For nearly two decades, obstetrician Shim Sang-duk aborted as many babies as he delivered -- on average, one a day, month after month.
"Over time, I became emotionless," the physician said. "I came to see the results of my work as just a chunk of blood. During the operation, I felt the same as though I was treating scars or curing diseases."
Shim, 42, eventually came to despise himself, despite the money he earned from the procedures. So, two months ago, he founded an activist group of physicians who refuse to perform abortions and advocate prosecution for doctors who continue to do so.
The group's stand has brought a tidal wave of criticism from the Korean Assn. of Obstetricians and Gynecologists, which represents more than 4,000 physicians in this country where abortions, although technically illegal, are so prevalent it has been tagged as "the Abortion Republic."
Unlike in America, where doctors have been threatened and even killed for performing abortions, Shim says he's received death threats for deciding to stop performing them.
The controversy illustrates the stark differences between South Korea's attitude toward abortion and that of many Western nations. While often couched elsewhere as a battle between religious activists and those defending a woman's right to choose, the issue here carries no such emotional freight.
"Western societies see abortion as one of benchmark battles between conservatives and liberals -- while here there has not been even any academic discussion," said Lee Na-young, a sociology professor at Seoul's Chung-Ang University.
In South Korea, religious groups and women's rights advocates have remained largely silent on the issue, analysts say.
"During church sermons, we barely talk about abortion, which is considered an individual matter," said Hwang Pil-gyu, a minister on the life and ethics committee of the National Council of Churches in Korea. "Many churches have put this issue on the back burner."
Shim has critics even outside the medical field. Some say he's grandstanding. Others criticize his emphasis on the financial incentive of performing abortions.
"The whole discussion seems to be about his giving up profits from the abortions he doesn't do," Lee said. "This isn't the issue."
But Shim's campaign has triggered a rare public debate on abortion. Lawmakers now call for tougher enforcement of existing laws, and are asking parents to reassess the cultural value of childbirth.
Beginning in the 1970s, officials advocated fewer births as a way to fuel economic productivity. The policy was perhaps too successful: Birthrates in South Korea plummeted. A decade ago, officials reversed their stand, calling for residents to have more babies.
Yet the declining fertility trend has proved difficult to reverse. The country's birthrate is now among the lowest worldwide, with just 1.19 live births per woman.
Meanwhile, abortion rates have kept their pace, many say. Every year, 450,000 babies are born here; Health Ministry officials estimate that 350,000 abortions are performed each year. One politician says the number of abortions is actually four times higher -- nearly 1.5 million.
Now there are calls to strengthen a 1973 mother-child protection law, long criticized for containing loopholes and for being rarely enforced. Some lawmakers want to prosecute more physicians for performing abortions and close down underground clinics where the procedures cost as little as $70.
For the first six months of 2009, only three of 29 abortion-related cases were prosecuted, said Chang Yoon-seok, a member of the ruling Grand National Party, who supports tougher sanctions.
"Even though illegal abortions are widespread . . . it is true that everyone keeps quiet and does not say anything about it," the politician said in a statement.
Dressed in his white lab coat, the bespectacled Shim embodies a new public consciousness against abortion.
In the lobby of his Ion clinic, a sign explains his new philosophy. "Abortions, which abandon the valuable life of a fetus, are the very misery for the nation and society as well as pregnant women, families and ob-gyn doctors," it reads.
For years, Shim rarely, if ever, even used the word "abortion." Rather, he said, he sought to "erase" or "prevent" the fetus.
"I bought into the government's argument that it was OK to do this," he said. "It was good for the country. It boosted the economy."
Still, Shim was often baffled by his patients' behavior: After receiving their abortions, he said, most women cried.
"Many patients cry when they give birth," he said, "but these were a different kind of tears."
Although Shim's clinic made one-quarter of its profits from performing abortions, he tried harder to dissuade patients from choosing the option.
He started a website where he was contacted by other physicians. Although he claims support from 700 doctors, he acknowledges that only 30 have stopped performing the procedure.
Many others have withdrawn their support under pressure from peers. But for Shim, the benefits were immediate. "I feel like a young doctor again," he said.
The decision was difficult financially. His clinic has lost so many patients that Shim says he may soon be forced to close.
But Shim won't reconsider. The physician recalled his final abortion.
He had already sworn off the procedure when a longtime patient called him, distraught. He met with the mother of two for hours and begged her to go home and reconsider.
The following morning, she still wanted the abortion. So Shim relented. After the procedure, he said, she cried.
Ju-min Park of The Times' Seoul Bureau contributed to this report.