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North Korea has an aging population. It is guesstimated that current fertility is below the replacement level. So I suppose it should not have been a shock to see a Radio Free Asia story titled “North Korea Forbids Doctors to Perform Abortions, Implant Birth Control Devices.” An unnamed source, this time in Yanggang province, told the RFA Korea service that the order came down on 8 October making birth control procedures (typically the implantation of an intra-uterine device) and abortion illegal with unspecified penalties for doctors who violated the new law.
This turn in policy, if true, is reminiscent of the ban on abortions and IUDs, imposed initially in 1966 in Romania after Nicolae Ceausescu took power, and subsequently extended to other forms of birth control. Initially the crude birth rate soared, but after two years began converging back toward its previous level. The policy was a public health catastrophe: maternal mortality exploded, 87 percent of which was accounted for by illegal abortions which had become one of the principal methods of birth control. At its peak, “Romania had the highest maternal mortality in all of Europe by a factor of ten.” After 1983, birth rates were no longer published, and beginning in 1986, “a 30 day delay was imposed on birth registration to avoid acknowledging infant deaths in the first month of life, a statistical ruse designed to reduce the infant mortality rate which had soared to 25.6 infant deaths per 1,000 births in 1985.”
Thousands of abandoned children warehoused in derelict orphanages were a byproduct of the policy.
Then, when it seemed the situation could not get any worse, disaster truly struck. I will simply quote a Human Rights Watch report written in 1990:
“As odd as it now seems, Romania was at low risk for an AIDS epidemic. The country was too poor and had too little hard currency to support an active drug trade, and the regime was so repressive of homosexuality that individual practices never added up to a network of contagion. What is more, Romanians rarely went abroad, and aside from some third-world medical students and dock workers, foreigners rarely visited. Thus, a handful of cases that appeared in the mid-1980s might still be a handful—if not for the additional fact that some one or another of them donated blood.”
That alone still might not have been enough to create calamity except that given the extraordinary rise in infant mortality, physicians were charged with saving babies. Short on antibiotics, the doctors began injecting them with drugs rather than administering the medicines orally. And as HRW puts it “Because disposable needles were unavailable, autoclaves were antiquated, and the nurses too ignorant or tired to spend fifteen minutes necessary to boil the needles, Hepatitis B, and finally, the HIV virus were passed from one child to another.”
The consequence was thousands of HIV-infected orphans.
Notice any parallels?
The conventional wisdom is that pronatalist policies are ineffective: people decide to have children or not to have children for a host of economic and social reasons. If one really wants to boost the birth rate, affordable child care, not restrictions on access to birth control, seems to be the more likely recipe. And that is what makes the RFA story, if true, so curious: one would think that the North Koreans might have grasped that the collapse of the social safety net (in particular, supports for mothers) might have something to do with the fall in the birth rate. And to be clear, the RFA story alleges that the North Koreans have banned IUDs and abortions—not all forms of contraception. But then again that is how Ceausescu started out as well.
Nicolae Ceausescu visited North Korea and enjoyed a close relationship with Kim Il-sung (who reciprocated the visit). To the extent that we know anything about the inner workings of North Korea, we know that the North Korean leadership was stunned by Ceausescu’s overthrow and execution. One would think that discontent created by his disastrous pronatalist policies would have been noted in the North Korean post-mortem assessment. Perhaps not. Or perhaps it is just that things in North Korea are so stove-piped, and the climate of fear created by the numerous purges and executions is so great, that no one who knows this story is willing to speak up.
