Korea’s Multiple Births, Second Highest Globally: High-Risk Pregnancies and Substantial Childcare Burdens Call for Policy Attention and Support

• ■ As of 2023, Korea’s multiple birth rate was 26.9 per 1,000 live births. The rate of higher-order multiple births (triplets or more) was 0.59 per 1,000 live births, the highest among countries in the Human Multiple Births Database (HMBD).

• ■Multiple pregnancies pose significant risks to both mothers and fetuses, and the associated medical costs are approximately 4 to 5 times those of singleton pregnancies.

• ■The domestic statistics on multiple births are limited to basic information, such as the number of live births, birth weight, and gestational age. 
  

• ■It is crucial to establish an empirical database on households with multiples and to build integrated and sustainable health and welfare service systems that reflect actual policy demand.

KIHASA has published issue No. 458 of Health and Welfare Issue and Focus, titled “The Trends and Challenges of Multiple Births in Korea.” The lead author is Bae Hye-Won, Senior Researcher, Department of Social Services Policy Research.

“While Korea’s total fertility rate is among the lowest in the world, the rate of multiple births has been steadily increasing with the rise in fertility treatments,” noted Senior Researcher Bae, outlining the background of her research. She identified increasing maternal age and advancements in medically assisted reproduction (MAR) as the main drivers of this trend. Given the continued increase in the number of fertility treatments (from 146,354 in 2019 to 200,007 in 2022) and in the number of patients undergoing such treatments (from 123,322 in 2019 to 136,905 in 2022), she anticipates that the proportion of multiple births among total births will remain stable or even continue to rise in the near future.

Her research shows that Korea’s multiple birth rate was 26.9 per 1,000 live births in 2023, making it the second highest among countries included in the Human Multiple Births Database (HMBD), after Greece (29.5 per 1,000 live births). The rate of higher-order multiple births (triplets or more) was 0.59 per 1,000 live births in 2023, the highest among HMBD countries and roughly three times the HMBD average of 0.21.

Multiple pregnancies are classified as high-risk for both mothers and fetuses. Mothers expecting multiples face two to three times the risk of complications such as preeclampsia and gestational diabetes compared with singleton pregnancies, and the rates of preterm birth and low birth weight are 50 to 60% higher than those for singletons. After birth, 73% of multiples require admission to the neonatal intensive care unit (NICU), and overall medical costs for multiple pregnancies are approximately four to five times those of singletons. In addition, about 70% of parents of multiples report experiencing severe psychological and emotional distress during the first two years after birth, and 30.2% of mothers of multiples suffer from major depression.

Senior Researcher Bae said that parents of multiples, who tend to give birth at an older age, face significantly higher risks during pregnancy and childbirth, with their pregnancies more likely to result in preterm birth and low birth weight. They also often encounter multidimensional challenges after childbirth, including health issues and heavy caregiving burdens. She emphasized that this calls for continuous monitoring and policy attention from a medium- to long-term perspective.

According to Bae, domestic statistics on multiple births remain limited. “They lack the necessary data to gain a comprehensive understanding of parenting practices, caregiving environments, and associated policy needs,” she said. She suggested, “It is crucial to establish an empirical database on households with multiples and to conduct policy research in order to accurately assess their circumstances. We need policy coordination and discussions on an institutional approach in order to build integrated and sustainable health and welfare service systems that reflect actual policy demand.”