In Korea, once labeled as a country that could disappear first in the world due to low birthrates, the sound of babies crying is growing louder again. In the first quarter (January–March) of this year, the number of births was 75,013, up 14.8% from a year earlier. But delivery rooms to receive these babies are in short supply. Expectant mothers are struggling to book deliveries, and hospitals are mired in staffing shortages. We examined the problems in Korea's delivery infrastructure. [Editor's note]
A person surnamed Kim (36), who gave birth to a first child in April this year, moved at 30 weeks of pregnancy from Eunpyeong District, Seoul, to Gyeryong, South Chungcheong. The move came after the husband's workplace transfer was finalized, but Kim fell into deep concern ahead of delivery. That was because there wasn't a suitable delivery hospital near the new home.
Kim ultimately delivered in nearby Sejong, not in the residence. Because of a thyroid condition, Kim had to choose a hospital that could provide collaborative care with family medicine, and since traveling alone was difficult, the husband had to take leave for every checkup. Kim said, "A hospital in Daejeon 20 minutes from home had suspended deliveries since February," adding, "When I excluded hospitals that required admission to a postpartum care center, there were almost no options."
Kim's case is not an exception. As regional delivery infrastructure collapses, more expectant mothers are moving to nearby cities because they cannot find a hospital to deliver within their residence. Obstetrics and gynecology clinics cannot accept pregnant patients due to staff shortages, and mothers are resorting to 'out-of-town deliveries' in a vicious cycle.
◇ One in three areas nationwide is a 'zero-delivery' zone
According to the study "Korea's delivery workforce gaps and redefining preterm-birth policy," released on the 23rd by Seo Young-seok of the Democratic Party of Korea, 84 out of 252 cities, counties, and districts nationwide in 2024 had no delivery medical institutions at all, designated as "zero-delivery zones." That accounts for 33.3% of the total.
The number of babies born to mothers in these areas was 24,176, about 10% of all births that year. Even after accounting for multiples such as twins, roughly 1 in 10 mothers had to deliver outside their residence.
The problem is that even regions with remaining delivery facilities cannot be at ease. If an existing hospital shuts down due to staffing shortages, the entire regional delivery system can be shaken in an instant.
Recently, Seohae Obstetrics and Gynecology in Jeju City, a key delivery hospital in Jeju Province, announced online that it plans to close in August. The hospital is known to have two directors alternating on-call duty 365 days a year. As of last year, it handled 870 births, accounting for 28% of all births in the province.
Anxiety is also growing among mothers in nonmetropolitan regions. A person surnamed Jang (31), who delivered at Seohae Obstetrics and Gynecology late last year, said, "The medical staff looked overwhelmed trying to handle too many patients," adding, "As I plan for a second child, I even wonder, 'Is it okay to keep living in Jeju?'"
◇ Government-designated maternal and neonatal centers also face staff shortages… 'delivery ping-pong'
Government-designated maternal and neonatal centers are not free from staffing shortages either. These centers are dedicated medical institutions responsible for delivery and treatment of high-risk mothers and newborns. They operate by severity as critical (2), regional hub (20), and local (33). Each institution receives up to 600 million won per year.
But many centers are failing to meet the staffing standards set by the government. Under Ministry of Health and Welfare guidelines, a regional hub maternal and neonatal center must have at least four obstetricians and two subspecialists in neonatology. A local maternal and neonatal center needs at least two obstetricians and one subspecialist in neonatology.
Currently, 13 of the 20 regional hub maternal and neonatal centers are operating without meeting these standards. Incheon, North Chungcheong, South Chungcheong, North Jeolla, South Jeolla, South Gyeongsang, and Jeju had no regional hub centers that met the staffing criteria. In most cases, the number of obstetricians fell short. Some specialists were absent due to overseas training or leave.
As regional delivery infrastructure weakens, incidents of failing to find a hospital in emergencies are recurring. In Cheongju, North Chungcheong, a 29-week fetus recently died during emergency delivery surgery. Local hospitals refused transfer citing lack of specialists, and surgery began only after three hours in Busan, but the fetus could not be saved.
◇ Creating 'university hospital charts' to prepare for emergencies
Some pregnant people, worried that transfers may be virtually impossible when an emergency delivery is needed, are preparing what's called a 'big-hospital chart' in advance. Short for a university hospital chart, the idea is that leaving a prior medical record at a tertiary hospital may slightly increase the chances of transfer during an emergency.
A person identified as A, who had an emergency delivery in South Chungcheong early this year, said, "I should have prepared a big-hospital chart like my friends," adding, "If transfers during emergencies were at least guaranteed, the concentration at top-tier hospitals could also be eased."
Experts say regional delivery infrastructure has already reached its limit. Kim Jae-yeon, president of the Korean Society of Obstetrics and Gynecology, described regional delivery infrastructure as "close to a desert." Kim said, "No pregnant person can predict whether they will deliver preterm or need an emergency delivery," adding, "Having a baby outside the capital area has become like a gamble."
Kim emphasized the need to improve compensation systems to prevent the exodus of medical staff and to build a rapid transfer system. Kim said, "We must improve delivery reimbursement rates and ease legal risks so medical staff do not leave the field," adding, "It is also urgent to establish transfer and transport systems that can quickly move high-risk mothers and newborns."