Regional OB-GYN Clinics Decline 8% as Seoul Area Grows 11%

"The OB-GYN clinic where I had my first child, which had a great reputation in the area, had a 'delivery services suspended' notice when I went back after getting pregnant with my second," said a 44-year-old woman surnamed Lee, who lives in Seo-gu, Daejeon.

"I feel lost, wondering if I need to travel to Sejong or Seoul," she sighed. As a high-risk pregnant woman due to her age, she is also considering commuting to a university hospital an hour away by car.

Metropolitan concentration and accelerating low birthrates and aging populations are driving the collapse of essential medical services even in major metropolitan cities. The exodus from essential medical specialties known as "nae-oe-san-so" (internal medicine, surgery, obstetrics, and pediatrics) is intensifying, with neighborhood clinics on the front lines of healthcare showing severe concentration of essential departments in the Seoul metropolitan area.

According to data on "Regional Changes in Four Specialty Clinics Over the Past 10 Years" from the National Health Insurance Service, exclusively obtained by Seoul Economic Daily on June 2, the number of OB-GYN clinics in the Seoul metropolitan area increased by 76 (10.8%) from 703 in 2016 to 779 in 2025. In contrast, non-metropolitan areas saw a decrease of 47 clinics (7.8%) from 601 to 554 over the same decade. The figures were calculated from clinics with specialty designation data among institutions established as of the end of each year.

Nationally, OB-GYN clinics increased slightly by 29 (2.2%) from 1,304 in 2016 to 1,333 in 2025, but the gap between metropolitan and non-metropolitan areas widened significantly. Daejeon recorded the highest decline rate among non-metropolitan cities, dropping by 10 clinics (21.7%) from 46 in 2016 to 36 in 2025.

In Daejeon's southwestern district, an OB-GYN hospital that had served local mothers since 2007 announced in mid-December last year that it would suspend delivery services including natural births and cesarean sections, causing public concern. In a notice sent to expectant mothers, the hospital stated: "For 18 years since opening, we have handled deliveries for the Gwanjeo-dong, Gasuwon-dong, Jinjam-dong areas, as well as Gyeryong City and Nonsan. However, birth rates have declined sharply in recent years, with the 2024 total fertility rate reaching 0.748." The notice continued: "Despite difficult circumstances caused by low birth rates, we strived to continue serving this region's deliveries, but operating a 24-hour hospital has now become impossible."

The crisis extends beyond obstetrics. As unprecedented low birthrates persist, pediatrics faces a crisis not only in non-metropolitan areas but across the entire Seoul metropolitan region, including Seoul itself. Pediatric clinics in the metropolitan area decreased by 16 (1.2%) from 1,296 in 2016 to 1,280 in 2025. Non-metropolitan areas barely maintained their numbers, going from 876 to 879, though significant declines were seen in Ulsan (-17.9%), South Jeolla Province (-14.3%), and Daejeon (-11.1%). Pediatrics is the only specialty among the four where the number of metropolitan clinics decreased compared to a decade ago. According to the Health Insurance Review and Assessment Service's "Healthcare Facility Opening and Closure Status" data, pediatrics had the highest closure-to-opening ratio among all specialties nationwide last year, with 59 clinics opening and 89 closing.

Over the past decade, surgery clinics increased by 115 (27.1%) in the metropolitan area while decreasing by 28 (5%) in non-metropolitan regions, widening the regional gap. Internal medicine clinics, however, grew by 767 (35.5%) in metropolitan areas and 495 (21.8%) in non-metropolitan areas, for a nationwide increase of 1,262 (28.5%). This reflects the growing elderly population seeking medical care while hospitals for children close.

These changes in the medical landscape directly mirror regional depopulation caused by plummeting birth rates. Comparing newborn numbers between 2016 and 2025, both metropolitan (-30.7%) and non-metropolitan (-41.3%) areas recorded severe negative growth. During this period, the population of children and adolescents under 18 continued to decline at an annual average rate of 3.0%. Although the pace of decline in births has temporarily eased since 2024, the under-18 population in all 16 metropolitan cities and provinces except Sejong City has continued to fall without a single rebound over the past decade.

The Medical Innovation Committee, an advisory body under the Prime Minister's Office leading the Lee Jae-myung government's healthcare reform, has identified strengthening regional, essential, and public healthcare as a core task and is proposing various solutions including a "regional doctor system." However, critics say these measures fall short of producing tangible changes amid nationwide population decline and regional depopulation crises. They argue that alongside population policies, efforts to improve healthcare efficiency through active use of information and communications technology (ICT) must proceed in parallel.

"Policies that simply raise fees for underpaid essential medical services and increase the number of doctors have limitations," said Kwon Yong-jin, a professor at Seoul National University Hospital's Public Healthcare Center. "It is urgent to build systems that can actively utilize not only telemedicine but also remote monitoring and consultations using digital technology."