Time constraints from detection to prescription pose barriers

In-clinic dispensing rules, doctors' refusal rights add complications

Rural areas with few obstetric facilities face steeper burdens

Minister of Gender Equality and Family Won Min-kyung briefs reporters on the government's plan to introduce abortion medication at Government Complex Seoul in Jongno-gu, Seoul, on Sept. 16. [Yonhap]
Minister of Gender Equality and Family Won Min-kyung briefs reporters on the government's plan to introduce abortion medication at Government Complex Seoul in Jongno-gu, Seoul, on Sept. 16. [Yonhap]

Despite the government's formal move to bring oral abortion medication into the regulated healthcare system, experts say significant barriers to real-world access remain. Concerns are mounting that the nine-week prescription limit and a two-year requirement for in-clinic dispensing could, when combined with limited hospital access and cost burdens, sustain demand for pills obtained outside official channels.

The Ministry of Gender Equality and Family, the Ministry of Health and Welfare and the Ministry of Food and Drug Safety presented the abortion medication introduction plan at the 14th National Policy Coordination Meeting, held at Government Complex Seoul on Sept. 16. The government said it aims to introduce the drug in the first quarter of next year, and proposed that for the first two years, medication be dispensed and administered at medical institutions following a physician's diagnosis and prescription.

Experts say the formal introduction of the medication could improve safe medical access to abortion, but warn that overly restrictive conditions may limit the policy's effectiveness.

The gestational age limit is the first concern raised. Kim Jeong-hye, an associate research fellow at the Korean Women's Development Institute, said the nine-week threshold the government proposed could become another barrier for users. "Access issues remain, and the timeframe is simply too short," she said.

After recognizing a pregnancy, a person must take a test and then find a clinic — a process that takes time. If there are not enough prescribing facilities in the person's area, additional time is needed for appointments and travel. Even after reaching a clinic, if a doctor refuses to prescribe, the patient must seek another provider, potentially pushing the gestational age past nine weeks.

Kim said access is shaped by many factors, including the number of abortion-capable clinics and prescribing physicians in a given area, clinic hours, cost, social stigma and an individual's menstrual cycle.

"The nine-week limit is not simply a matter of a woman confirming she is pregnant within nine weeks and going to a hospital," she said. "The time it takes to recognize a pregnancy and get to a clinic, and the possibility that a doctor will refuse to prescribe — all of these push the gestational age further along."

The in-clinic dispensing requirement set to apply for the first two years is also cited as a variable affecting access. Kang Gyeong-yeon, secretary-general of the Pharmacists for a Healthy Society, said the process of confirming gestational age, taking the medication and then returning for a follow-up could require at least three clinic visits.

"You go to the hospital to confirm the gestational age, take the first pill, come back one to two days later for the second pill, and then return once more within one to two weeks — that is a minimum of three visits," Kang said. "Depending on the situation, it could be four."

However, while the government announced the in-clinic dispensing principle, it has not yet disclosed exactly how much of the medication process — including administration and follow-up observation — would be required to take place at a medical facility. Kang said that if in-clinic dispensing and administration are strictly enforced as announced, "availability and access to the medication will drop sharply." She added that if the time and cost of repeated hospital visits compound with the social stigma around obstetric care, an online distribution market could persist.

Na Yeong, director of the Center for Reproductive Rights and Sexual Health "SHARE," also identified hospital access and medical costs as the primary barriers. "Ultimately, most people consider the medication because of the burden of going to a hospital and the cost of care," Na said. "If insurance coverage is not extended and in-clinic dispensing regulations are not eased, the institutional mechanisms needed to guide people who currently buy pills online toward safe, prescribed care will be inadequate."

'Regional access gaps are wide — supplementary measures needed'

The Network for Guaranteeing the Right to Safe Abortion for All holds a press briefing on the government's abortion medication introduction announcement at Gungmin Yeondae in Jongno-gu, Seoul, on Sept. 17. [Provided by the network]
The Network for Guaranteeing the Right to Safe Abortion for All holds a press briefing on the government's abortion medication introduction announcement at Gungmin Yeondae in Jongno-gu, Seoul, on Sept. 17. [Provided by the network]

Concerns about regional disparities in healthcare access were also raised. The Women's Committee of the Korean Doctors for Health Rights said at a press briefing on Sept. 17 that restricting prescribers and facilities to specialists and specially equipped institutions — and requiring registration or licensing — could widen access gaps between regions.

According to the group, 72 of the country's 250 municipal and county districts were classified as childbirth-underserved areas as of 2023. In areas with few obstetric clinics, patients must travel to neighboring areas, and if the nearest clinic does not prescribe the medication, they must search for yet another provider — compounding the time and financial burden.

The Women's Committee said that in areas with a shortage of medical facilities, a voluntary registration system alone would be insufficient to fill the prescriber gap. It called for supplementary measures such as designating public or tertiary medical institutions as authorized prescribers, and establishing telemedicine and emergency prescription referral systems.

The committee also raised concerns about blanket requirements for in-clinic waiting or short-term hospitalization. It noted that mifepristone, the first medication in the regimen, produces almost no noticeable physical symptoms after ingestion, while the bleeding, abdominal pain and fever that may follow misoprostol, the second medication, are expected side effects — meaning there is insufficient medical justification to require all users to remain at a clinic.

Experts accordingly suggest that abortion medication be managed as a prescription drug, but that patients be allowed to take it at home after a physician's diagnosis and prescription.

Kim said the option she has long advocated is making the medication available at pharmacies rather than requiring a hospital prescription, noting that pharmacy dispensing is compatible with prescription-drug controls. She also called for a review of blanket requirements for procedures such as ultrasound examinations.

Kang agreed that the medication "should be managed as a prescription drug and used under a physician's diagnosis and prescription," but added that "allowing patients to take it at home afterward is necessary to improve access."

Na said that if abortion were treated as an essential medical service like any other condition — with official medical information provided accordingly — reluctance to seek clinical care would diminish significantly. She said government-level information provision and institutional improvements to access must go hand in hand.


newday@heraldcorp.com