SEOUL, July 21 (AJP) - For seven years, South Korea's abortion debate has remained trapped between a Constitutional Court ruling that struck down the country's abortion ban and a legal vacuum that has left women navigating an unregulated market for medication.
President Lee Jae Myung has now thrust the issue back onto the government's agenda by questioning why women seeking to terminate pregnancies are still being driven toward illicit online sellers for a medicine that is legally prescribed across much of the developed world.
At a Cabinet meeting on July 14, Lee instructed the government to find a way to permit the proper use of mifepristone even before lawmakers complete long-delayed revisions to abortion laws.
"Even if it creates some difficulty for the government, we should make it possible for the drug to be administered properly," Lee said.
"I think it is irresponsible for the government to leave things as they are."
Lee also suggested doctors could temporarily be given professional discretion over prescribing the medicine, arguing supervised treatment is preferable to women buying unidentified products online without prescriptions or follow-up care. Relevant ministries have begun consultations under the Office for Government Policy Coordination.
His intervention has transformed what had largely been a dispute among regulators, women's rights groups and medical organizations into a broader test of whether the government can move administratively while the National Assembly remains deadlocked.
At the center of the debate is mifepristone, used together with misoprostol, the internationally accepted medication regimen for early pregnancy termination and approved in nearly 100 countries.
Can approval come before abortion-law reform?
Progressive Party lawmaker Son Sol, who has proposed revisions to Korea's abortion laws, argues it can.
She said the Ministry of Food and Drug Safety already has authority under the Pharmaceutical Affairs Act to review and approve mifepristone independently of broader abortion legislation.
"Marketing authorization should be pursued first, while amendments to the Mother and Child Health Act and related laws covering the legal definition of pregnancy termination, standards for medical provision and national health insurance coverage should proceed at the same time," Son told AJP.
The distinction is significant.
Drug approval determines whether a medicine satisfies standards for safety, efficacy and quality, along with approved dosage, indications and gestational limits. Separate legislation would still be required to determine who may prescribe the drug, where it may be dispensed, how complications are managed and whether treatment qualifies for national health insurance.
Son's amendment to the Mother and Child Health Act, introduced in March, remains stalled in committee along with a companion bill extending national health insurance coverage for abortion care.
The legislative impasse dates back to April 2019, when South Korea's Constitutional Court ruled that blanket criminal punishment for abortion disproportionately infringed women's right to self-determination. The court gave lawmakers until the end of 2020 to devise a replacement framework, but Parliament failed to act, causing the criminal provisions to lapse on Jan. 1, 2021.
The result has been an uneasy legal overlap in which criminal penalties disappeared while the country's medical and regulatory systems were never comprehensively updated.
Medical evidence versus political deadlock
Medical specialists say the debate should be grounded in evidence rather than political rhetoric.
Lee Yong Soo, a pharmacology professor at Duksung Women's University, explained that mifepristone blocks progesterone receptors needed to sustain pregnancy, while misoprostol induces uterine contractions to expel pregnancy tissue.
Because the medicines are administered only once, prolonged drug toxicity is not the principal concern, Lee said. Greater risks arise from incomplete abortion, excessive bleeding or infection, making proper follow-up care essential.
Cho Jung Hwan, professor of pharmacy at Sookmyung Women's University, said neither portraying the regimen as experimental nor describing it as harmless accurately reflects current scientific evidence.
Clinical studies cited in U.S. prescribing information show complete termination rates of approximately 96 to 97 percent through 70 days of pregnancy, he said. Around 2.6 to 3.8 percent of patients require surgical intervention because of ongoing pregnancy, incomplete expulsion, bleeding or patient request, while serious adverse reactions occur in fewer than 0.5 percent of cases.
He nevertheless stressed that safe introduction would require screening for ectopic pregnancy, assessment of contraindications, informed consent, emergency referral systems and follow-up examinations seven to 14 days after treatment.
Any Korean approval, he said, should combine scientific review with quality control, patient counseling, emergency care and clearly defined legal responsibility.
That evidence-based middle ground remains largely absent from Korea's illicit market.
Na-young, head of the Center for Sexual Rights and Reproductive Justice, or SHARE, said many women, particularly teenagers, continue purchasing abortion pills through unregulated channels without knowing the ingredients or dosage.
A five-year regulatory loop
Hyundai Pharmaceutical first applied for Korean approval of Mifegymiso in July 2021.
The company withdrew the application in late 2022 after the MFDS requested additional safety, efficacy and quality data. It reapplied in December 2024, and the application remains under review.
The prolonged process reflects two separate questions.
One concerns whether the product satisfies Korean pharmaceutical standards.
The other is whether the government is prepared to determine prescription rules before lawmakers agree on a comprehensive abortion framework.
Critics of immediate introduction argue that approval alone cannot resolve issues including medical liability, emergency treatment, conscientious objection and protections for minors.
Ahn Sang-hoon, a People Power Party lawmaker and former Seoul National University professor, said political hesitation reflects interests extending well beyond medicine.
"The reason the South Korean government and political community have been passive on the issue of pregnancy termination is that it is not confined to an area of professional judgment such as medicine, but involves the complex interests of various groups, including religious communities," Ahn told AJP.
"This is an issue that requires consideration not only of a specific medication but also of cultural responses, including efforts to promote adoption."
Is access a constitutional obligation?
Jeff King, professor of law at University College London, said recognition of a protected personal choice does not automatically create a constitutional obligation for governments to provide abortion services.
A court could, for example, conclude cannabis use should not be criminalized without requiring governments to facilitate access, he said.
The analysis changes, however, if people cannot safely exercise a legally protected choice because the government fails to regulate access to necessary medical treatment.
King was more critical of delaying pharmaceutical review solely until lawmakers complete abortion legislation.
If regulators do not ordinarily suspend drug reviews because a treatment is politically controversial, withholding a decision on mifepristone could indicate opposition to abortion rather than ordinary pharmaceutical standards, he said.
In that case, prolonged delay itself could become vulnerable to constitutional challenge.
His analysis broadly aligns with South Korea's National Human Rights Commission, which last year urged the government to integrate abortion care into the public health system, apply national health insurance coverage, train medical professionals and introduce abortion medication as an essential medicine.
Other countries separate approval from service rules
International experience suggests pharmaceutical approval, abortion law and health-care delivery need not be resolved simultaneously.
France approved mifepristone in 1988, the United States in 2000 and Japan in 2023. England and Wales permanently allow eligible patients to receive early medical-abortion medication through teleconsultation and complete treatment at home.
The World Health Organization similarly supports self-managed medical abortion before 12 weeks, provided patients have accurate medical information, quality-assured medicines, trained health-care providers and access to emergency treatment when needed.
The international record therefore offers little support for either extreme. It does not endorse unrestricted online sales, but neither does it suggest governments must postpone pharmaceutical approval until every legal and ethical question surrounding abortion has been resolved.
Two clocks are running
The Lee administration now faces two separate timelines.
One runs at the Ministry of Food and Drug Safety, where Hyundai Pharmaceutical's application remains under review.
The other runs at the National Assembly, where abortion-law revisions have remained dormant since March.
The president's remarks cannot resolve questions over gestational limits, insurance coverage, conscientious objection or medical liability.
But they have made one point increasingly difficult for the government to avoid: continued inaction is itself a policy choice.
Medical experts broadly agree that authorization must be accompanied by screening, follow-up care and emergency medical support.
Lawmakers remain divided over how abortion should ultimately be regulated.
The question is no longer whether South Korea can continue postponing a decision.
Women seeking abortions have already been absorbing the consequences through uncertain products, high costs and fragmented medical care.
The issue now is whether Lee's intervention finally connects decriminalization with a functioning health-care system — or merely opens another chapter in a debate that has already outlasted the law it was meant to replace.
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