Perception of Baby Boxes and Anonymous Childbirth among Female College Students in South Korea

Introduction

The “baby box,” a secure location where women can leave their unwanted newborn babies, is a relatively new phenomenon in South Korea. Although the first baby box was established in December 2009 by a church minister in Seoul, it has become widely known to the public since 2011 with the amendments to the Adoption Law (“Act on Special Cases Concerning Adoption”). This law, which came into effect in August 2012, drastically changed South Korea’s adoption practices. The new adoption law requires birth registration of the baby before the commencement of the adoption process, which places a considerable burden on birth mothers—mostly young, unmarried women—experiencing unwanted pregnancy and childbirth. Before the amendment, it was a customary practice, although illegal, for birth mothers to leave their babies with an adoption agency without birth registration, and for adoptive parents to register them as birth children after adoption. This traditional practice provided the opportunity for anonymous birth in South Korea (Lee, 2017). However, the new adoption law requires that permission be sought from the Family Court as part of the adoption process and the child’s birth certificate is one of the documents that must be submitted to the Family Court.

Owing to the social stigma associated with births out of wedlock in South Korea, unmarried mothers are reluctant to reveal their pregnancies and childbirths, even to their family and friends. Registering the child’s birth may endanger their secret. Thus, desperate mothers abandoned their babies instead of entrusting them to an adoption agency. The number of babies found in the baby box has increased significantly since 2012. In March 2010, the first baby was found in the baby box and four babies were submitted during the entire year. This increased to 37 in 2011 and 79 in 2012, peaking at 280 in 2014 as the baby box received media attention in 2013, and another church in Gunpo, Gyeonggi, set up a second baby box in 2014 (Lee, 2017). The total number of children found in the first baby box between March 2010 and June 2016 was 1,186 (Hyun, Lim, & Ahn, 2017). However, baby boxes in South Korea lack a legal basis; several debates exist surrounding them, with local government repeatedly warning the church to stop running them. Baby-box supporters insist that it protects children’s lives by protecting the anonymity of the mothers and saves desperate mothers from the stigma related to birth out of wedlock. In contrast, those opposed to the baby box criticize the fact that it aids or induces the abandonment of babies and infringes upon the child’s right to know their origins.

The UN Convention on the Rights of the Children (UNCRC) recognizes that a child should be registered immediately after birth and has the right to know and be cared for by their parents (Article 7). The UNCRC (2014) has expressed its serious concerns about the baby-box program and urged nations that run such schemes to shut them down. However, closing down baby boxes without legitimate alternatives may endanger the children’s lives, which violates the children’s right to survival and development expressed in the UNCRC (Article 6). Additionally, an inordinate emphasis on children’s rights to know their origin may conflict with the right of women to choose anonymity regarding their births.

Given the insufficient support afforded single mothers, it would be impractical to compel all young unmarried mothers to rear their children. Furthermore, the requirement of birth registration for the adoption process imposes a psychological and emotional burden on unmarried mothers. Thus, a balanced consideration of both children’s and women’s rights is needed to appropriately protect both groups’ rights.

Historically, baby boxes and anonymous births have been used worldwide as measures to help women in similar situations, usually those undergoing an unwanted pregnancy and wanting to relinquish their child after birth. In South Korea, the baby box has been a matter of contention since its establishment in 2009 and a universal birth registration system and anonymous births have been suggested as alternatives.

Under the universal birth registration system, also called the birth notification system, health care professionals must register babies born in hospitals with the national birth registration system. Since birth registration is a parental responsibility, several newborns remain unregistered in the system and abandoned by their parents. If a universal birth registration system were introduced, it would be impossible for parents to leave a baby in a baby box. There are also concerns that a universal birth registration system would prevent unmarried women from opting for hospital delivery so as to avoid having the child’s birth registered, possibly endangering the lives of both mother and child. Thus, several attempts to legislate for anonymous births have been made in the last decade in South Korea’s National Assembly (Hyun et al., 2017),¹ but these bills failed to pass because of a lack of social consensus regarding the necessity and validity of the anonymous birth system. To establish a legal system that safeguards vulnerable groups of mothers and children, agreement among members of society is required as a prerequisite. Although some countries have already established similar baby-box programs or anonymous birth systems, differences in cultural background mean some countries’ perceptions of childbirth out of wedlock may differ (Lee & Kim, 2019). Thus, it is necessary to understand social perceptions of baby boxes and anonymous births before formulating relevant policies.

Few studies have examined social perceptions of baby boxes and/or anonymous births in South Korea or other countries. One study examined the social perceptions of baby boxes and infant abandonment among young people in Korea and found that positive perceptions of baby boxes were slightly higher than negative perceptions; however, toleration of infant abandonment was generally low (Lee & Kim, 2019). Attitudes toward infant abandonment differed by respondents’ age, education level, marital status, and employment status, with older, highly educated, married, and employed persons less tolerant of the practice (Lee & Kim, 2019). Similarly, a survey of professionals (staff members or researchers in the field) was conducted in 2017. The majority agreed on the necessity of an anonymous birth system, with some preconditions such as counseling for the mothers, ensuring children’s access to birth information, and expanding support for single mothers (Hyun et al., 2017). Although the target groups in both cases were limited, these studies are nevertheless significant in that they attempted to reveal the social perceptions of baby boxes and anonymous births.

Once an anonymous birth system is introduced, the largest potential user group would be young unmarried mothers. Examining the opinions of the people most concerned with the issue would help discern the possible strengths and weaknesses of the system. This study therefore aimed to provide basic data for government legislation and implementation of an anonymous childbirth system by investigating perceptions of baby boxes and the anonymous childbirth system among Korean female college students.

• Question 1. How do female college students perceive baby boxes?
• Question 2. How do female college students perceive the anonymous childbirth system?
• Question 3. Do perceptions of baby boxes and anonymous childbirth system vary depending on the general characteristics of female college students?

Literature Review

The history of infant abandonment goes back further than expected, even as far as ancient Greeks and biblical times (Choi, 2017). Depending on a country’s cultural and historical background, diverse societal measures have been developed to solve the problems of unwanted pregnancy and baby abandonment. The most common types of measures have been the baby box and anonymous birth programs, although the name and operational system of such programs may differ by country.

Although the main subject of this study is societal perceptions of the social measures tackling infant abandonment, few studies have addressed societal perceptions of baby boxes and/or anonymous births. This could be because of the long history of these programs, which were established based on religious values or ideas of the sanctity of life. Thus, the laws and programs of countries with established systems dealing with these issues were examined in this section, with reference to the stance of the UNCRC. Three countries—France, Germany, and the United States—with heterogeneous programs are examined for comparative purposes. France has a long tradition of an anonymous birth system, still in use today, and Germany has developed both an advanced anonymous birth system, termed “confidential birth,” and a baby-box program (Babyklappe). The United States has a legalized baby-box program called “Safe Haven.”

Sub-conclusion

Implications were found through the investigation of policies responding to unwanted birth and infant abandonment in the countries examined.

Anonymous birth has been used as an alternative to baby-box programs in two of these three countries. Anonymous birth has some advantages over the baby-box program in that it can provide medical support and counseling services to mothers considering relinquishing their child. When the confidential birth system was first introduced in Germany, the German government actively publicized the counseling service to ensure the anonymity of pregnant women, and the majority of women chose a traditional birth or adoption instead of a confidential birth after counseling (Han, 2019). This means that the counselling services provided for prospective mothers are quite effective.

In South Korea, a church running a baby box changed its name to “Baby Room” in 2015 and started providing counseling services to mothers if they requested them. Through counseling, information on support for child-rearing and adoption was provided. These services, however, have no legal grounds, as is the case for the baby-box program itself. Legal and institutional systems need to be provided in response to unwanted childbirths and infant relinquishment in South Korea.

The confidential birth system in Germany is generally regarded as a fair compromise between mothers’ and children’s conflicting interests. The UN Committee and many researchers support a confidential birth system for anonymous births (Han, 2019; Seo, 2014; Simmond, 2013), although there are concerns regarding the introduction of a confidential birth system in Korea. If a child can access their birth document after a certain age, biological mothers who dread being found out might not choose a confidential birth (Hyun et al., 2017). What South Korea needs is an anonymous birth system that considers both the reality of unmarried mothers and their children’s right to know their origin (Han, 2018; Seo, 2014). To institute such a system, an infrastructure for the provision of counseling services for women experiencing unwanted pregnancies should be prepared (Seo, 2014; Shin, 2015). Furthermore, child-rearing support for single mothers who want to keep their children should be reinforced (Han, 2018) so that the choice of anonymous birth would be considered as a last resort.

The most appropriate system for Korean society should be devised based on the reality of birth mothers and the consensus among members of society. Furthermore, public awareness campaigns are important for the effective utilization of these options by young mothers (Bartels, 2012; Grylli et al., 2016).

Method

Study Participants

Table 1 shows the sociodemographic characteristics of the female college students participating in this study. Most of the participants were juniors (32.8%), followed by freshmen, seniors, and sophomores. Overall, 84.8% were attending four-year universities, and the other 15.2% were attending junior colleges. By academic division, most (67.8%) were studying humanities and social sciences, followed by the natural sciences and engineering (20.2%), art, music, and physical education (8.3%), and other (3.7%).

Table 1

Sociodemographic Characteristics of Participants

Results

Perceptions of Baby Boxes

Table 2 shows female college students’ perceptions of baby boxes. Of the participants, 48.0% responded that they knew exactly what baby boxes were, and 40.7% had heard about them in the news. Only 11.3% responded that they had never heard of baby boxes. The result indicates that awareness of baby boxes was high among female college students.

Table 2

Perceptions of Baby Boxes

Next, 66.3% of female college students approved of parents leaving their child in a baby box, whereas only 33.7% disapproved. The reasons for approval were as follows: 53.6% of the participants who approved did so because it prevented child abandonment, 39.1% because the child should be raised by someone ready to be a parent, and 5.3% because the mother could be free of the social stigma attached to giving birth outside marriage. Conversely, the reasons for disapproval were as follows: 54.5% of the participants who disapproved did so because baby boxes encourage child abandonment, 21.8% because putting a child whose birth is not registered in a baby box will keep the child from knowing about his or her birth parents, and 9.6% because it is illegal to raise children at an unauthorized facility.

Table 3

Approval or Disapproval of Baby Boxes and Reasons

As for the reasons children are abandoned in baby boxes in Korean society, 43.5% of the students in this study responded that it is because the parent cannot raise the child alone because of financial difficulties, 31.1% because the parents gave birth without being mentally ready, 17.6% claimed that it was due to the social stigma attached to giving birth outside marriage, and 4.8% responded that the mother may be in a situation where she cannot carry out a birth registration.

Table 4

Reasons for Abandoning Children in Baby Boxes

Of the female college students, 33.7% responded that if they became pregnant without getting married, they would raise the child alone, 23.5% indicated that they would marry the father and raise the child together, 21.5% responded that they would give the child up for adoption, and 6.7% claimed they would leave the child in a baby box. A further 11.1% said they would get an abortion, and the remaining 3.5% responded that they would decide after discussing the situation with their parents or that they did not know what they would do.

If the participants were to give birth without getting married and raise the child alone, most (71.5%) said that the support they wanted most from the government was financial aid, followed by vocational training and access to a job connection service (16.7%), prior claim over facility use (4.3%), a family relationship enhancement service (3.0%), and a housework service (1.5%). Others included anti-bias education to improve awareness of single mothers and single-parent families.

Table 5

Coping with Non-Marital Pregnancies and Government Support Services

Perception of Anonymous Childbirth

Regarding perception of the anonymous childbirth system among the participants, 78.9% said that they had never heard of it, 16.1% that they had heard about it in the news, and only 5.0% said that they knew exactly what it was. This indicates that female college students have an extremely low level of awareness of anonymous childbirth.

Table 6

Perceptions of Anonymous Childbirth

If the participants were to give birth without getting married and could not raise the child themselves, 77.4% responded that an anonymous childbirth system would be required, while 22.6% said it would not be necessary. Of those who felt such a system would be necessary, 33.1% said that the mother’s pregnancy might be unwanted and that giving birth would therefore place her in a difficult position, 24.1% that the birth mother and the child could be protected from social stigma, and 24.1% that the system could guarantee women’s right of choice. Additionally, 17.9% responded that the system could protect the child’s safety by preventing abandonment. In contrast, those who were opposed to such a system gave their reasons as follows: 43.7% said that the system could become a tool whereby parental responsibility could easily be avoided, 32.0% that the system could be misused, and 18.4% suggested that it violated the child’s right to know about their origins. Other responses included that such a system would make it difficult to confirm the real father’s intention and thus his rights would not guaranteed, or that the system might make the parents feel less guilty about giving up their child.

Regarding appropriate users of the anonymous childbirth system, most participants (92.4%) cited victims of sexual violence, followed by single mothers younger than 19 years (75.4%), and women with non-marital births (45.2%). However, only 39.3% responded that all women who wanted to opt for anonymous births should be included within the scope of the system.

Furthermore, for information provision and operational procedures in case a child born to an anonymous mother wanted to obtain information about his or her birth mother when they become an adult (at 18 years), most participants (54.5%) responded that “information regarding the birth mother must only be provided for the child born to an anonymous mother if the birth mother agrees.” Other responses included “information must be provided without conditions when the child reaches a certain age (18 years) and requests information about his or her birth mother” (27.4%) and “if the birth mother refuses to disclose information, the child must be able to ask for a court hearing” (17.8%).

Table 7

Attitudes Toward an Anonymous Childbirth System and Reasons.

Regarding the age limit at which the child born to an anonymous mother might be eligible to obtain information about their birth mother, 50.2% responded that 18 years would be appropriate, and 27.8% that it should be possible at any time regardless of age. Other responses were that this should be possible when the child is mentally mature, or when the birth mother agrees, regardless of the child’s age, while 20% said they did not know.

Regarding the scope of information disclosure when providing information about the birth mother for a child born to an anonymous mother, 33.9% responded that their mother’s name, date of birth, address, and contact number must be disclosed; 26.5% that only the birth mother’s name and date of birth must be disclosed; 12.0% that the birth mother’s name, date of birth, and address must be disclosed; and 9.8% that the birth mother’s name, date of birth, and contact number must be disclosed. A further 15.2% responded that all information about the birth mothers should be provided. Other responses included that only the information that the birth mother wishes to disclose must be provided or that it is not right to provide the birth mother’s information at all.

Table 8

Opinions Regarding the Implementation of Anonymous Childbirth

Table 9

Importance of Rights

Table 10

Differences in Opinions about Baby Boxes According to School Type

Finally, regarding which is more important, “the child’s right to know about his or her origin” or “the woman’s right to keep the birth a secret,” 58.5% of the participants responded that the former is more important, 41.5% the latter.

Differences in the Perception of Baby Boxes and Anonymous Childbirth according to General Characteristics

A χ2 test was conducted to examine whether there was a difference in the perception of baby boxes and the anonymous childbirth system according to the general characteristics of the female college students, such as year, school type (four-year university or junior college), and academic division. The results of the analysis showing statistically significant differences are as follows:

First, the results of examining approval or disapproval of baby boxes depending on participants’ school type show that in cases where parents who cannot raise their children because of unavoidable circumstances leave them in a baby box, the students attending four-year universities were more likely to approve, to a statistically significant level, than those attending junior colleges.

Next, as a result of examining different opinions about the need for an anonymous childbirth system depending on academic division,⁴ it was found that a significantly higher ratio of students in the humanities and social sciences considered the anonymous childbirth system undesirable compared to those in other academic divisions.

Table 11

Differences in Opinions about Anonymous Childbirth Depending on Academic Division.

Discussion

The purpose of this study was to assess perceptions of baby boxes and the anonymous childbirth system among female college students in South Korea, seen as potential users of the system, with the aim of providing basic data for future governmental legislation and implementation of the aforementioned system. The main points based on the results of this study are discussed below.

First, this study showed that awareness of baby boxes was high among female college students in South Korea, possibly because of the continued media controversy about them since 2013. By contrast, most of the students were unaware of the anonymous birth system. Although the Korean government announced the introduction of birth notification (a universal birth registration system) and an anonymous birth system in the “Children’s Policy for an Inclusive Nation” in May 2019, our findings suggest that an effective process for gathering the opinions of members of South Korean society—including women—and arriving at a social consensus is still lacking. Therefore, before the implementation of an anonymous childbirth system, the public must be made aware of the program. Further, extensive discussions on its necessity and feasibility are required before the system is introduced.

Second, although most of the study participants (78.9%) had never heard of the anonymous birth system before the survey, the majority (77.4%) were in favor of it for reasons such as “childbirth may be due to unavoidable circumstances,” “protecting the mother and children from social stigma,” and “guaranteeing women’s right to choose.” In Korea, controversy persists over baby boxes and they are not legally approved. The simultaneous introduction of both a birth notification system and an anonymous birth system may be an effective alternative to baby boxes. If only the birth notification system, which requires medical staff to report births to national or public institutions, were introduced, single mothers who are reluctant to report their children’s births might avoid giving birth in those medical institutions. This might endanger the mothers’ and children’s lives, whereas the anonymous birth system, which permits the anonymous birth of children on condition that the mothers receive counseling, would facilitate a safe delivery.

Third, the majority of students who participated in this study believed that children are abandoned in baby boxes because of “financial difficulties.” They also cited financial support from the government as the most urgent requirement. However, at the same time, the reference to “social stigma” as the main reason for child abandonment was lower than expected (17.6%). This may reflect the changing perception of childbirth outside of marriage in Korean society. The stigma remains but has become less harsh with changing public perceptions. Furthermore, if they were to become pregnant as single mothers because of unavoidable circumstances, the majority of the participants (57.2%) responded that they would raise the child themselves or marry the father to raise the child together. In contrast, only a small number of participants said that they would leave their children in baby boxes or get an abortion. As the main objective of the anonymous childbirth system is to encourage and help mothers to give up their anonymity and raise their children (Han, 2018), policies authorizing governmental support for single mothers must be strengthened significantly, and soon. Currently, governmental support for single mothers is limited to initial support for childbirth and hospital expenses, childcare, counseling for psychological and emotional help, and paternity tests. Thus, realistic and ongoing support must be provided for raising children and achieving economic independence. If financial difficulty is the main reason for infant abandonment and is a more important issue than the social stigma associated with childbirth out of wedlock, the need for baby boxes or anonymous births should diminish, if not completely disappear, with the strengthening of support for single mothers.

Fourth, a significantly higher proportion of those participating in this study felt that the anonymous childbirth system is appropriate for victims of sexual violence and single mothers under the age of 19, rather than for all unmarried pregnant women and any woman wanting to give birth anonymously. This finding may suggest disagreement over the intended target group of the anonymous childbirth system, based on beliefs that the system may be abused to avoid the responsibility of raising children. Therefore, further consideration and discussion are required regarding which groups should be allowed to avail of this system.

Fifth, although more than half of the study participants (58.5%) responded that the child’s right to know about their origin was more important than the woman’s right to anonymity, a majority also stated that it was appropriate to “provide information about the birth mother to the child only if the birth mother consents.” A higher proportion of respondents disagreed with the idea that children could request such information through the court system or upon reaching a certain age. If children can access information about their birth mothers (without their consent) after reaching a certain age, such mothers may conceal their whereabouts by avoiding going through the anonymous childbirth system (Hyun et al., 2017). Therefore, the introduction of the German confidential birth system in Korea may raise concerns about women’s reluctance to choose it. The anonymous childbirth system should seek a balance between the right of single mothers to keep deliveries confidential and the right of their children to know about their mothers. The resolution of this conflict of interests is not easy, and the system has been repeatedly revised even in countries where it has been introduced for some time. However, the problem remains unsolved, and the solution will differ according to the social environment and cultural characteristics of each country. One possibility is that intermediary institutions that can mediate contact between mothers and children may be considered instead of directly disclosing the mother’s personal information to the child.

Sixth, perceptions of baby boxes and anonymous childbirth differed according to school type and academic division. This suggests that there may be differences of opinion among women, indicating the necessity of collecting views from various groups and discussing them sufficiently before introducing the system.

Finally, counseling services must be systematically organized by specialized agencies for women who experience difficulties with unwanted pregnancies. In Germany, counselors provide single mothers with detailed information about various means of support for childrearing, adoption, anonymous childbirth procedures, and the rights of birth mothers and children, as well as legal considerations (Choi, 2017). In addition, pregnancy counseling centers provide follow-up support after childbirth (Ahn, 2017). Similarly, in Korea, the implementation of the anonymous birth system requires appropriate procedures and contents for counseling services and the establishment of counseling institutions (e.g., single-mother counseling facilities). Additionally, an extensive public awareness campaign on the anonymous birth system is needed so that women suffering unwanted pregnancies may consider it as one of their options.

Currently, the Korean government is preparing legislative measures to address the issues of unwanted pregnancy and abandonment. An anonymous childbirth system could be one such measure. Upon introduction of the system, its operational details, such as the target group and the requirement for counseling services, should be delineated in line with stakeholders’ opinions, society in general, and the cultural characteristics of that society. Furthermore, the system should consider the rights of both women and children and seek a balance between them.

This study provides basic data for government legislation and the implementation of an anonymous childbirth system. However, it does suffer from some limitations. First, the study participants were limited to female college students, who constitute only a portion of the potential users of the system. They also belong to a very specific age group and represent a highly educated social group. Thus, their opinions do not represent all potential users of the system or the general public. Second, the majority (78.9%) had never heard of the anonymous childbirth system. Thus, their opinions may be based on the restricted information provided by the researchers and without due consideration. There is a chance that they will change their opinions with the availability of more information. Lastly, data on their personal characteristics were not collected, making it impossible to investigate the variables affecting their opinions. A more thorough survey with a broader and more representative sample would give a much more accurate view of what may constitute a social consensus among the South Korean public.

Acknowledgments

Funding for this paper was provided by Namseoul University.

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