North Korea's policy of "self-reliance" has contributed to its chronic food shortages; its rugged land and relatively harsh climate are not conducive to productive farming. The collapse of the Soviet Union in 1991, along with bureaucratic mismanagement and natural disasters in North Korea, began a series of agricultural crises that lasted for much of the 1990s and continue today. North Korea has typically been reluctant to ask for food aid from international organizations but it did receive support from the World Food Programme in the mid-2000s. A 2002 nutrition study found that 39 percent of North Koreans were stunted (low height for age), an indicator of chronic malnutrition; the situation had barely improved several years later.4
Nonetheless, North Korea's willingness to conduct and publish nutrition surveys with assistance from UNICEF and the World Food Programme since 1998 and to publish its 2008 Census has not only been surprising, but has revealed many of its internal problems. In 2009, a Multiple Indicator Cluster Survey-4 was conducted with the assistance of UNICEF. The results will be enlightening.
Carl Haub is senior demographer at the Population Reference Bureau."
Source: http://www.prb.org/Publications/Articles/2010/northkorea-population.aspx
Maternal Mortality Rate Recently:
"Maternal mortality rate: 81 deaths/100,000 live births (2010)
Definition: The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.
Source: CIA World Factbook - This page was last updated on June 30, 2015"
Source:http://www.indexmundi.com/north_korea/maternal_mortality_rate.html
Definition: The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.
Source: CIA World Factbook - This page was last updated on June 30, 2015"
Source:http://www.indexmundi.com/north_korea/maternal_mortality_rate.html
The Plan to Improve Maternal Health:
Maternal health in North Korea
According to http://www.ippf.org/our-work/programmes/innovation-fund/north-korea, their plan to improve Maternal Health is in the following:
"Introducing medical abortion, enhancing women’s choices and increasing access to safe abortion in the Democratic People’s Republic of Korea.
The Korean Family Planning and Maternal and Child Health Association (KFP & MCHA) conducted medicalabortion services for the first time on a pilot basis in our country… By doing so, KFP & MCHA is playing a pioneering role in the implementation of the National Strategy on Reproductive Health by increasing clients’ rights to informed choice in abortion methods." (KFP & MCHA Annual Report 2007)
Why is this work important?
In the Democratic People’s Republic of Korea (DPRK), surgical abortion by a doctor is the only safe and legal method of induced abortion available.
However, 16% of women suffer complications after undergoing the procedure, particularly women that have repeated or late abortions.
Despite liberal abortion laws in the DPRK, medical professionals have no clear understanding, skills or knowledge of abortion methods other than surgical abortion. They also lack up-to-date technology.
This leaves women both limited in choice and left vulnerable to complications resulting from the only abortionmethod available.
Why is this project innovative?
By introducing medical abortion for the first time in DPRK, the project is leading the way in increasing women’s choice of safer abortion methods by:
We have government support throughout. The Memorandum of Understanding (MoU) between the Government of the DPRK and KFP & MCHA signed at the outset highlights the success of the project’s advocacy strategy.
The MoU provides legal legitimacy to the project and ensures government support throughout.
KFP & MCHA has also successfully initiated relationships with stakeholders such as community leaders, media professionals, and medical personnel in both government and ri (or grassroots) hospitals.
An important component of the project was the training of trainers, which provided the necessary knowledge and skills to 60 service providers, who can now train others in the techniques of safe medical abortion.
Medical equipment and supplies provided by IPPF, including scanners and abortion drugs (misoprostol and mifepristone), ensure optimum conditions for the delivery of high quality abortion services.
Most importantly the project started providing the first medical abortions in the DPRK in December 2007 and solidified its position as a pioneering organization in the sexual and reproductive health sector.
What next?
Throughout 2008, KFP & MCHA is continuing to provide medical abortions to women at 4 static clinics.
They provide referrals for women accessing sexual and reproductive health services through 3 mobile clinics.
The project has been received very favourably by government and clients alike, and they expect to provide safe medical abortions for hundreds of women by the end of the project."
"Introducing medical abortion, enhancing women’s choices and increasing access to safe abortion in the Democratic People’s Republic of Korea.
The Korean Family Planning and Maternal and Child Health Association (KFP & MCHA) conducted medicalabortion services for the first time on a pilot basis in our country… By doing so, KFP & MCHA is playing a pioneering role in the implementation of the National Strategy on Reproductive Health by increasing clients’ rights to informed choice in abortion methods." (KFP & MCHA Annual Report 2007)
Why is this work important?
In the Democratic People’s Republic of Korea (DPRK), surgical abortion by a doctor is the only safe and legal method of induced abortion available.
However, 16% of women suffer complications after undergoing the procedure, particularly women that have repeated or late abortions.
Despite liberal abortion laws in the DPRK, medical professionals have no clear understanding, skills or knowledge of abortion methods other than surgical abortion. They also lack up-to-date technology.
This leaves women both limited in choice and left vulnerable to complications resulting from the only abortionmethod available.
Why is this project innovative?
By introducing medical abortion for the first time in DPRK, the project is leading the way in increasing women’s choice of safer abortion methods by:
- Demonstrating that medical abortions are safe and acceptable alternatives to surgical abortions
- Introducing misoprostol and mifepristone for the first time, with approval from the government
- Advocating to the government for the approval of medical abortion services and integration in the nationalsexual and reproductive health strategy
- Engaging stakeholders to ensure that medical abortion is recognized by grassroots to government levels
- Improving the quality of abortion services by training medical personnel and providing essential equipment and supplies
- Increasing the number of medical abortions to one-third of all abortions
We have government support throughout. The Memorandum of Understanding (MoU) between the Government of the DPRK and KFP & MCHA signed at the outset highlights the success of the project’s advocacy strategy.
The MoU provides legal legitimacy to the project and ensures government support throughout.
KFP & MCHA has also successfully initiated relationships with stakeholders such as community leaders, media professionals, and medical personnel in both government and ri (or grassroots) hospitals.
An important component of the project was the training of trainers, which provided the necessary knowledge and skills to 60 service providers, who can now train others in the techniques of safe medical abortion.
Medical equipment and supplies provided by IPPF, including scanners and abortion drugs (misoprostol and mifepristone), ensure optimum conditions for the delivery of high quality abortion services.
Most importantly the project started providing the first medical abortions in the DPRK in December 2007 and solidified its position as a pioneering organization in the sexual and reproductive health sector.
What next?
Throughout 2008, KFP & MCHA is continuing to provide medical abortions to women at 4 static clinics.
They provide referrals for women accessing sexual and reproductive health services through 3 mobile clinics.
The project has been received very favourably by government and clients alike, and they expect to provide safe medical abortions for hundreds of women by the end of the project."