SEOUL — In South Korea’s capital, residents who have undergone vasectomies or had their tubes tied may soon be able to receive a cash reimbursement for reversing the procedures, as Seoul looks to boost birthrates. The metropolis of 9.6 million had a fertility rate of 0.55 last year, the lowest in the country — which has the lowest rate in the world.
According to a budget proposal released this week, the Seoul city government is planning to offer up to $730 to around 100 people to cover costs related to the reversals, including medication and hospital stays. The cost of the reversal procedures is already covered under South Korea’s national health insurance, while vasectomies and tubal ligations are not.
The approximately $73,000 allocated for the plan is a small portion of the fertility-related provisions in the proposed budget, which includes about $5.9 million for medical care for pregnant patients over age 35. It also allots about $1.6 million in funding for public wedding venues.
The provision is aimed at “easing the financial burden on families wishing to become pregnant,” according to the announcement. The effort suggests that the city government is targeting even those who have taken decisive, medical steps to prevent pregnancy as it looks to increase birthrates. South Korea’s falling birthrate has been attributed in part to the difficulties of balancing child care and a career as well as the high cost of raising children.
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Dosang Bahn, 32, got a vasectomy in Seoul last year before the birth of his third child. He said he is skeptical of the new policy. “I find it pointless. I doubt those who had already undergone the procedure would reverse it to have more children.”
Bahn, who works in advertising, explained that the social and financial pressures of child-rearing were his main reasons for getting a vasectomy in the first place — and he is mindful of the logistical difficulties he encountered, including multiple visits to the doctor.
“For me personally, the surgical procedure was awkward and I don’t want to go through it — or its reversal — again, especially when my wife and I are done with our family planning,” he said.
Of the two birth control methods, tubal ligations are more invasive, have a higher risk of complications and are more difficult to reverse than vasectomies. Vasectomy reversals are about 90 to 95 percent effective, according to Stanford Medicine, while pregnancy rates after tubal ligation reversals vary from 50 to 80 percent, according to the Cleveland Clinic.
About 110 reverse vasectomy procedures are recorded annually in Seoul, according to national insurance data cited by a government official.
Seok Seon Yoo, a urologist at Trueman Men’s Clinic in Seoul, said in an email that of the thousands of vasectomies he has performed for patients, “maybe 1 to 2 percent” of them later want the surgery reversed.
Of those who come in for a consultation, the vast majority end up deciding to get a vasectomy “because they have already fully consulted with their wives and family,” he said. Many in Korea opt for vasectomies “because of their safety, very low complications, and cost-effectiveness,” Seok said.
In some countries, pronatalist government efforts are criticized for focusing on short-term solutions such as cash bonuses instead of more lasting, sustainable changes such as making child care more affordable or improving gender equality in the workplace. In a 2022 academic paper, authors Stuart Gietel-Basten, Anna Rotkirch and Tomas Sobotka noted that in places with low birthrates, many people say they want more children than they end up having, creating gaps that are “often symptoms of societal and economic dysfunction.”
In South Korea, incentivizing sterilization-reversal procedures is not an uncommon approach to low fertility. More than 30 local governments have taken up similar initiatives, according to local media. When Gimcheon, a city about 120 miles southeast of Seoul, announced last year that it would give around $730 to people who have had a reversal procedure, the mayor said the policy was expected “to play a role in creating a childbirth-friendly atmosphere and increasing the population.”
Sunhye Kim, a professor at Ewha Womans University in Seoul who studies reproductive health and rights, said that while Seoul’s proposed policy may be beneficial to some people who require financial assistance for the procedures, “it will not increase the birthrate.”
In 2004, the South Korean government added the country’s low fertility rate and aging society to the national agenda as a point of concern. The same year, the country’s national health insurance ended its coverage of birth control methods including tubal ligations, IUDs and vasectomies and began covering sterilization reversals and IUD removals instead the following year.
Kim draws a parallel between government intervention in the 1970s and ’80s and today. Decades ago, South Korea “aggressively implemented sterilization procedures as part of its anti-natalist policies” aimed at decreasing the birthrate, she said, while, in more recent years, contraception and abortion services have been regulated and limited “because the low fertility rate trend is regarded as a national crisis.”
The “right of all individuals to choose whether to have children” should be guaranteed, Kim said. “This new policy announcement simply confirms that changing population policies can easily regulate or control individuals’ reproductive health and rights.”