In April 2019, the Constitutional Court of South Korea ruled that the provisions of the Criminal Act criminalizing abortion were unconstitutional and required the National Assembly to revise the law by the end of 2020 [1]. When the legislature failed to enact replacement legislation within the deadline, the penal provisions automatically lapsed on January 1, 2021. This historic legal shift meant that, for the first time since 1953, abortion was no longer a criminal offense. However, this change in legal status has not been accompanied by a corresponding transformation in healthcare provision. Abortion has not been integrated into the public health system as an essential reproductive health service, and the absence of statutory guidance, clinical protocols, and regulatory oversight has created a “healthcare vacuum.” Within this policy and institutional void, providers lack clear professional standards, and patients are left to navigate a fragmented, largely privatized service landscape. As a result, access to abortion in South Korea today is determined less by legal prohibition than by the availability, willingness, and interpretive discretion of individual healthcare providers.

Against this backdrop, this paper examines how abortion has functioned in South Korea, the social, legal, and policy contexts that led to the Constitutional Court’s decision to strike down the abortion ban, and the challenges that have emerged in the post-decriminalization landscape. It identifies key problems in current abortion service provision and discusses the roles healthcare providers should play in this evolving environment, alongside the structural and policy reforms required to integrate abortion into the public healthcare system. By situating these issues within broader legal, institutional, and sociocultural dynamics, the paper seeks to contribute to the advancement of reproductive health rights in South Korea and to inform strategies for ensuring equitable, stigma-free, and rights-centered abortion care.

Abortion was first criminalized in South Korea under the 1953 Criminal Act. However, during the period of aggressive state-led family planning from the 1960s through the 1980s, aimed at reducing population growth, abortion was widely practiced and, in some cases, implicitly encouraged. The 1973 Mother and Child Health Act provided the legal basis for family planning programs and specified limited grounds for lawful abortion. Within this demographic policy framework, the abortion ban was often regarded as a “dead letter [2].” By the mid-2000s, as public discourse on a “low fertility crisis” intensified, the state shifted from population control to pronatalist policies and revived anti-abortion enforcement as part of this agenda [3]. This shift culminated in 2016, when the Ministry of Health and Welfare announced revisions to the Medical Service Act that increased penalties for physicians performing illegal abortions. The measure galvanized public attention and sparked widespread mobilization for the repeal of the Criminal Act’s abortion provisions. It marked a critical turning point, reframing abortion not merely as a moral controversy between “pro-choice” and “pro-life” camps but as an urgent reproductive health issue requiring systemic policy reform [4].

Internationally, reproductive health rights have been recognized as fundamental human rights under instruments such as the 1994 International Conference on Population and Development Programme of Action and the Convention on the Elimination of All Forms of Discrimination against Women. These define reproductive rights as encompassing the ability to decide freely and responsibly on the number, spacing, and timing of children, with access to the necessary information and means to do so, free from discrimination, coercion, and violence [5,6]. The World Health Organization likewise affirms that access to safe and legal abortion is an essential element of comprehensive reproductive health care, indispensable for protecting the health, rights, and lives of those who may become pregnant [7]. South Korea’s longstanding criminal restrictions raised significant concerns about its compliance with international treaty obligations and proved inadequate in safeguarding the health and rights of its population.

Despite the Constitutional Court’s landmark 2019 ruling striking down the abortion ban and the subsequent decriminalization that took effect in 2021, the integration of abortion into the public health system remains incomplete. Legal reform has established a symbolic guarantee of reproductive rights, but without parallel policy measures, institutional frameworks, and provider training, access to safe and timely abortion care continues to be shaped by structural gaps, medical gatekeeping, and uneven regional availability. This post-decriminalization moment, therefore, presents both opportunities and challenges in transforming reproductive health rights from a formal legal entitlement into a substantive reality.

This article has examined how, despite the repeal of Korea’s abortion ban, institutional voids, uneven service provision, and persistent stigma continue to restrict access to safe abortion care, and how the practices of healthcare providers shape both the possibilities and the limitations of this post-decriminalization landscape. Decriminalization was only the starting point; realizing reproductive autonomy requires embedding abortion within a supportive public health system and addressing the structural and cultural barriers that continue to limit access. Empowering providers as clinicians, advocates, and educators is therefore essential to ensuring equitable abortion care. Within this context, nurses play a particularly vital role, not only in direct clinical practice and patient counseling but also in advocacy efforts to reduce stigma, advance reproductive health rights, and educate patients and communities. By doing so, nurses help ensure that reproductive rights are realized as lived realities rather than remaining symbolic declarations.