Did the socioeconomic inequalities in avoidable and unavoidable mortality worsen during the first year of the COVID-19 pandemic in Korea?

OBJECTIVES: This study examined changes in socioeconomic inequalities in mortality in Korea before and after the outbreak of coronavirus disease 2019 (COVID-19). METHODS: From 2017 to 2020, age-standardized mortality rates were calculated for all-cause deaths, avoidable deaths (preventable deaths, treatable deaths), and unavoidable deaths using National Health Insurance claims data and Statistics Korea's cause of death data. In addition, the slope index of inequality (SII) and the relative index of inequality (RII) by six income levels (Medical Aid beneficiary group and quintile of health insurance premiums) were computed to analyze the magnitude and change of mortality inequalities. RESULTS: All-cause and avoidable mortality rates decreased steadily between 2017 and 2020, whereas unavoidable mortality remained relatively stable. In the case of mortality inequalities, the disparity in all-cause mortality between income classes was exacerbated in 2020 compared to 2019, with the SII increasing from 185.44 to 189.22 and the RII increasing from 3.99 to 4.29. In particular, the preventable and unavoidable mortality rates showed an apparent increase in inequality, as both the SII (preventable: 91.31 to 92.01, unavoidable: 69.99 to 75.38) and RII (preventable: 3.42 to 3.66, unavoidable: 5.02 to 5.89) increased. CONCLUSIONS: In the first year of the COVID-19 pandemic, mortality inequality continued to increase, although there was no sign of exacerbation. It is necessary to continuously evaluate mortality inequalities, particularly for preventable and unavoidable deaths.

Investigation of the abortion-related experience of the providers, women, and advocators in South Korea: The neglected essential healthcare service.

OBJECTIVE: The decriminalization of abortions in South Korea in 2019 has not been followed by the establishment of policies ensuring access to abortion services. This study aimed to explore the current challenges and barriers for quality abortion services in the Korean healthcare system. METHODS: Eleven women, six healthcare providers, and 11 advocates participated in in-depth interviews in 2020. Experiences of abortion were analyzed using the modified Availability, Accessibility, Acceptability, and Quality (AAAQ) framework. RESULTS: While informal, access to surgical abortion services was possible in general. However, accessibility to services and information varied according to women's age, marital status, and physical condition. Considering that the Korean government has been reluctant to adopt proactive measures to ensure access to abortion services, the quality of abortion care in Korea remains questionable, with the mandate of male consent for abortion prevailing. The women interviewed in this study expressed dissatisfaction with their current access to and the quality of abortion services. CONCLUSION: Abortion is an essential service that ensures the sexual and reproductive health and rights of women. Although abortion was decriminalized in Korea in 2019, it remains an informal and stigmatized service. Further research and policy efforts are required to ensure access to abortion in Korea.

The association of women's experience of abuse in childhood with depression during pregnancy and the role of emotional support as a moderator.

BACKGROUND: This study aimed to examine the prevalence of antenatal depression and experience of abuse during childhood, to analyze the association between having experienced childhood abuse and depression during pregnancy, and to explore the role of emotional support as a moderator of that association. METHODS: In total, 44,770 pregnant women were analyzed from the self-administered registry for risk assessment at community public health centers in Seoul, Republic of Korea, for home visiting service provision between 2015 and 2019. The Edinburgh Postnatal Depression Scale (EPDS) was applied for the assessment of depression. The adjusted effects of childhood abuse experience on antepartum depression according to emotional support as an effect moderator were estimated. RESULTS: Depression was present in 2,451 pregnant women (5.5%), and 1,506 (3.4%) reported having experienced physical, emotional, or sexual abuse in childhood. After adjustment of covariates, pregnant women who had experienced abuse during childhood had EPDS scores 2.79 points higher than pregnant women without such experiences, and those who lacked emotional support during adulthood had 4.96 points higher than their counterparts. The difference in EPDS scores based on childhood abuse experience among women who reported emotional support (2.86) was larger than the difference in EPDS scores among those with no emotional support (1.91) (P for interaction = 0.0106). CONCLUSIONS: The experience of abuse in early life and emotional support in later life are both independently important for understanding antenatal depression in Korean women. More comprehensive emotional support is needed for pregnant women who experienced abuse in childhood.