Wider access to abortion in Japan has largely remained elusive a year after the historic approval of medical abortion pills.
In April last year, lawmakers approved the use of the two-step abortion pill — MeFeego Pack — for pregnancies up to nine weeks. Before that, women in the East Asian nation could only receive a surgical abortion in private clinics by designated surgeons that often charge as much as $370.
Financial strain aside, women were often required to provide proof of spousal consent to receive an abortion, making it nearly impossible for them to make the decision on their own. Reports showed that even for single women, doctors still asked for permission of a male partner before agreeing to perform such surgeries.
Despite the approval of the abortion pill, only 3% of all clinics with abortion services in Japan provide them a year after the pill’s approval, according to Kumi Tsukahara, independent researcher of reproductive health and rights, "and none of them have a Maternal Body Protection Law (MBPL) designated doctor," Tsukahara told VOA News.
Under the MBPL, the controversial requirement for spousal consent before a doctor can prescribe oral abortion medication still exists — it’s the same condition for gaining permission for a surgical abortion.
"Unfortunately, there are no signs of change with regard to either," the expert said.
In contrast to countries with better abortion access, Japan’s approved abortion pills cannot be administered more than once — sometimes, multiple tries are necessary — and the pregnant women will still need to resort to surgical abortion that involves a serious risk to their health.
Since such surgeries are only allowed in private clinics and are considered profitable by designated doctors, they often charge the same price or higher for abortion pills as for a surgical abortion. Neither measure is covered by Japan’s national health system.
"The high prices and low affordability depending on individual doctors, the inaccurate information given by doctors who cannot use drugs to guide people to conventional surgical procedures, the unjust situation and the state’s failure to respond, and the women are disempowered to have a sense of entitlement on their part," Tsukahara explained.
Abortion rights activist Kazuko Fukuda, who spearheads a grassroots movement to push for women’s rights to end pregnancies in Japan, echoed the sentiment.
"The abortion rights [in Japan] didn’t improve," Fukuda told VOA News. "Of course, this [approval of oral abortion] was better than nothing, but conservative politicians went against such pills before the approval. … It’s mandated that women have to stay in hospitals that provide beds until the end of the abortion, but designated private clinics don’t usually have beds."
Women in Japan are banned from taking abortion pills at home. They must be in hospitals and take the pills in front of the doctors as authorities fear that they might resell them. If violated, these women can be subject to imprisonment for up to a year.
Male-dominated political scene
Abortion is still a big taboo in politics, and real rights improvement will go a long way, Fukuda added.
"News of women being arrested for giving birth alone and abandoning them is still very common -- we hear that just a few days ago. … The government should repeal the criminalization of abortion. [Things don’t work] as doctors are still afraid of being sued so they require signatures from boyfriends to prescribe abortion pills."
Last year, Japan started a study, selling morning-after pills over the counter without prescription. However, the study suffers limited availability in many cities. Girls under 15 are not allowed to purchase them, and those ages 16 to 18 must be accompanied by a parent to buy the pills.
Both experts VOA spoke with say that the information and availability of these contraceptive pills doesn’t appear high in online searches — the usual method for the targeted group to look for contraception.
Japan ranked among the lowest of developed countries in a March report this year by the World Bank in terms of women’s rights.
Currently, women account for less than 10% in Japan’s lower house of parliament and 27% in the upper house. In local politics, only 15% of women are on the front line. The gender pay gap in Japan reached 40%, according to a report from the Organization for Economic Co-operation and Development (OECD).
Women’s issues like abortion access or contraceptive measures are often not viewed as priorities for female politicians.
"In the male-dominated politics, a lot of women have to become more conservative and look strong to be accepted so it’s really hard for women to liberal or supportive in this kind of thing [abortion and contraception in the parliament]," Fukuda said.
Women blamed for low fertility rate
Social stigma connected to abortion remains strong as Japan blames women for its low fertility rate. The country hit a record low number of births last year.
"The Japanese government has attributed the ‘decreasing number [fertility rate] to 'women who don’t give birth,' women are made to feel socially guilty for trying to choose not to give birth. Of course, such an issue construction is itself highly biased and misogynistic," said researcher Tsukahara.
Fukuda said that the government’s support of favorable reproductive policies stops with women who don’t want babies.
"Anything against that [wanting babies] is not supported at all. Many people think that ‘contraception’ is a taboo and even taking [morning after] pills can expose to judgment as a promiscuous woman. It’s not easy for women to talk about it."
