Abstract
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Purpose
The purpose of this study was to explore the in-depth perceptions of newborn care among North Korean refugee women through focus group interviews. This research aims to provide foundational data for developing newborn care education programs tailored for North Korean refugee women preparing for motherhood.
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Methods
This qualitative study employed focus groups to investigate perceptions of neonatal care among North Korean refugee women of childbearing age (20–45 years old). Conducted from August to September 2022, the sessions included five non-pregnant women and four who were currently pregnant.
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Results
Both pregnant and non-pregnant women expressed ambivalent feelings, characterized by a blend of expectation and fear regarding childrearing. Pregnant women articulated specific parenting strategies and viewed childrearing as a more tangible responsibility in light of physical changes and social isolation. In contrast, non-pregnant women expressed vague aversion and anxiety about the lack of information and support systems, stating that they could only endure childrearing with adequate external support. Notably, pregnant women emphasized the psychological conflict stemming from disrupted self-realization and shifts in their identities as mothers.
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Conclusion
This study revealed differences in childrearing perceptions among North Korean refugee women based on their pregnancy status. It underscores the necessity for developing customized education programs that consider life stages and psychological readiness, as well as the importance of establishing social support systems.
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Key words: Democratic People’s Republic of Korea; Newborn infant; Perception; Refugees
INTRODUCTION
Taking on the role of a parent without preparation while still adapting socio-culturally to a new society increases the psychological and mental stress of raising a child [
1]. In particular, North Korean refugee women are receiving attention as a group that experiences care on multiple levels: at the intersection of their political identity as “North Korean refugees” and their biological roles as women and mothers [
1]. These women experience economic difficulties and unstable employment in the process of adapting to life in South Korea, psychosocial stress in the process of fleeing North Korea, insufficient social activities or formation of social networks, and a lack of a support system where they can obtain help or information [
2-
5]. These factors contribute to the psychological burden of being a parent and can cause withdrawal from care activity [
2,
3]. Furthermore, they face a three-way problem of having to perform the role of a parent with no knowledge of parenting methods or the educational system in South Korea [
4].
North Korean female defectors often lack education on contraception, sexual health, and women’s health management due to the conservative sexual ethics and rigid patriarchal norms in North Korean society. Furthermore, the strenuous labor, pregnancy, and childbirth they experience during the defection process, as well as while in China or other third countries before entering South Korea, can negatively impact their health and the care of their newborns [
5]. Reportedly, North Korean refugee women experience a high psychosocial burden due to inadequate knowledge about newborn care, a lack of social support systems, and low parenting self-confidence, and there are concerns that this could negatively affect their children’s development [
6-
8]. Moreover, reports indicate that their access to medical services and support systems during childbirth and postpartum care is limited, hindering their ability to provide adequate care for their infants and promote women’s health [
9,
10].
Lee [
6] noted that North Korean refugee women have poor basic health knowledge required for newborn care and low infection management competency, which causes them to experience high anxiety and low self-efficacy in caring. Lee and Jeon [
7] directly related poor social support and low psychological resilience to increased parenting stress among North Korean refugee women, highlighting the need to systematize emotional interventions and parental education for them. Han and Oh [
8] reported that these women complain repeatedly of loneliness, isolation, and social withdrawal after childbirth, and that this, combined with lack of cultural/institutional knowledge in South Korea, exacerbates isolation and instability in practicing parenting.
Qualitative research has highlighted that North Korean refugee women encounter various challenges during pregnancy, childbirth, and infant care, such as economic difficulties, social isolation, lack of access to medical care, and cultural differences. Notably, the absence of information and social support for newborn care complicates their ability to fulfill maternal roles [
10]. This situation can delay the physical and psychological recovery of North Korean refugee women after childbirth and, coupled with social isolation and insufficient information, significantly inhibits their health management behaviors [
11]. Additionally, differences in postpartum care and parenting cultures between North and South Korea impose further psychosocial burdens on their maternal roles [
12]. These studies underscore the necessity of establishing an integrated and culturally appropriate support system [
3].
Research on parenting among North Korean female defectors has primarily focused on early migration issues, such as settlement support, family breakdown, and cultural adaptation [
1-
8,
10,
12]. However, there is a lack of in-depth qualitative studies specifically examining newborn care within domestic research. Given that newborn care is crucial for maternal confidence and infant health outcomes, there is an increasing demand for comprehensive, experience-based research in this area.
As of March 2025, there were 34,352 North Korean defectors residing in South Korea, with women comprising 72.1% (24,783). Among them, approximately 19,457 (78.5%) were women of childbearing age (20–49 years old) [
13]. It is crucial to emphasize the need for timely and appropriate maternal health education and newborn care support for North Korean refugee women in the pregnancy preparation and early motherhood stages, given their significant representation in this population. While some women may not have yet experienced childbirth or parenting, those contemplating pregnancy or motherhood show a strong interest in and concern about future parenting. Therefore, providing accurate information and support to this group is essential for fostering healthy motherhood and effective newborn care practices. In recognition of this need, this study conducted focus group interviews (FGIs) with North Korean refugee women who are either preparing for pregnancy or are currently pregnant, aiming to explore their perceptions of newborn care.
Providing fertile and pregnant North Korean refugee women with educational support regarding pregnancy, childbirth, and newborn care to enable even limited self-care may reduce the likelihood of high-risk pregnancy and childbirth in terms of women’s health and could have positive effects on childbearing by inspiring confidence in newborn care. Recognizing these needs, the present study conducted FGIs with North Korean refugee women who were either non pregnant or currently pregnant. The aim was to explore their perceptions, challenges, and needs related to newborn care. By examining the unique psychosocial and cultural factors that influence how these women approach early motherhood, this study seeks to generate foundational data to support the development of culturally sensitive, life-stage-specific educational programs and practical policy interventions. Ultimately, this research aims to improve the quality of newborn care and strengthen maternal role fulfillment among North Korean refugee women in South Korea.
The purpose of this study was to explore the in-depth perceptions of newborn care among North Korean refugee women via FGIs to provide basic data for the development of newborn care education programs for North Korean refugee women preparing for motherhood.
METHODS
Ethical statements: This study was approved by the Institutional Review Board (IRB) of the University of Hannam (IRB no., 202104-0002-03). Informed consent was obtained from all participants (or their parent legal guardians).
1. Study Design
This qualitative study, which collected data through FGIs, aimed to analyze the perceptions of newborn care of North Korean refugee women. FGIs are a research methodology used to collect qualitative data through focused conversations about the shared characteristics of a group of people. The data collected is effective in understanding and gaining insights into a specific research topic [
14]. Therefore, we conducted FGIs to investigate the understanding of North Korean refugee women of newborn care and identify their educational needs. The reporting of this study was based on the methodology of the COREQ (consolidated criteria for reporting qualitative studies) [
15].
To recruit participants, after obtaining approval from the leaders of centers or civilian organizations for North Korean refugee women, we explained the study purpose and participant conditions to representatives from North Korean women refugee groups. People who fit the study objectives, methods, and criteria were recruited and given contact details. If they contacted the researcher directly to indicate their intention to participate in the study, phone interviews were conducted to verify that they met the inclusion criteria. Snowball sampling was performed, focusing on the already recruited participants, until the required sample size had been satisfied. The criterion for the number of participants is that 4 to 5 are needed to achieve thematic saturation, as the group of North Korean defector mothers is homogeneous and discusses sensitive internal experiences and emotions [
16]. Therefore, we recruited no more than five participants per group.
The participants are North Korean refugee women of childbearing age. Specifically, the criteria include: (1) adult women aged 20 to 45 or women who are currently pregnant (from the time of diagnosis until delivery); (2) those who can communicate effectively in Korean; and (3) the exclusion of individuals with high-risk pregnancy-related conditions (such as diabetes, hypertension, severe pre-eclampsia, or placenta previa) or other chronic illnesses, as well as women who have previously given birth.
Focus groups provide more information when participants do not know one another. However, participants who know one another can be included to improve the feasibility of the study. Thus, in the Seoul metropolitan area, participants from the target population were recruited through recruitment announcements and snowball sampling among acquaintances. Each group interview lasted between 1.5 and 2 hours, with 4–5 participants per group. Based on the dropout rate of 10% [
17], a total of 10 participants were recruited: five unmarried non-pregnant women and five married pregnant women. However, one pregnant participant voluntarily withdrew from the study due to poor health condition during the research process, resulting in nine participants. Krueger and Casey [
14] suggest that 1–2 focus groups may suffice for in-depth exploration, particularly when participants share similar backgrounds and the research topic is clearly defined. The FGIs were conducted in August and September 2022, and participants were joined by a lead and an assistant moderator. Efforts were made to maximize group dynamics to encourage all participants to contribute to the interview, and snacks and tea were prepared to encourage them to converse comfortably. They were informed that they might be contacted by telephone or for online interviews if content required further explanation during data analysis.
A study participation explanation sheet was handed out for participants to read before the interviews. A simple general characteristics survey was administered to gather information and if required, participants were consulted about personal issues. The interviews were conducted at a quiet café chosen by the participants at their preferred time, and measures were taken to ensure that their privacy was fully protected. At the start of the FGI, the study purpose and procedures were explained to the participants, and their written consent was obtained before beginning. During the FGIs, to identify participants’ different perceptions and perspectives, they were informed of the rules for debate to ensure a permissive, unthreatening environment and to encourage them all to actively contribute to the interview. The lead and assistant moderator participated in the FGIs. The lead moderator guided the discussion, while the assistant moderator took notes and observed participants’ nonverbal cues. Both moderators had prior experience in qualitative research with vulnerable populations, including North Korean refugees, and had received training in qualitative interviewing and focus group facilitation.
After the group had introduced themselves to one another, they were informed of methods for sharing their opinions, and the interview started with a question from the lead moderator. The whole interview process was recorded with participants’ prior consent and continued until data saturation was reached, when participants’ responses became repetitive and no new themes emerged [
18]. Each group interview was conducted only once, as data saturation was reached within the single session. During the interviews, time was allocated for the researchers to ask questions and verify that they had accurately understood participants’ statements. Before concluding the interview, the researchers verified that the participants’ experiences had been appropriately summarized. The interview content was transcribed for analysis as soon as possible.
To develop questions for this study, the research problem was first clarified, and then draft questions were composed. The draft questions were inspected and reviewed by an expert panel to construct the final questions. The expert criterion was at least 10 years of research or work experience at a center or office for North Korean refugees. The selected experts were a nurse at the Ministry of Unification’s Settlement Support Center for North Korean Refugees (Hanawon), who was judged to have a strong understanding of North Korean refugee women, and a professor who has delivered lectures for more than 5 years on nursing for children and women’s health.
The questions were organized into the opening question, key questions, and closing question. The questions used in the study are listed below.
Opening question: (1) Could you describe how you feel about babies?
Key questions: (1) What do you think are the most important aspects of newborn care?; (2) What can mothers do for their children in South Korean society?; (3) Could you describe how you feel about newborn care?; (4) What do you think are the conditions for pregnancy, childbirth, and childrearing?; (5) What do you think is required to care well for a baby in South Korean society?; (6) What factors do you think could interfere with pregnancy, childbirth, and childrearing?
Closing question: (1) Is there anything else you would like to say about caring for a baby?
The group non-pregnancy (NP) interview was conducted on August 17, 2022, and the group pregnancy (P) interview on September 18. The interview lasted 120 minutes for Group NP and 110 minutes for Group P. Before starting, participants were informed that the interviews would be recorded.
To prevent data loss, the interview content was recorded and transcribed using the Naver Clover Note program (Naver Corp.), with key words noted down. The researcher listened to the interview multiple times and transcribed it again. To ensure the reliability and validity of the data, the researcher reviewed the entire recording to confirm that nothing was omitted during transcription and completed the final transcript. The accuracy of the transcribed data was verified through a member checking process with the participants, which continued until December 2022 after the transcription was completed. The final transcript was compiled on A4 paper in 10-point Batangche font with line spacing of 160%. The total volume was 59 pages: 32 pages for the interview with Group NP and 27 for the one with Group P.
4. Data Analysis
During the analysis process, the researcher maintained a research journal to document the interpretation and decision-making processes, enhancing transparency and reliability. Additionally, a member check process was conducted to share some research findings with participants and gather feedback on whether the interpretations accurately reflected their perceptions. All data analysis was conducted independently by the researcher, and the data were analyzed using a method tailored for FGI results, following a structured approach to ensure rigor and consistency.
1) Initial coding
The researcher repeatedly read the transcripts to understand the overall flow and context. Codes were assigned based on meaningful sentences or phrases within the transcribed text. Significant statements were underlined in relation to the main research questions, and open-ended codes were used to capture important expressions. Similar concepts were grouped and labeled to reflect the core ideas conveyed in the interviews.
2) Code categorization and theme derivation
The researcher classified the main contents of meaningful statements and expressions, repeatedly reviewing the analysis units for categorization. Codes with similar meanings were integrated into higher-level categories, ultimately leading to the derivation of core themes.
3) Data interpretation and meaning construction
Based on the derived categories, the researcher interpreted North Korean women’s perceptions of newborn care and examined the relevant sociocultural contexts that shape their perspectives.
5. Methodological Rigor
To ensure the rigor and credibility of the results, the researcher referred to the four criteria of trustworthiness for qualitative research suggested by Guba and Lincoln [
19]. Accordingly, the quality of the analytical process and results was reviewed systematically across four dimensions: credibility, fittingness, confirmability, and auditability. First, to ensure credibility and confirmability, the whole interview process was conducted in a controlled environment, and during data collection, the researcher minimized their own interpretation by directly quoting participants’ expressions. Additionally, during the analysis process, this researcher tried to enhance validity by recording subjective thoughts and interpretation in a research log. This researcher also conducted a member-checking process, where shared some research results with participants and received feedback on the accuracy of subjective interpretations. Fittingness was assessed based on whether the data sufficiently reflected the perceptions of newborn care among a specific group of North Korean refugee women. By including members of diverse ages, marital and childbirth experiences, and settlement periods, two groups were formed: one consisting of five women who were not currently pregnant but planning to become pregnant, and another of four women who were currently pregnant. This approach captured a range of perceptions and needs related to newborn care at different stages of the maternal experience, aligning with the research objective of identifying life-cycle support strategies for North Korean refugee women. Confirmability was ensured by systematically recording and reviewing all stages of data collection and analysis, including original transcripts, coding notes, and theme development. Participants reviewed the interview transcripts to confirm the accuracy of the content, ensuring their perspectives were faithfully reflected. For auditability, we explicitly recorded the whole data collection, analysis, and interpretation process, and the generated categories and themes were repeatedly compared and refined during the research process. An audit trail was systematically recorded, including transcribed data, analysis notes, and code tables. Through these processes to ensure rigor, we made efforts to analyze in greater depth the meaning and structure within participants’ experiences and perceptions of newborn care.
RESULTS
In the first stage, interviews were conducted with non-pregnant (
Table 1) and pregnant (
Table 2) North Korean refugee women, and specific themes for their perceptions of childrearing were identified. Next, the themes for the results for pregnant and non-pregnant women, separately, were unified to derive categories and subcategories. In the second stage, shared regions in the perceptions of child-rearing between pregnant and non-pregnant women were derived. The researcher then identified differences within the shared regions in perceptions of childrearing between pregnant and non-pregnant women.
1) Participant characteristics
Group NP consisted of five unmarried, non-pregnant North Korean refugee women. They had no prior experience of pregnancy or childbirth and thus expressed uncertainty about future maternal and parenting roles (
Table 3).
2) Themes identified from the data
From the interview data, we derived 15 themes, which we combined into five subcategories and two categories (
Table 1). Categories of ambivalence and role expectations were derived. These participants, since they were unmarried and had no clear plans yet for pregnancy or childbirth, perceived vague difficulties regarding something they had not experienced themselves. They expressed conflicting emotions regarding childrearing due to the negative aspects of self-sacrifice and having to give up on one’s own life, but also the great joy that newborns bring. However, they felt that basic newborn care could be a huge burden due to their lack of experience, and showed concerns that they might accidentally harm their child. Furthermore, they felt a sense of responsibility regarding the expectation of accepting their role as a mother and wanting to care well for their child. Participants mentioned that childrearing could not be managed alone and required cooperation with nearby support. However, for North Korean refugee women especially, the absence of their mothers emerged as a vulnerability.
Regarding conditions for pregnancy and childbirth, nine themes were derived, which were combined into six subcategories and two categories (
Table 2). The two categories were preparing to accept motherhood and ensuring support systems. North Korean refugee women are often separated from their mothers and have no close acquaintances after fleeing North Korea, meaning they need a support system to provide help when they become pregnant or give birth. Participants also discussed differences in sex culture between North and South Korea and the unhappiness of children born from unplanned pregnancies as a result of insufficient sex education. They were afraid of undesired pregnancies, and thought importantly of responsible pregnancy based on proper education. They also discussed the sense of responsibility of being a parent who recognized certain North Korean-style parenting methods as abuse, and did not inherit these parenting styles.
1) Participant characteristics
Group P consisted of four pregnant North Korean refugee women. They were currently preparing for childbirth and faced more immediate concerns regarding balancing motherhood with personal and social life (
Table 3).
2) Themes identified from the data
From the interview data, 29 themes related to childrearing were identified, which were combined into eight subcategories and three categories (
Table 4). The three categories for pregnant North Korean refugee women’s perspectives of childrearing were ambivalence, role expectations, and life imbalance. These pregnant women showed similar ambivalence regarding childrearing as their non-pregnant peers. However, in addition to the realistic difficulties of parenting they would soon face, they also perceived the birth of their child as a new life through which they would shed their old life alone. However, they perceived themselves as a separate entity to that of their child, as well as the surety of themselves as a mother who must care for a baby. They perceived a sense of responsibility as a mother who rather than what they want to do right now, comforts themselves as they establish plans for after their child has grown. Participants had significant worries about social life and work while currently pregnant, expressed major yearning due to the understanding of childrearing as sacrifice and discontinuation of work experience, and recognized childrearing as a life imbalance.
Regarding conditions for pregnancy and childbirth, 20 themes were derived, which were combined into six subcategories and two categories (
Table 5). The two categories were preparing to accept motherhood and a realistic support-based environment. Pregnant North Korean refugee women showed will and effort to obtain information related to pregnancy, childbirth, and parenting via the internet such as on YouTube or online communities. They discussed fetal education, the education they had received in their own youth, and importance of the environment one grows up in for parenting. They expressed concerns that the different parenting methods in North and South Korea could cause their baby harm in South Korea. They also expressed their concern about whether they could follow private education in South Korea. They discussed the limitations of information gathering through books and the internet as first-time mothers, and indicated the need to know methods of caring for the baby in advance through accurate and detailed information about newborn care. Participants felt a sense of regret about leaving North Korea because they had no mother or acquaintances who could help after childbirth. They felt homesick and required help from their husband.
When the results from both groups were synthesized, four overarching themes emerged: ambivalence toward motherhood, reflecting the simultaneous feelings of joy and burden associated with childrearing; role expectations and responsibility, indicating a strong awareness of maternal duty despite inexperience or limited resources; lack of supportive systems, highlighting how separation from mothers and limited social networks heightened vulnerability; and life imbalance, particularly pronounced among pregnant women, related to concerns about discontinuing work and social activities.
Together, these findings show that both pregnant and non-pregnant North Korean refugee women experienced ambivalence and a strong sense of maternal responsibility while grappling with the absence of supportive systems. For pregnant women, childrearing was especially linked to feelings of imbalance among personal, social, and maternal roles.
4. Shared Regions and Differences in Perceptions of Newborn Care between Pregnant and Non-pregnant Women
Building on these overarching themes, further analysis was conducted to explore the similarities and differences in perceptions of childrearing, pregnancy, and parenting between the two groups. While the integrated themes offer a general understanding of North Korean refugee women’s maternal experiences, examining areas of convergence and divergence enables a more nuanced comparison. Consequently, shared aspects among both pregnant and non-pregnant participants, as well as unique differences specific to each group, were identified and are presented in the following section.
1) Ambivalence
Two shared areas emerged in the perceptions of newborn care of both pregnant and non-pregnant North Korean refugee women. These were (1) ambivalence between positive and negative perceptions of childrearing and (2) sense of responsibility. This ambivalence was not only emotional but also culturally shaped, reflecting women’s experiences of transition between North and South Korean parenting norms. Non-pregnant women exhibited ambivalence, characterized by vague expectations about their baby. However, the sense of burden was greater, as this event had not yet realistically impacted their lives. In contrast, pregnant women experienced heightened ambivalence at the intersection of their sense of responsibility for actual care and the challenges of maintaining life balance. They viewed childrearing as an impending reality, leading to a mix of joy and expectation, yet they also felt a stark contrast between the burdens and expectations associated with parenting as they underwent the physiological changes of pregnancy.
Thus, the nature of ambivalence differed: non-pregnant women anticipated hypothetical challenges based on past experiences and cultural memories, while pregnant women faced immediate, reality-based concerns shaped by their current transition into motherhood.
“First, because I’ve never had a child... I think, won’t it be difficult? (tilting their head)... Still, I have idealistic notions. I want to care for them while treating them like a princess.” (Non-pregnant woman A)
“Isn’t it difficult to raise a child?... I still haven’t thought about it, but… You can love them and love them and wouldn’t there be no end to it?” (Non-pregnant woman B)
“Babies are so beautiful... They’re beautiful and lovely and delicate, so of course you have to care for them no matter what, but... Um... I feel like it’s hard labor... It must be very difficult... I feel like you become a slave to your baby.” (Non-pregnant woman C)
Conversely, for pregnant women, this ambivalence was further emphasized at the interface between the sense of responsibility for actual care and problems of life balance. Pregnant women perceived childrearing as an impending reality, and so while there were joy and a sense of expectation, the sense of burden and expectation regarding childrearing were starkly contrasted as they experienced the physiological changes of pregnancy. Pregnant women also discussed negative aspects such as yearning and sadness for their life that was changing, envy toward unmarried women without children, the efforts and difficulties involved in childrearing, and discontinuation of their work experience.
“I keep thinking, where did you come from? And when I pray for my child, I’m so grateful to this child for trusting me and coming into this harsh world. That overwhelming feeling sometimes makes me cry, and I wonder if it’s not depression.” (Pregnant woman 1)
“Of course, people who aren’t married and don’t have children can spend time on and enjoy themselves, but you know there’s also a happiness that only children can give you.” (Pregnant woman 2)
“Childrearing is our natural right as a mother. I think it’s a gift given by God. But in reality, won’t it be very difficult?” (Pregnant woman 2)
“(Sighing) Originally, I wanted to work right away, but I got pregnant sooner than I expected... I had to give up on work (hehehe).” (Pregnant woman 3)
“I don’t have any family, and so I have to raise them all by myself. Because I have to do it all myself, when it’s difficult, I’m sometimes a little envious when I look at my unmarried friends. I wonder how it would be if I could do my own things a little in life...I still haven’t been able to do things like self-improvement, and in that regard, I think I feel a strong sense of longing. When I think that I haven’t gone out into society, a person feels a sense of depression, you know.” (Pregnant woman 2)
I had the thought that maybe, in my heart, there’s a sadness that I’m going in this direction now, and I might not be able to do all the things I want.” (Pregnant woman 1)
The perceptions of pregnant and non-pregnant women were similarly ambivalent in describing babies as a blessing and gift, and as a marvel and joy. Non-pregnant women had a perception of mutually dependent care, while pregnant women had a perception of care as imbalance in life. As soon as they thought of childrearing, non-pregnant women recalled how they were raised by their own mothers and noted the strong influence from their surroundings. On the other hand, pregnant women reported that with the start of childrearing, their family was a greater priority than their own work, discussing this as a process of having to endure the sacrifice of giving up on much of themselves. They also expressed a sense of depression at the discontinuation of social life, and perceived childrearing as an imbalance in life, such as worrying about the discontinuation of their work experience, whether work and parenting could be performed in parallel, or whether they could find employment again.
“I think the influence of the environment or people helping alongside me is important. When I see someone having a hard time raising their child, I think, will I be like that too? (tilting head)... (omitted) I think the surrounding circumstances have a major influence.” (Non-pregnant woman B)
“Another woman I know got pregnant recently, and they’re having a really difficult time. (omitted) But another person I know, their child is around 3 years old now, and they’re raising them so beautifully. She tells me if I have children, she’ll raise them for me. She likes it so much. So I realized [people’s experiences can be] completely opposite... and I become a little confused. Information in your environment is really important, and I think acquaintances truly have a major influence.” (Non-pregnant woman C)
2) Role expectations
The second shared area was role expectations, where women perceived a sense of duty and burden regarding childrearing, and worried about what they had to do to fulfil their role. Regarding role expectations, non-pregnant women perceived a sense of responsibility for childrearing. Among non-pregnant women, role expectations were more anticipatory and framed as preparation for future motherhood. Specifically, due to the lack of knowledge about basic concepts and care relating to babies, they felt fear and worry that they would not be able to care well for a child, felt certainty as a mother, self-doubt about parenting, and a sense of responsibility, perceiving the need to prepare to become a mother. Pregnant women expressed that role expectations were an urgent responsibility they were already enacting, accompanied by heightened anxiety about their ability to provide care in the present moment. They perceived babies as fragile beings and described motherhood as a responsibility that demanded sacrifice. These differences reflect how cultural adaptation and lived pregnancy status shaped distinct experiences of maternal responsibility.
“When I see those things (abuse), I think you shouldn’t have had a child if you won’t take responsibility. Why are they like that?” (Non-pregnant woman D)
“When I raise [a child] now it’s okay, and I can choose, but when the child gets bigger, I have to become a person who can guide them to make the right choice for themselves.” (Pregnant woman A)
3) Conditions for pregnancy, childbirth, and parenting
The two shared perceptions for conditions for pregnancy and childbirth were acceptance of motherhood and a realistic support environment. For non-pregnant women, perceptions were largely anticipatory and conditional, characterized by a need for knowledge, preparation, and reliable support before committing to pregnancy or childbirth.
In contrast, pregnant women described these conditions as immediate and experiential, emphasizing their current physical and psychological readiness. They rejected certain North Korean parenting practices and actively sought accurate, practical information to aid their impending childbirth. They underscored the importance of husbands and surrounding support in coping with the challenges of actual childrearing.
In summary, while both groups shared similar thematic areas, their perceptions diverged in terms of temporal and experiential orientation. Non-pregnant women viewed childrearing and motherhood as potential future challenges, whereas pregnant women experienced them as pressing realities within the cultural transition of resettlement.
“Actually, I’m a bit sorry, but... I wish someone like a social worker would come and teach me directly. In fact, if they did that, I feel like next time I could do a little better myself. If they would visit directly and help bathe the baby or in a given state [check] whether they have a fever or where they’re hurting.” (Non-pregnant woman C)
“In the education I received and environment I grew up in, mothers just said no and hit [their children] (makes a hitting gesture).” (Non-pregnant woman A)
“Although you can study everything on YouTube here, if there is a limit there, then you’re limited to doing what your parents did. Here, they can come to your house and show you an example of what to do, and help directly... Because I think that helps a lot. Regardless of the [differences between] North and South Korea, I think that [having someone to help] would be especially helpful for North Korean refugees. Most people who flee North Korea don’t have family. So that’s something that’s really necessary.” (Pregnant woman D)
“Raising a child isn’t something you do alone. When in Rome, do as the Romans do. So to do well here, shouldn’t we raise children the way they’re raised here? To do that, I think receiving education on how to be a mother or father is important.” (Pregnant Woman C)
“It’s still not easy to raise children in our society. And if you have a child, some places you go, they still treat you like a sinner, you know. Like if you’ve brought a baby somewhere, and because they’re a baby of course they might cry, and if they cry, people criticize you, and so mothers feel really sorry.” (Pregnant woman B)
DISCUSSION
The present study explored the perceptions of North Korean refugee women regarding newborn care through FGIs. The aim was to establish a foundation for developing educational programs tailored to women at different life stages, including pre-pregnancy and pregnancy. The findings revealed that participants had limited knowledge and experience related to newborn care, facing challenges in child-rearing due to cultural adaptation and insufficient social support. Although the participants were expectant mothers without prior childcare experience, differences emerged in their perceptions of newborn care and the conditions surrounding pregnancy, childbirth, and parenting—particularly between single women planning future pregnancies and married women currently pregnant. These differences appear to be influenced by marital status and length of residence in South Korea, averaging 5 years among non-pregnant women and 10 years among pregnant women. Therefore, it is crucial to identify the specific perceptions and needs of North Korean refugee women and to develop structured, needs-based educational interventions that promote healthy experiences in pregnancy, childbirth, and childcare.
Common areas in the perception of newborn care among North Korean refugee women were ambivalence toward care and role expectations. These perceptions originated from expectations and fears of childrearing, confusion caused by changes in self-identity, and psychological conflict occurring at a transition point in their lifecycle.
Both pregnant and non-pregnant women described childrearing as a complex experience involving a mixture of joy, expectation, burden, and a sense of responsibility. However, the two groups showed differences in their ambivalence. Non-pregnant women perceived childrearing as mutually dependent care, whereas pregnant women viewed it as a source of imbalance in life.
Non-pregnant women expressed vague expectations about motherhood, accompanied by fear of mistakes, lack of information, and insufficient support systems. Similarly, Borovoi et al. [
20] reported that non-pregnant women experience both vague expectations and emotional burden regarding childrearing. In other words, they hold complex emotions between idealized expectations and a realistic sense of distance.
This finding aligns with Rasmussen et al. [
21], who found that women experience both positive feelings about childrearing and a “loss of control in life and changes in identity,” making ambivalence more prominent.
Pregnant women, on the other hand, more intensely experienced the realistic burden of impending childrearing. Hormonal changes, physical discomfort, and anxiety about childbirth can lead to emotional swings, resulting in conflicting feelings of expectation and burden. According to Hamzavi et al. [
22], pregnant women’s negative perceptions of childrearing decrease when they receive higher levels of social support.
This highlights the importance of providing community-based education before pregnancy to help women understand the realities of childrearing, reduce anxiety, and develop a positive attitude. Therefore, strategies to strengthen social support are essential.
Furthermore, Cutler et al. [
23] found that higher levels of depression among fertile women were associated with greater ambivalence, while stronger social support reduced ambivalence. A stronger identification as a mother and greater preparedness for the parental role also decreased ambivalence.
In conclusion, customized support that considers the internal emotions, social support levels, and pregnancy preparedness of North Korean refugee women is necessary.
In this study, both pregnant and non-pregnant North Korean refugee women showed role expectations as a mother, but the patterns differed. Non-pregnant women expressed fear due to a lack of parenting knowledge, which is related to perceptions of responsibility in a state of unpreparedness. Pitso and Kheswa [
24] noted that for women before pregnancy or those pregnant aged 10–19 years, lack of psychological preparation and anxiety about other’s views negatively affect care responsibility. Furthermore, pregnant women went beyond the simple perception of “having to care well for their baby” and also discussed internalization of values in the process of growth and specific plans for parenting. These perceptions are part of a process of integrating their identity during pregnancy with their role as a mother, highlighting the important role of self-awareness in healthy prenatal psychological development [
25]. The comment made by non-pregnant woman C, “in that case, it’s better not to have a child,” can be understood as signaling hesitation or doubt about taking on parental roles, which aligns with observations, as Kanku and Mash [
26] also found. In their study, non-pregnant women felt vague fear and aversion toward childrearing more strongly in situations with no direct relation to responsibility and that they were unprepared. Pregnant woman A’s statement, “I have to guide my child,” goes beyond simple newborn care and includes the perception of a mother’s role as someone who raises a child and gives direction. Ediz and Uzun [
27] emphasize that pregnant women tend to experience both internalization of values and reconstitution of their identity between social responsibility and changes in their own lives.
The two groups of North Korean refugee women demonstrated different perceptions regarding the conditions for pregnancy, childbirth, and parenting. Non-pregnant women repeatedly emphasized that they “want to give birth only when they have a support system” and underscored “the importance of having people to help.” They believed that the role of a parent could only be sustained when an “environment of education and support” was established before marriage and pregnancy.
This perspective is consistent with Al-Mutawtah et al. [
28], who reported that even non-pregnant women anticipate anxiety and information gaps as prospective parents and hold expectations of social support.
In South Korea, the pregnancy and childbirth support system is relatively comprehensive. It includes health infrastructure and policy-based assistance such as antenatal services, postnatal care subsidies, and newborn health education [
29]. Moreover, as the importance of postnatal care continues to grow, the latest WHO recommendations [
30]—aimed at enhancing continuous health services for maternal and newborn well-being—align with Korea’s postnatal care framework.
Even during the COVID-19 (coronavirus disease 2019) pandemic, the Korean government maintained maternal and newborn health through rapid response measures and national cohort management programs [
31]. These efforts contributed to the overall stability of the maternal and newborn health management system.
Despite this, participants in the study reported limited awareness of how to access and use these available resources. This finding is particularly significant for North Korean refugees, who often face challenges navigating public systems due to limited legal rights, social networks, and emotional stability during their adjustment to life in South Korea.
The need for a robust support system is therefore critical. Refugees with insufficient social capital, cultural understanding, and emotional resilience may struggle to benefit from existing services. Similarly, Hamzavi et al. [
22] found that social support enhances psychological stability even before pregnancy, whereas the absence of such support negatively affects decision-making and attitude formation related to pregnancy.
Non-pregnant participants also expressed a preference for practical and personalized education. One woman stated, “It would be good to be taught directly by a social worker next to me,” and another added, “Simulated education is more important than YouTube.” These remarks reflect a desire for interactive, experience-based learning rather than passive information consumption.
Among non-pregnant women, decisions regarding childbirth often involved conditional readiness. Many indicated that they would consider pregnancy only once they felt fully informed and emotionally prepared. This demonstrates a cautious and context-dependent approach to family planning.
Pregnant women, by contrast, expressed emotional distress and psychological withdrawal. Comments such as “I’m depressed because I can’t participate in social life” and “I can’t do what I want because I have to care for my baby” reveal feelings of frustration and loss of autonomy. They also described physical and psychological limitations, lack of information, and insufficient support systems.
Additionally, pregnant women shared feelings of yearning and internal conflict regarding the changes in their life direction after childbirth. According to Talbot et al. [
32], pregnant women often suffer from social isolation, sleep disturbances, and emotional loneliness, all of which are closely linked to long-term depression. This corresponds with participant B’s statement: “I have to raise my baby alone” and “I can’t meet people and I become depressed.”
Furthermore, Smorti et al. [
33] reported that pregnant women experience greater emotional fatigue when “motherhood is unwelcome,” particularly in societies where childrearing activities or children’s crying in public are stigmatized.
These findings collectively highlight the importance of fostering a more socially tolerant and supportive culture toward childrearing, especially for vulnerable populations such as North Korean refugee women.
The differences in perception of pregnancy, childbirth, and parenting between pregnant and non-pregnant women are consistent with Tani and Castagna [
34]. Specifically, “because pregnant women are directly exposed to psychological stress and role change, information accessibility and lack of social support present as real crises.” Non-pregnant women tend to form perceptions of motherhood based on imagined experiences rather than direct engagement, often viewing the prospect of motherhood favorably contingent upon the presence of a supportive environment. This conditional acceptance aligns with the emphasis on contextual factors influencing pregnancy and parenting decisions found in previous qualitative analyses. Moreover, the unique nature of North Korean refugees is an obstacle for both pregnant and non-pregnant women, and the absence of one’s mother or acquaintances who can help demonstrates the reality of a severe lack of support within South Korea society. Many North Korean refugee women face a breakdown in family structures, making the absence of mothers or female relatives who can offer guidance, especially during pregnancy and the postpartum period, particularly noticeable. The lack of intergenerational support and unfamiliar cultural backgrounds in early motherhood can intensify feelings of isolation and anxiety among North Korean refugee women. In addition to institutional support, there is an urgent need for realistic, intimate assistance accompanied by psychological and emotional support. To this end, it would be helpful to enable realistic emotional support through mentoring programs between older and newer mothers, as well as connecting childcare helpers or mentors with mothers-to-be. The need for support should be recognized as more urgent than that of general South Korean pregnant women.
This study examined the perceptions of newborn care among North Korean female defectors who were either preparing for pregnancy or currently pregnant. A key finding was the emotional ambivalence commonly observed among participants. This ambivalence reflected structural and cultural trends shaped by specific challenges faced during their adaptation to Korean society, including a lack of experience, information, and social support, alongside hope and affection for their future children.
The study recruited participants residing in Seoul and the surrounding metropolitan area, considering accessibility and interview scheduling, which ensured a degree of consistency in service accessibility and infrastructure. However, this approach also introduced limitations. The results may not fully represent the perceptions of North Korean defector women living in rural or marginalized areas with weak institutional support and insufficient community resources [
35]. Additionally, the low utilization rate of available services among participants suggests that even with sufficient resources, accessibility may still be inadequate. Therefore, it is essential to provide culturally sensitive information and relationship-centered support tailored to participants' characteristics. In the new system, their perceptions of infant care cannot be separated from the broader context of adaptation and survival, as they must learn motherhood while also reconstructing their identities and confronting loss, trauma, and alienation. Consequently, efforts to support them must extend beyond practical education to include emotional recognition, culturally rooted mentoring, and trust-based support within the community.
CONCLUSION
In this study, we analyzed differences in perceptions of newborn care and conditions for pregnancy, childbirth, and parenting between pregnant and non-pregnant North Korean refugee women preparing to become first-time mothers, and demonstrated the need for customized support measures. By analyzing their expressed concerns, emotional states, and expectations, it became clear that their experiences of motherhood are deeply intertwined with broader social and structural challenges, including unfamiliar healthcare systems, disrupted family support networks, and limited cultural alignment with mainstream parenting norms in South Korea. While both pregnant and non-pregnant women expressed ambivalent perceptions including a mixture of expectation and fear regarding childrearing, pregnant women mentioned specific parenting strategies and perceived childrearing as a more realistic responsibility amidst physical changes and social isolation. Non-pregnant women expressed more vague aversion and anxiety about the lack of information and support systems, and that they could only endure childrearing if they received sufficient external support. In particular, pregnant women highlighted the psychological conflict of discontinued self-realization and changes in their identity as a mother. This study demonstrated differences in perceptions of childrearing among North Korean refugee women depending on whether or not they were pregnant, and suggests the need to develop customized education depending on life cycle and psychological preparedness, and to construct social support systems.
To effectively address these multifaceted needs, community health workers and health service providers should actively engage in early identification, culturally appropriate education, and building trust-based relationships with North Korean refugee women facing challenges related to pregnancy, childbirth, and childcare. Through these initiatives, South Korea can enhance the health and well-being of North Korean refugee women and their children, as well as promote their social integration.
ARTICLE INFORMATION
Table 1.Perceptions of newborn care by non-pregnant women
|
Themes |
Subcategory |
Category |
|
Vague difficulties (raising a child is difficult, I don’t know) |
Vague negative attitudes toward care, self-sacrifice |
Ambivalence |
|
Giving up one’s own life |
|
|
|
Hard labor |
|
|
|
Depression |
Feeling lost |
|
|
Burdensome |
|
|
|
Recalling the image of mothers crying together when their babies cry |
|
|
|
Worrying that I might care for my baby even a little incorrectly |
|
|
|
Mixed feelings (difficulty and joy) |
Difficult to accept but also joyous |
|
|
Liking babies but not wanting to give birth |
|
|
|
Idealistic perceptions of babies (they’re beautiful) |
|
|
|
Surety of becoming a mother |
Sense of responsibility |
Role expectations |
|
Understanding the feelings of one’s parents |
|
|
|
Self-doubt and desire to be a good parent (I want to be a good mother) |
|
|
|
Embarrassment due to acquaintances who were unaware of the physical changes during pregnancy |
Pregnancy as an enormous challenge |
|
|
Recalling acquaintances who did not recognize pregnancy and were surprised at the diagnosis thereof |
|
|
Table 2.Conditions for pregnancy, childbirth, and childrearing by non-pregnant women
|
Themes |
Subcategory |
Category |
|
Preparations for childbirth (several), necessity of preparing for childrearing |
Perceptions of childbirth and parenting |
Preparing to accept motherhood |
|
The burden of childbirth |
|
|
|
The responsibility of pregnancy, the importance of planned pregnancy |
Sense of responsibility |
|
|
Perceptions of insufficient sex education and differences in sex culture between North and South Korea (characteristics of North Korean refugees): contraception and abortion |
Accurate sex knowledge and cultural understanding |
|
|
Knowing the human rights of women and babies / Preventing abuse |
Awareness of human rights |
|
|
Thinking care will be very difficult due to the absence of one’s mother (an especially important characteristic of North Korean refugee women, who are separated from their parents) |
Care support resources |
Ensuring support systems (practical support-based environment) |
|
Desire for real and simulated education |
Educational support |
|
Table 3.Information about the participants
|
Group |
Age (yr) |
Period of residency in South Korea |
Education (after entry) |
Occupation |
|
Non-pregnancy group |
|
|
|
|
|
Mean total |
30.2 |
5 yr 8 mo |
|
|
|
A |
30 |
4 yr 10 mo |
University graduate |
Office worker |
|
B |
29 |
6 yr 1 mo |
University student |
Office worker |
|
C |
28 |
4 yr 4 mo |
University student |
Office worker |
|
D |
29 |
8 yr 2 mo |
University student |
Student |
|
E |
35 |
6 yr 0 mo |
High school graduate |
Office worker |
|
Pregnancy group |
|
|
|
|
|
Mean total |
34.5 |
10 yr 1 mo |
|
|
|
1 |
33 |
4 yr 8 mo |
University student |
Student |
|
2 |
39 |
14 yr 2 mo |
High school graduate |
Head of a civilian organization |
|
3 |
38 |
15 yr 11 mo |
University graduate |
Housewife |
|
4 |
28 |
5 yr 8 mo |
High school graduate |
Housewife |
Table 4.Perceptions of newborn care by non-pregnant women
|
Themes |
Subcategory |
Category |
|
• Depression |
Confusion (physical changes and confusion, unexpected physical/emotional difficulties) |
Ambivalence |
|
• Vagueness, feeling lost |
|
• Fear |
|
• Difficulty (morning sickness, etc.) |
|
• Perceptions of differences in parenting methods |
|
• Difficulty of the first-time experience |
|
• Regret |
Another life (yearning and comparisons due to changes in life before and after childbirth, confusion in one’s new role [as a mother]) |
|
|
• Sorrow at leaving behind a daily life alone (envy or yearning for life before pregnancy) |
|
• Struggling with social life, withdrawal, and depression |
|
• Natural but unfamiliar acceptance of oneself as a mother |
|
• Happiness given by babies (it just feels good) |
Positive perceptions (similar to a non-pregnant woman), affection and assigning significance to one’s child, an attitude of accepting a child as a positive turning point in one’s life |
|
|
• Babies are a gift, even if they are difficult and require effort |
|
• Babies are a marvel |
|
• Grateful for the presence of a baby (to oneself, who is unprepared) |
|
• Perception of the baby and myself as separate entities |
Perceptions of identity (new perceptions of oneself and one’s life through childbirth and parenting, the process of past and present emotions intermixing) |
Role expectations |
|
• Inalterability, adaptation over time |
|
|
|
• Vicarious satisfaction through one’s baby (comparison with one’s own life—thinking about the process of growing up in North Korea) |
|
|
|
• Difficulty handling one’s baby because of their tiny size, caution |
Sense of responsibility (worrying about how to handle one’s baby) |
|
|
• Fear about parenting (that I might not be able to raise them well) |
|
• Lack of preparation |
|
• Necessity of effort |
|
• Surety |
Baby’s existence and perceived value |
|
|
• Children are important and must be respected |
|
|
|
• The right of a mother |
|
|
|
• Change in values prioritizing family over work |
Enduring sacrifice |
Life imbalance |
|
• Disconnection of social life |
|
|
|
• Disappointment at having to put aside many things, e.g., self-improvement |
|
|
|
• Depression due to discontinuity of work experience |
Discontinuity of work experience |
|
|
• Worries about performing work and parenting in parallel |
|
|
|
• Worries about finding employment again |
|
|
Table 5.Conditions for pregnancy, childbirth, and childrearing by pregnant women
|
Themes |
Subcategory |
Category |
|
• Mindset and preparations for becoming a mother (physical and psychological) |
Acceptance and preparation for the roles of motherhood |
Process of accepting motherhood |
|
• Acceptance of the process of becoming a parent |
|
• Feeling the importance of fetal education |
|
• Importance of the will to learn about parenting, will to participate in parenting programs |
Growth through learning and information-seeking |
|
|
• Finding childbirth products and information on YouTube or online communities |
|
|
|
• Recognizing the importance of education through parenting programs |
|
• Learning through indirect experience |
|
• Perception of the importance of early education |
Importance of parenting philosophy and environment |
|
|
• Effects of family and environment on childrearing |
|
• Inheritance of parenting methods |
|
• Comparison with others, one’s own unique parenting philosophy |
|
• Concerns about the different parenting methods in North and South Korea |
Social support: difficulties accessing education and information (environmental barriers) |
Practical support-based environment |
|
• Difficulties with realistic education in South Korea/worries about private education in South Korea |
|
|
|
• Discomfort acquiring information from books or the internet (I don’t know) |
Educational support |
|
|
• Unfamiliarity with methods of obtaining information |
|
|
|
• Limits of searching for data (YouTube, self-learning) |
|
|
|
• Potential for using inaccurate data/difficulties obtaining accurate data |
|
|
|
• Some regret about leaving North Korea due to the lack of support systems |
Psychological support: psychological challenges and need for emotional support |
|
|
• Desire for husband’s support |
|
|
|
• Homesickness and recognition of the need for emotional stability |
|
|
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