Acceptance and effectiveness of contraceptive service in rural Korea
It is known that the Korea is now one of the countries having national policies
and programs in support of family planning and giving high priority to developing
the program through the health center net work.
Since the public health responsibility for family planning is a new development
in Korea, efficient programming of family planning service requires adequate
knowledge and experience based on the actual practice of contraceptive methods in
Korean community, especially in a rural setting.
To provide such information, it is fortunate for us that starting in 1962 an
action type research program made possible through a generous grant of the
Population Council, New York, is now being conducted by Yonsei University College
of Medicine in the rural area of Koyang, Korea.
The overall objective of the Koyang project is to demonstrate and evaluate the
possiblity of reducing the birth rate through family planning education and
The area chosen for the study was Wondang Myun(township), Koyang Gun(county)
which is located 13 miles north of Seoul and has about 9,000 inhabitants in 7
villages, Kimpo Myun, having a population of about 12,000 in seven villages has
been designated as the control area for a comparative study. For an unbiased
appraisal of any anticipated change in the study area, a comparable area with a
similar population but without our program is mandatory. Kimpo Myun is located 20
miles west of Seoul and separated from the study area by the Han River.
The study began with a baseline survey of information, attitudes and practices
related to family planning in September, 1962, in both the experimental and the
Following the baseline survey, intensive educational and clinical sevices were to
begin in the study area only from October, 1962.
Also the first evaluation of our program, a brief re-interview of the same
respindents contacted in the first sample survey was scheduled for both areas
during the winter of 1963 in order to observe what changes had occurred in
fertility rate and in the practice of conception control during this one year
period of the program.
From the start of the action program in October 1962 to March 1964, a total of
620 couples participated in the contraceptive sevices of the Koyang Family Planning
Study Project. This figure represents 45% of the total number of 1,357 women 15-14
years of age living with their husbands in the study area as of December 31, 1963.
As experience in other areas, acceptance occurred most often among couples with 3
or more children (74.2%).
Out of 620 participants about 74% or 461 were classified as users on March 1964,
and 26% or 159 subsequently discontinued use with various reasons; 68(11%) did so
because of accidental pregnancy, 30(4.8%) wanted baby, 21(3.1%) contraception
abandoned, 30(4.8%) moved away, and 2(0.3%) not contacted.
About 70% of the 461 active users (including readmission of 43 women out of 111
women who were accidentally pregnant once or more) have been practicing for 6
months or more at the end of observation.
Of 620 participants in the project, 313 or 50.4% accepted only one of the two
methods (condom and foam tablet) offered through the period of study; 263 couples
relied on condom, 50 on foam tablets. Of those who tried more than one of the
prescribed method, 251 couples used two, and 56 couples three or more methods.
The subsequent methods found to have been practiced by the participating couples
at the last observation were condom 395(63.7%), foam tablet 93(15%), condom and
foam tablet 89(14.4%), rhythm combined with other methods 19(3.1%) and other
methods 24(3.8%). Therefore, their preference for condom is clear, and this means
that the practice of contraception is now under the leadership of husbands, even
though the contraceptive supplies were introduced by wives into the home through
female family planning workers.
The pregnancy rate of 62 before registration declined to 30 while the
participating couples were under observation. This reduction of about 50% indicates
no more than the 1st stage of contraception endeavour but a low order of efficiency
in comparison with the studies in other countries.
Even though pregnancy rate with use of condom was lower than that with other
methods combined, the higher level of those in general suggest that all methods
offered were used irregularly or not according to instructions.
While 388 or 62.5% of users(620) reported as regular users(no omission of use at
any time), it is common, as experienced in other studies, that many couples failed
to admit irregularity in use until the wife has become pregnant. While no great
confidence can be placed, the distribution of accidental pregnancies ere classified
according to the explanation given by the participants.
The most weight to those who associated conception with omission and irregular
use (555%) was claimed mainly husband's objection in use of condom.
We introduced and encouraged the use of simple traditional contraceptives and
assessed their effectiveness in reducing the birth rate, the foam tablet and condom
methods were recommended as first choies for trial. However, our field workers
explained to the villagers all five proven contraceptive methods and asked them to
choose freely among them. All contraceptive supplies were provided free of charge.
In order to assess our action program for about one year, the comparative or
evaluation study, previously mentioned, was carried out by re-interviewing the same
wife contacted during the baseline survey in both the control and the study areas.
At this re-survey, only 448 or 91.2% of 491 wives in Wondang and 415 or 86.8% of
478 of the wives in Kimpo who had been previously contacted interviewed. The sample
loss was mainly due to move-outs from the area(about 10%).
It is interesting to note that about 80% of the respondents in both areas, stated
they were informed of the family planning program. When asked who had explained the
program to them it was found that while the family planning worker was the major
source of information in both areas, the women workers were also mentioned as the
source by about one third of the respondents in the control area. However, in
actual practice of conception control, the percentage of acceptors increased about
4 time in the study area in comparisom with the first survey. Also, the acceptors
were found to have increased two times in the control area.
In examining the proportion of contraceptive methods currently practicing the
users of foam tablet have somewhat decreased but remained at the 20% level in both
areas, while the proportion of condom users have increased 4 times in the study
area as well as in the control area.
Asked the reasons for practicing family planning, about two-thirds of the
acceptors mentioned the economic problems especially in raising and educating
children. It is true that the general public are becoming increasingly conscious of
the necessity to limit the number of their children due to the preasure of various
socio-economic factors such as poverty and social enlightenment.
In the reason given for not having practiced family planning, a desire for more
children especially for sons was the most prominent factor.
It may be too early to assess the effects of our Action Program at this stage in
terms of birth rate, but the vital data collected by the 1st and 2nd surveys of the
sampling households could provide some indication in the birth rate in both areas.
In the study area, the crude birth index was changed from 42 to 32 while the index
in the control area 40 to 34. Even though such difference in rates is still
subjects to sampling error, it can be said that the difference between the 1st year
birth rate and the 2nd year rate in Wondang is statistically significant at 95%
confidence level. Whether such a decrease is due to the contraceptive practice
and/or induced abortion is subject to further evaluation.
Also, the downward trend of birth rate in the control area leads us to the
assumption that the Korean birth rate is not at lease increasing by family
limitation including induced abortion and conrtaceptive methods for the past years.