‘We need to change’: The morning-after pill debate in Japan

When Megumi Ota needed the morning-after pill in Japan, she couldn’t get a prescription in time under a policy that activists call an attempt to “control” women’s reproductive rights.

“I wanted to take it but I couldn’t take it over a weekend,” when most clinics are closed, she told AFP.

Unable to make an appointment in the 72 hours after sex, when the drug is most effective, “I just had to leave it to chance and got pregnant.”

Emergency contraception cannot be purchased without a doctor’s approval in Japan and is not covered by public health insurance, so it can cost up to $150.

It is also the only drug that must be taken in front of a pharmacist to prevent it from being sold on the black market.

Emergency contraception cannot be purchased without a doctor's approval in Japan and is not covered by public health insurance, so it can cost up to 150 USD

Emergency contraception cannot be purchased without a doctor’s approval in Japan and is not covered by public health insurance, so it can cost up to 150 USD Photo: AFP/Philip FONG

Abortion rights are so restrictive, activists say, with consent required from a male partner, and a surgical procedure is the only option because abortion pills are still not legal.

A government panel was formed in October to study whether the morning-after pill should be sold over-the-counter, as in North America, most of the EU and some Asian countries.

But gynecologists have raised concerns, including that it could increase the spread of disease by encouraging casual, unprotected sex.

Ota decided to terminate the pregnancy after her partner, who refused to use a condom, reacted coldly to the news.

“I felt helpless,” said the 43-year-old, who was 36 at the time and now runs a sexual trauma support group.

Japan has world-class healthcare, but is ranked 120th out of 156 countries on the World Economic Forum's Gender Gap Index, which measures health among other categories. Japan has world-class healthcare, but is ranked 120th out of 156 countries on the World Economic Forum’s Gender Gap Index, which measures health among other categories. Photo: AFP/Philip FONG

Japan has world-class healthcare, but is ranked 120th out of 156 countries on the World Economic Forum’s gender inequality index, which measures health among other categories.

“In Japan’s system, there is a perception that women can abuse what they have and do something wrong,” said reproductive rights advocate Asuka Someya.

“There is a strong paternalistic tendency in the medical world. They want to keep women under their control.”

Reproductive rights advocate Asuka Someya says Japan's approach needs to change Reproductive rights advocate Asuka Someya says Japan’s approach needs to change Photo: AFP/Philip FONG

The debate comes with reproductive rights in the global spotlight.

In the United States, the Supreme Court appears poised to overturn a 1973 ruling that guaranteed access to abortion throughout the country, while Poland enacted a near-total ban on interruptions less than two years ago.

There are an estimated 610,000 unplanned pregnancies each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo.

Abortion has been legal since 1948 and is available up to 22 weeks, but the consent of the spouse or partner is required. Exceptions are only granted in cases of rape or domestic abuse, or if the partner is dead or missing.

Last year, a British pharmaceutical company asked Japanese health authorities for approval of its abortion pill, which can be used in early pregnancy.

There are an estimated 610,000 unplanned pregnancies each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo. There are an estimated 610,000 unplanned pregnancies each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo. Photo: AFP/Philip FONG

But until a decision is made, those seeking a break must undergo an operation to remove tissue from the uterus with a metal or plastic instrument.

The procedure costs around 100,000 to 200,000 yen ($800 to $1,500), with late-stage abortions sometimes even more expensive.

Someya, who had an abortion as a student, said she was “terrified” and wished she could “choose more comfortably between the different options.”

“I was informed of the risk that the operation could make me sterile, but I thought I was to blame,” said the 36-year-old, who now sees abortion as medical care that women deserve to have access to.

Birth control options are also limited in Japan, where condoms are by far the preferred method and alternatives are rarely discussed openly.

Birth control pills were approved in 1999 after decades of government deliberation – compared to just six months for Viagra.

They are currently used by just 2.9% of women of childbearing age, compared to a third in France and nearly 20% in Thailand, according to a 2019 UN report.

Meanwhile, IUDs, which stay inside the uterus to prevent pregnancy, are used by 0.4%, while implants and injections are not available.

Gynecologist Sakiko Enmi, a key member of the campaign for better access to the morning-after pill, said the government should not drag its feet.

Levonorgestrel, a drug used in emergency contraception to delay or prevent ovulation, has been legal in Japan for more than a decade.

But “it doesn’t reach those who really need it, due to poor accessibility and price”, said Enmi.

Women can see a doctor online, but they must still take the morning-after pill in front of a pharmacist — the only drug in Japan that has this requirement as a standard, says the Tokyo Pharmaceutical Association.

A previous government panel rejected the availability of over-the-counter emergency contraception in 2017, and many doctors continue to oppose the change.

In October, a poll by the Japan Association of Obstetricians and Gynecologists found that 40% of its members were against the proposal.

Overall, 92% said they were concerned, with the report stating that “this country needs to improve sex education before considering making the emergency contraceptive pill available over the counter.”

Enmi, however, is adamant about what needs to happen.

“We have to change,” she said. “Women should be able to make decisions for themselves.”

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