Pregnancy, Caesareans and Body Image in Korea

(Celebrity mother Byun Jung-soo (변정수), posing in July 2005 and then July 2006. Source)

I’ve been reading a lot about Korean modernization recently, and it’s been interesting to see how the few feminist sources on that uniformly emphasize the sociological themes of the nuclearization of the family and “housewifization” involved in the process that “traditional” accounts lack. Related are the adoption of rational, Western models of health-care and mothering as symbols of that modernity too, and hence I came to be reading the following description of becoming a mother in Korea in the very same week that my second daughter suddenly arrived:

“Women experience acute conflicts and tensions in accepting their new, post-birth identities. Especially amongst the younger women [interviewed], the “mother” identity conflicts severely with their identities as an independent, self-reliant professional woman, or as a lover or wife of a young husband. Moreover, in the 1990s, mass media touts images of beauty, youthfulness and competence; this discourse on femininity, which implies that women should continue to be “feminine, slim, and competent,” makes it much more difficult for them to accept the physical and social changes accompanying childbirth. Therefore, women exert tremendous efforts to lose the extra pounds they put on during pregnancy, and some, concerned with their body shape after delivery, even diet during pregnancy. Some choose to bottle-feed their babies instead of breast-feeding simply because they want to go on a diet immediately following delivery. Also, some young women commented that they suffered from post-partum depression, which resulted in part from their own conflicts with their changed status.

(Kim, 1997: 363. My emphasis)

Of course, the first half of the paragraph is applicable to virtually any new mother in any developed society, whereas the part that I’ve emphasized is probably most common in Korea and East Asia. But however perverse it sounds, in a sense it’s a logical conclusion to the excessive emphasis that Korean women tend to place on their body images, demonstrated by the fact that, for instance, while Korean women in their twenties are the slimmest in the OECD they actually consider themselves to be the most obese personally (reference to be added over my coffee tomorrow morning; for now, see here). With plenty more factoids like that to offer based on my research on Korean women’s body images, then personally I’m not at all fazed by this new information (new to me that is), and have a gut instinct that the statement is equally if not more applicable of Korean mothers today than when it was first written.

(Update: For an interesting, more down-to-earth description of becoming a mother in Korea, see here)

(In March 2007. Source)

But let’s examine this “gut instinct” of mine for a moment. Certainly I think I’ve earned the right to able to make judgments on the validity of any statements made about Korean women’s body images, and that revelation of Kim’s is very much in line with what I already know about them. But then I’m only just beginning to scratch the surface of mothering in Korea specifically, and have no research of my own to back that up. Unfortunately, Kim provided no evidence for her assertion either.

Was it absolutely necessary for her to do so? Certainly in a thirty page article in an academic journal not every point needs to be religiously referenced, particularly if it is considered common-sense and/or an article of faith by readers, generally specialized academics already very familiar with the topic. Nor does a lack of evidence by any means imply fabrication either.

But the more I study the topic of Korean women’s body images, the more I become aware of what I previously regarded as common-sense for the subject may sometimes be little more than preconceptions on my part. Take what I regard (update — formerly regarded: see here, here, and here!) as Korean women’s Caucasian body ideals for instance. While there is much more basis to my belief in those than the fact that it is extremely rare to see a Korean rather than a Caucasian model in lingerie advertisements (see here for a summation of them), it’s also true that those advertisements were certainly the most visible and glaring piece of evidence in favor of them: turn on a Korean TV, open a Korean women’s magazine, or simply wait for a bus, and one is soon bombarded with images of Caucasians. Hell, of course Koreans place them on a pedestal.

(Source)

But at the very least, the recent revelations that Korean models merely disdain lingerie modeling as “beneath them” (update — in hindsight, things were a little more complicated than that; see here for more details) demonstrates that things are more nuanced than they may at first appear, and cross-country comparisons (see here and here) of the number of Caucasians in Korean advertisements need to be reexamined in the light of this new information: would the numbers of Caucasians drop dramatically if lingerie advertisements were excluded? More pointedly, did they lead me to see inferiority complexes and racial motivations in other aspects of Korean women’s body images where none actually existed?

Naturally I don’t think so, but it’s good to remember that what passes as common-sense is really very specific to cultures, periods, individuals and their agendas, as I’m sure any expat in Korea is fully aware. The author of this recent post on the bodies of young Chinese gymnasts at Feministing, for instance, quotes a study that finds 46% of American women to naturally have “rectangular” body shapes, whereas to me (and this commentator) that figure is simply absurd. But the otherwise excellent quality of that post also leads me to believe that the author didn’t simply pick and choose a source which best supports her arguments; rather, she genuinely believes that most American women generally do not have the curvy, hourglass figures that have been so venerated historically, and both our notions of common-sense just so happen to support our different takes on that (see here and here for mine).

Hence, what one author or groups of authors regards as common sense always needs to be challenged. To me, the classic experiments of Harry Harlow reveal this truism best.

(Source: fotos.rotas)

Back in the 1950s and 60s, it was generally believed by the scientific community that rats were just as effective experimental subjects as primates for learning about human behavior, a position that just so happened to be much cheaper and convenient for researchers too. It was also believed that there was absolutely no basis to the idea that children with bad parents would be more likely to be bad parents themselves either. To prove the former wrong in particular, Harlow conducted:

…a series of experiments on mother-child bonding in rhesus monkeys. With hindsight, many of Harlow’s tests seem quite hideous. In order to demonstrate that it was comfort rather than food alone that baby monkeys sought from their mothers, he created a pair of monstrous models: cloth mother and wire mother. Cloth mother was soft and cosy. Wire mother was hard and uncomfortable, but delivered milk. No prizes for guessing which one the babies preferred to cling to. Some mothers were even worse. In order to investigate maternal rejection, brass-spike mother, air-blast mother and others like them were brought into play. Harlow had no time for the euphemisms which, even today, are used to soften the descriptions of experimental procedures in scientific papers. The apparatus he devised to impregnate females whose courtship skills had been destroyed by their sterile upbringing was known as the rape rack. The inverted pyramid used to impose isolation, in order to investigate the origins of depression, was the pit of despair.

The results were exactly what you might have expected. Children need mother love. Upbringing matters. Females who are neglected as children go on to neglect their own children. But Harlow’s experiments were needed to convince the experts of this self-evident truth. And those experts held sway over the child-rearing practices of the day. Monkeys had to suffer so that children might not. The University of Wisconsin’s psychology department was nicknamed “Goon Park” because its address, 600 N. Park, could read that way on carelessly addressed letters. As a comment on crude behaviorism, though, the name could not be bettered.

(“The Goon Show”, The Economist, Jan 23rd 2003. My emphasis)

Unfortunately, any “choice” of English-language sources to use on Korean sociology is usually a choice between finding the one source you’ve found and…well…not using any at all, but it’s still something to be aware of. This led me to look much more critically at a 2001 article from the Los Angeles Times on the popularity of caesarean sections in Korea (the best I could find by googling) than I would have previously, and as a result I’m surprised to say that South Korea seems to have received an undeserved bad press for its supposedly high rates compared to Western countries. Some excerpts from it:

(Source: butejin)

Labors of a Caesarean Culture

By Mark Magnier, April 19, 2001.

…

Proportionately, South Korea performs more caesareans than any other nation, with 43% of its babies entering the world under the knife, compared with 20% in the United States. Public health experts say many Koreans, awed by modern Western medicine, believe that caesarean deliveries are safer than natural births.

…

But more than simple misperception appears to be driving up the caesarean numbers. Until recently, doctors and hospitals earned three times more, or $1,490, for a caesarean birth than for a natural one. Add in longer hospital stays, and the fees jumped as high as $8,000.

“The major blame should go to the doctors,” says Kim Ki Young, deputy research manager with South Korea’s National Health Insurance Corp. “They’re always urging women and frightening them in order to boost their fees.”

Doctors, however, cite factors other than profit, including a legal system that absolves physicians of most liability in the case of caesarean births but leaves them vulnerable when accidents occur during natural ones.

Women often report being told weeks in advance that they will need a caesarean, even though medical literature suggests that the procedure should be a last resort generally decided on in the delivery room after signs of trouble appear.

Another factor in the incredibly high levels, public health officials say, is convenience. Doctors prefer to handle births during regular office hours rather than see their schedules upset by a long labor that lasts late into the night.

…

South Korean public health officials say the 43% figure is so high that they have been reluctant to report it to international research organizations. Recently, in an effort to reverse the trend, the government insurance corporation-part of a universal system funded by company and employee premiums-has dramatically reduced its reimbursement schedule for a caesarean, although the operation still generates more income for doctors than does a natural birth.

…

But the most common argument is the different ways the two procedures are treated in court. Under the assumption that a birth requiring a caesarean must be problematic by definition, the law saddles doctors performing caesareans with much less liability than in cases of natural birth. The fact that the law spurs more caesareans was an unintended consequence.

“The courts are always finding doctors guilty, so it’s common sense they try and avoid natural childbirth,” says Park Moon Il, professor of obstetrics at Seoul’s Hanyang University.

The number of childbirth malpractice suits in South Korea remains tiny by U.S. standards-49 for the entire country in 1999 out of 616,000 births. But the Health Ministry plans to submit legal changes to the National Assembly this year that would equalize liability in caesarean and natural births.

Not all the blame, however, can be placed on doctors’ shoulders. Women also play a role for some very unscientific reasons. One commonly held belief in Korean society is that women who undergo caesareans will be thinner and physically more attractive than those who give birth naturally. Another holds that the sex life of women who undergo caesareans will be better than that of their natural-birth peers because the birth canal will not have been distended.

Also prevalent in South Korea’s education-obsessed society is the view that squeezing the baby’s head through the birth canal risks dulling the child’s intelligence, ultimately hurting the youngster’s chances of getting into a prestigious university.

“The important thing is to eradicate these myths,” says Kim Sang Hee, director of WomenLink, a South Korean nonprofit group.

Saju, Korea’s art of numerology derived from ancient Chinese practices, is another culprit. Superstitious mothers-to-be visit saju masters for advice on the best days to give birth to children who will be healthy, wealthy and wise. Armed with the input, they request caesareans.

…

The publicity has resulted in more women questioning doctors when told that they need a caesarean. “I can see a change taking place among medical consumers and future mothers,” says Chung Hee Kyung, a senior reporter of the Women’s News, a weekly newspaper. Still, most believe that it could take many years before a fundamental shift in the culture is visible.

Medical experts say part of the sharp rise in the caesarean rate stems from South Korea’s greater affluence over the last few decades, during which its society enthusiastically embraced Western medicine. Only now is the pendulum swinging back as Koreans rediscover the benefits of midwives and other long-standing medical traditions.

…

I was tempted to cut and paste the entire article, but the length prevented that. Instead, I chose to highlight both the unique elements to South Korea’s birth culture it mentions and those which are actually just as applicable to virtually any modern medical system too. But perhaps this American cartoon puts it best:

(Source)

But while interesting, figures in newspaper reports without reference to sources are next to useless really, something I’ve begun to repeatedly emphasize on the blog recently (sorry). This blog post providing a summary of different countries’ rates of Caesarean births doesn’t provide them either unfortunately, but does demonstrate that the figures for South Korea, while excessive, are not particularly higher or lower than in many other countries. Paradoxically, that’s still relevant despite the lack of sources, because while the author of that may well have had at least a subconscious desire to exaggerate and/or select sources which gave high rates, there’s no reason to suggest that in a blog not at all related to Korea that those of Korea in particular were done so more than any other countries mentioned.

Moreover, one author that does mention her sources, albeit to books which I’m not going to dogmatically link to the Amazon pages of here, is Maureen Baker (2007), and the excerpts from her book below demonstrate that South Korea practices are by no means exceptional:

…

Rates of Caesarean deliveries vary by the age, social class, and ethnicity of the mother, with older, wealthier, and ‘European’ or ‘white’ women more likely to experience such deliveries in Canada, the United States, Australia and New Zealand (Baker:83).

Considerable controversy exists over [the rising rate] of Caesarian births, which are increasing partly because women are having their first baby later in life and medical practitioners tend to define these births as ‘high risk’ Doctors and nurses view childbirth as risky if women are over age of 35…

Doctors use Caesarean deliveries to limit the risks of vaginal birth but also to reduce their potential legal liability if the birth becomes complicated. However, Caesareans also can be conveniently scheduled in advance and command higher fees because they require more medical expertise.

…

Some older and wealthier women may ask their doctors for a Caesarean delivery because they are encouraged to believe that they are safer, but also because they can be scheduled in advance. Some journalists have suggested that a few women are convinced that [they] provide aesthetic and sexual benefits over vaginal births (i.e., an abdominal scar is seen as a lesser disadvantage than a ‘loose vagina’ from vaginal birth that may impede sexual satisfaction (Baker: 84).

…

The steadily increasing rate of Caesarean births over the last century has become one of the most contested issues in maternity care. The WHO…suggests that the optimum rate should fall between 5 and 15%….however, in some regions of a number of countries, rates range from 25 to 45% of all births.

…

If a doctor cautions a pregnant woman that vaginal birth could be risky for her, few patients would have the means of evaluating this medical advice and most would be likely to accept [it]. Doctors, as well as pregnant women and their families, do not want to take unnecessary risks in childbirth.

I’m not suggesting for a moment that Mark Magnier, the author of the Los Angeles Times article, lied or exaggerated in his article, but I do suspect that only one source was used for the figures in it. Had more been, then I suspect that the (more accurate) article would never have made it into print, reporters – and bloggers – tending to emphasize the differences between the culture examined and that of the majority of readers, and hence a title along the lines of “Korean Rates of Caesarean Births About the Same as Most Western Countries” not quite being eye-catching to readers. On the other hand, the fact that Caesarean deliveries are usually performed unnecessarily overseas too doesn’t somehow render the same in Korea more acceptable somehow, and I recommend reading the owner of the blog Ranting of An Englishman’s account of the recent birth of his child for a personal negative experience of it here.

p.s. In hindsight, this post may have given the impression that my wife just had a Caesarean, and/or that I don’t have any problems with them. Quite the opposite, on both counts!

____

Baker, Maureen, Choices and Constraints in Family Life, Oxford University Press, 2007.

Kim, Eun-shil,  “Women and the Culture Surrounding Childbirth”, in Korean Anthropology: Contemporary Korean Culture in Flux, Anthology of Korean Studies Volume III, ed. By Korean National Commission for UNESCO (2003), pp. 343-371. Originally in Korea Journal, vol. 37, no. 4 (Winter 1997), downloadable here.