Articles regarding the oral abortion pill 'Mifegyne' continue to emerge. This has been especially true since President Lee Jae-myung mentioned Mifegyne during a Cabinet meeting.
His point was that we should also allow women to take Mifegyne legally. Subsequently, backlash from the medical community followed, including a critical statement from the Korean Association of Obstetricians and Gynecologists asserting, "Proposing a hasty policy to permit sales at the doctor's discretion is a very dangerous attempt that severely threatens women's right to health."

Of course, alternative voices exist even within the medical community. They argue that the reality of continually delaying the introduction of Mifegyne is what actually harms women's right to health. SBS YouTube channel <Discovery of Knowledge> met and interviewed Dr. Oh Jeong-won, an OB-GYN specialist who has long advocated for the necessity of introducing Mifegyne. Dr. Oh, who currently works in the Department of Preventive Medicine at Seoul National University Graduate School of Public Health, serves as vice chair of the Women's Committee at the Association of Physicians for Humanism and previously served as an assistant professor of Obstetrics and Gynecology at Soonchunhyang University Hospital Seoul. Below is a summary of the interview.

Q. You have actually performed abortion procedures, correct?

Dr. Oh Jeong-won: Yes. I performed procedures as an attending physician for 5 years, and I also performed them during my residency and training period.

Reporter Jeong Yu-mi: How are the abortion procedures you have performed carried out?

Dr. Oh Jeong-won: There is dilation and curettage (D&C), which scrapes out the conception products inside the uterus. Then there is vacuum aspiration, which inserts a suction device into the uterus like a vacuum cleaner to suck out the products of conception. Broadly speaking, there are these two types. However, D&C is a procedure that scrapes the uterine wall with medical instruments, so there is a possibility of damaging the endometrium or perforating the uterine wall. Therefore, D&C is currently recommended against, and vacuum aspiration is recommended as the primary method.

Q. What kind of drug is Mifegyne, which is being widely discussed right now?

Dr. Oh Jeong-won: There is a hormone called progesterone that maintains pregnancy. Mifegyne is a medication that acts against this hormone so that the pregnancy can no longer be maintained.

Reporter Jeong Yu-mi: And Mifegyne is currently not permitted in South Korea.

Dr. Oh Jeong-won: Yes, that is correct. It cannot be purchased or prescribed through official channels.

Q. It is already used in 101 countries, including all advanced nations. Why is it not permitted in South Korea?

Dr. Oh Jeong-won: That is because of the Mother and Child Health Act. Around the mid-1970s, several permissible grounds for artificial termination of pregnancy were created in the Mother and Child Health Act. Along with these few exceptions, it was explicitly specified using the term 'artificial pregnancy termination surgery.' As a result, only 'surgery' came to be utilized for pregnancy termination, but after that, the drug Mifegyne was developed.
Due to the restriction that surgery is explicitly stated in the law, its introduction domestically has been blocked, and that is also the basis on which the Ministry of Food and Drug Safety has been delaying its approval until now. However, since the 2019 constitutional non-conformity ruling on the criminalization of abortion, this law has effectively become a dead letter. It has become obsolete law.

Q. So even if it is not for the grounds specified in the Mother and Child Health Act, is it currently possible to undergo an abortion at a hospital?

Dr. Oh Jeong-won: Informally, yes. In fact, 30,000 people undergo abortions each year. Where would all these people go? Out of those 30,000, only 3,000 were receiving safe medical services. The remaining 27,000 had to manage their abortions somehow on their own.

Q. If someone does not receive a surgical abortion procedure, what methods are available?

Dr. Oh Jeong-won: If you just search 'abortion pill,' 'abortion,' or 'artificial pregnancy termination surgery' on the internet right now, an overwhelming number of advertisements pop up.

Reporter Jeong Yu-mi: Buying Mifegyne through Telegram isn't even difficult already.

Dr. Oh Jeong-won: That's right. The people who ship Mifegyne from overseas are called brokers, and there is a high possibility that the drugs they send are counterfeit. Secondly, 'Misoprostol' was already available in hospitals as a treatment for gastric ulcers. If approval is obtained from the Ministry of Food and Drug Safety, it can be used for pregnancy termination.

Reporter Jeong Yu-mi: It seems doctors can charge whatever price they want for Misoprostol.

Dr. Oh Jeong-won: When I searched online, it was 600,000 KRW for 6 weeks, 700,000 KRW for 7 weeks, 800,000 KRW for 8 weeks, 900,000 KRW for 9 weeks, and 1,000,000 KRW for 10 weeks. Since the risk increases with gestational age, they charge according to that risk. Honestly, it makes no sense. What kind of medical treatment is received like this?

Reporter Jeong Yu-mi: But so many women are already doing it that way...

Dr. Oh Jeong-won: Yes. And they demand cash.

Reporter Jeong Yu-mi: Right, because there shouldn't be any record left.

Q. It is said that women are even receiving cancer chemotherapy injections for abortion purposes. This has been reported in the news quite a bit.

Dr. Oh Jeong-won: Again, if you go online and search for medication abortion, a drug called 'MTX' appears quite openly. Methotrexate (MTX) is an essential anti-cancer drug for treating conditions like ectopic pregnancy—such as fallopian tube pregnancy—or hydatidiform mole, a gestational cancer. However, by taking advantage of its pharmacological mechanism, it is currently widely used for pregnancy termination. The injection (MTX) can only be administered when the gestational sac is not visible.

Reporter Jeong Yu-mi: So it is possible even if it is not an ectopic pregnancy?

Dr. Oh Jeong-won: Yes. Many people who feel burdened by surgery in the early stages do this. But this drug (MTX) was never designed or verified for abortion purposes in the first place. Anti-cancer drugs work by destroying rapidly multiplying and dividing cells, which applies to the products of conception during pregnancy. On the flip side, it also damages the liver, heart, bone marrow, and blood. Therefore, hepatotoxicity, nephrotoxicity, and hematologic toxicity can occur.

In the international community, these are drugs categorized not merely as 'Not Recommended,' but specifically as 'Recommend Against'—meaning do not use under any circumstances. There have been no surveys or investigations on what dosages are being used for abortions. Because hospitals prescribe and sell it informally in the non-covered domain, no one is managing or recording it.

Reporter Jeong Yu-mi: It is truly a vacuum state.

Dr. Oh Jeong-won: I would call it a new informal market rather than a vacuum.

Q. The Constitutional Court ruled the abortion law unconstitutional in 2019, so they have done nothing while this informal market took shape since then?

Dr. Oh Jeong-won: That's right. They stood idly by.

Q. After the President mentioned it recently, it made headlines, but I understand you have been advocating for the introduction of Mifegyne for a long time.

Dr. Oh Jeong-won: Mifegyne is the safest and most effective means for pregnancy termination.

Reporter Jeong Yu-mi: Are there still side effects, though?

Dr. Oh Jeong-won: Of course there are side effects. However, whenever we use medication, although there is always risk, we use it for therapeutic purposes when we judge that 'the benefits outweigh the risks.' Numerous studies comparing Mifegyne with surgical abortion have concluded that 'both have very rare side effects and are safe, provided they are used properly according to dosage.'

Fearing side effects to the point of not using Mifegyne is quite ironic when compared to the existing use of anti-cancer drugs like Methotrexate (MTX). While using those, people are afraid of side effects from the drug that has actually been proven safest and are unable to use it.
Q. You advocate introducing Mifegyne, but opposition within the medical community is substantial. What is the reason for this division within the medical community?

Dr. Oh Jeong-won: I think what the medical community worries about is not 'this medication must never be introduced,' but rather 'the environment for prescribing the medication must be safe.' Just like any medication, specific clinical guidelines and management guidelines are necessary when it is introduced. I interpret their stance as believing that leaving this solely to doctors' discretion protects no one. Medical personnel also need a safety net. In other words, I believe they are concerned about how this drug should be used, the restrictions associated with it, patient demands, costs, and similar aspects.

Q. Do you believe it is right to introduce Mifegyne first and then organize guidelines and other details?

Dr. Oh Jeong-won: Both should be done simultaneously. The medical community—the so-called experts—must establish clinical guidelines regarding when and to whom this medication should be prescribed, what procedures are necessary when prescribing it, and who the prescribing doctors should be. But I think establishing this can happen quickly. The process for setting guidelines for other medications is similar. I believe this is a situation where the medical community should prepare first rather than waiting for legislation.

Q. The Korean Association of Obstetricians and Gynecologists issued a very strong statement calling it 'an attempt that severely threatens women's right to health.'

Dr. Oh Jeong-won: I find it hard to accept the phrase 'harming women's right to health.' For 7 years, around 30,000 abortions have taken place each year, and failing to introduce this drug, neglecting it, or remaining passive are the very things that have been harming women's right to health. Methotrexate (MTX) is also being used despite having no clinical guidelines or management system.

Reporter Jeong Yu-mi: It is presumed that many women are buying and taking Mifegyne covertly. I wonder if there are cases where women take more medication because abortion fails.

Dr. Oh Jeong-won: Of course there are. In such situations, many people end up in the emergency room due to heavy bleeding, fever, or infection. When they arrive at the emergency room, not many can say, 'Actually, I bought medication online and took it.' Instead, they just say, 'I suddenly started bleeding,' which leads to misdiagnosis. Because it exists in an informal domain, patients cannot fully state their needs or voice their anxieties, nor can they be candid about their situation. Therefore, I cannot agree with the claim that this is 'for women's right to health.' In fact, women—the affected party—have never once been at the discussion table.

Q. The Korean Association of Obstetricians and Gynecologists also claimed that a 'bridging clinical trial' is necessary for Mifegyne. Is it needed?

Dr. Oh Jeong-won: It is by no means mandatory. In fact, drugs introduced to South Korea through bridging clinical trials account for only a tiny fraction—just 10%. I view that demand itself as an intentional tactic.

Reporter Jeong Yu-mi: Demanding a bridging clinical trial is itself an attempt to delay the introduction of Mifegyne?

Dr. Oh Jeong-won: Yes. They could have done it over the past 7 years. Rather than needing to conduct experiments, they should have established clinical guidelines suited to Korea's situation based on the evidence accumulated overseas.

Q. After the abortion law was ruled unconstitutional, why has it unfolded like this until now? Who should have moved first, and who failed to do what?

Dr. Oh Jeong-won: Each party has very different roles to play. The government needs to establish a support system, the National Assembly needs to propose legislation to bring this into the formal system, the Ministry of Food and Drug Safety needs to create relevant guidelines and introduce the drug, and the medical community or expert groups need to prepare guidelines on how to secure safe accessibility when it is introduced. But right now, everyone is passing the buck to one another... I do not know for whom this situation of delaying due to political or legal risks is safe, but I think they are delaying it because they judge it to be safe for themselves.

Reporter Jeong Yu-mi: This is just my suspicion, but could it be that OB-GYN doctors think performing abortion procedures or prescriptions as they currently do—without introducing Mifegyne—is more profitable?

Dr. Oh Jeong-won: Of course, there might be hospitals demanding financial compensation through this. In fact, most know what choice a patient will make if a hospital refuses an abortion. They will make a more dangerous choice and pay a higher cost... I do not want to think of it that way, but rather that a safer safeguard is needed.

Q. Listening to you, I feel there is still a long way to go. What are your thoughts?

Dr. Oh Jeong-won: There is a long way to go. A long way... but even today, someone is having an abortion. And that person is likely very isolated. They must be scared. Shouldn't someone be beside them?

Reporter Jeong Yu-mi: Though the road is long, is it a path that must be taken?

Dr. Oh Jeong-won: That is what I believe. I do question myself continuously. Nevertheless, I believe this is the right path right now.

Q. Lastly, could you summarize why the introduction of Mifegyne is necessary?

Dr. Oh Jeong-won: In the 2019 constitutional non-conformity ruling, it states that an abortion is not merely a choice, but a decision in which the individual stakes their entire life. When that decision is made, if one cannot access appropriate services in a timely manner, health can be put at risk, and so can social stability. Creating and neglecting such conditions is precisely what we must not do, yet these conditions have been left neglected for 7 years... Now, this neglect must come to an end.