In 1976, a 17-year-old Korean girl gave birth to her first child. A few months before the delivery, she had been forced to marry the man who raped and impregnated her.
"That was the norm at the time," Noh Geum-ju told The Korea Herald.
"When you get pregnant as an unmarried woman, you have to marry the father of your baby. Other options were unthinkable."
Her unhappy marriage was filled with extreme financial difficulties, to the point where she was forced by her husband to sell her blood.
But nothing was worse than learning that her family members secretly sent her 11-month-old son for adoption to give Noh an "easier life."
When she finally tracked down the hospital where her son was taken ― which was affiliated with adoption agents ― it had been abruptly closed. After crying for days, she descended into depression with frequent suicidal thoughts.
"I didn't know who I was anymore. I wanted to kill everyone, including myself," she said.
Noh, who currently heads Dandelions ― a group of Korean birth mothers ― still suffers from the trauma. She reunited with her son, who had been adopted to the US, in 2005, but the reunion did not make up for her 29 years of loss. Every March, her son's birth month, Noh falls physically ill.
On top of the language barrier and shock ― Noh had been thinking her son was adopted to a Korean family ― it was especially heartbreaking to learn that her son was struggling financially, she said.
"I still feel sad and angry," she said. "I feel guilty that I couldn't raise him on my own, and I am sorry again that I can't do much for him even today."
Trauma in secrets
South Korea remains one of the largest exporters of overseas adoptees in the world, having sent about 200,000 children abroad over the past six decades.
About 90 per cent of Korean adoptees are born to unwed mothers who have few resources to raise their children alone and are vulnerable to social stigmatization.
There have never been government support programs for birth mothers who put their children up for adoption. There is also little research by local scholars on the impact of overseas adoption on Korean birth parents.
"Our support programs are focused on mothers who choose to raise their children on their own," said Lee Hyun-ju, head of adoption measures at the Welfare Ministry.
Yet overseas studies have shown that many birth parents, like Noh, continue to mourn the loss of their children throughout their lifetime. This is an ongoing issue. Nearly 3,000 Korean babies were sent for overseas adoption from 2010 to 2013.
Even 12-20 years after adoption placement, about three-quarters of birth mothers continued to experience some feelings of loss and grief, a US study found.
The study also found that the mothers who tended to experience more longstanding grief were those who felt pressured into placing their children for adoption against their will or lacked opportunities to express their feelings about surrendering the baby.
Kim Eui-jung, a psychiatrist at Ewha Womans University Mokdong Hospital, said sorrow and depression, anger, guilt and denial are common among birth parents as they mourn their loss, and even after reuniting with their children.
"Korean culture places a lot of emphasis on maternal instinct and mothers' sacrifice, and as a result, we see many of them being too attached to their children," Kim said.
"They often see their children as their own possessions or an inseparable part of themselves, rather than as independent beings. And for one reason or another, the Korean birth mothers ended up relinquishing what many other women cherish the most. This puts them in a very isolated situation in Korean society. For this reason ― although there should be more research on this topic ― I assume Korean birth mothers may have emotional reactions that are unique and may not be experienced by birth mothers in other countries."
Secrecy surrounding pregnancy and adoption ― as most Korean birth mothers had been single parents ― can also make it challenging for the mothers to seek support, another reason behind the limited research into their experiences, Kim said.
"A key component to anxiety and depression are feelings of powerlessness," Kim said.
"If a birth mother was pressured or forced into placing her child for adoption, reunions and post-reunion days can be more overwhelming and difficult for her. She may even choose not to meet with the child at all, because it can be too painful for her to confront her past."
Birth mother Noh said she often felt misunderstood throughout her life, as many people, including her close friends, viewed her loss as her choice.
"What can you really except from the government when even your close friend tells you, 'You know, I had a very difficult life, too ― but at least I didn't give up my own children like you did'?" she said.