The pandemic offers an opportunity to improve access to contraception

ByDonald L. Leech

Jan 30, 2022

The founder of a youth movement advocating for sexual and reproductive health and rights in Japan is on a mission to improve access to emergency contraception for women across the country.

Kazuko Fukuda, founder of Nandenaino (Why don’t we have it?), says the emergence of COVID-19 has raised the profile of gender issues in Japan, presenting health organizations with a golden opportunity to lobby for increased education on women’s reproductive rights.

“We are getting more attention from the authorities than we have ever had before,” Fukuda said.

According to the Japanese Family Planning Association, only 2.6% of women are currently taking contraceptive drugs, with condoms and the most common withdrawal method used by sexually active couples to prevent unwanted pregnancies.

Morning after pills are available but they are expensive compared to other countries, costing between ¥6,000 and ¥20,000 and dispensed only to those able to provide a doctor’s prescription.

Abortion pills are currently not available in Japan.

Fukuda, 27, has first-hand experience of options for women abroad, leaving Japan to study in Sweden in 2016. She found the experience abroad surprisingly liberating.

“I didn’t feel judged anymore,” Fukuda says. “Asking for birth control pills in Japan is publicly admitting that you are sexually active, which is frowned upon by women in Japanese society. In the eyes of men, including doctors during consultations, we are perceived as women obsessed with sex.

Now based in Rwanda, where she works at the United Nations Population Fund as a program analyst, Fukuda continues to keep an eye on the situation in her country.

She says Nandenaino will continue its awareness programs and try to improve access to morning after pills. The organization also wants health authorities to approve abortion pills in Japan, as well as give women access to an abortion without having to first obtain written consent from the father.

The Maternal Health Law stipulates that doctors must obtain the consent of the woman and her spouse when performing an abortion. If a woman seeking an abortion is unmarried, many medical institutions insist on obtaining the consent of the man for fear of possible legal action – an unimaginable situation if the pregnancy is the result of sexual assault.

In 2020, a woman in an abusive relationship was denied access to an abortion by multiple medical facilities because she was unable to obtain her partner’s consent for the procedure. Following subsequent criticism of the case by advocacy groups, the Department of Health ruled last year that the consent of a partner or spouse was not required for an abortion in cases of domestic violence. .

Despite this progress, Fukuda says more can be done to improve basic sexual health education.

In practice, it is expensive for many young women to take birth control pills regularly, which cost ¥2,000-3,000 per month.

And then there is the need to break down the social stigma associated with taking birth control pills.

“Influenced by a strict hygiene policy after the Meiji Restoration as well as changing gender roles in more modern times, independent and sexually active women were seen as abnormal,” says Sakie Niwa, a gynecologist in Nagoya. “The shame has set in and, even today, such a mindset is unfortunately still strong.”

A woman’s age doesn’t seem to matter either, says Fukuda.

“I’ve received a number of messages from women in their 40s who are desperate because they’ve already raised children and don’t want to be pregnant anymore,” Fukuda says. “However, they don’t know how to say ‘no’ to their husbands.”

Birth control pills (left) and morning after pills (right) are prohibitively expensive in Japan compared to many other developed countries. | GETTY PICTURES

With COVID-19 restrictions and associated anxieties preventing many women from accessing health services when they need them most, authorities have been a bit more open to accepting change.

In October, Fukuda joined Pilcon chief Asuka Someya and Sakiko Enmi, an obstetrician who has been a strong advocate for better access to oral contraceptives, to give a presentation on reproductive rights at the Ministry of Health.

“It was encouraging that they were inviting young women like us to talk to them,” Fukuda says.

Even so, the trio still have some way to go to change ingrained attitudes in the healthcare system, with a senior member of the Japanese Society of Obstetrics and Gynecology reportedly saying he fears young people are abusing the morning after pill if it became too readily available.

Someya says birth control issues matter because they are directly linked to the country’s abortion rate.

According to data compiled by Pilcon, around 19,000 abortions are performed on women under the age of 20 each year in Japan, with around 160,000 total abortions performed each year.

Abortions in Japan are not cheap, with medical institutions charging between ¥100,000 and ¥200,000 for a procedure to be performed.

“Some women have a child because they were not informed enough or could not afford to pay for the abortion procedure,” Someya explains.

Someya says the introduction of abortion pills, which were first approved in France in 1988 and are now available in more than 70 countries around the world, could help reduce expenses, noting that the cost of a overseas pill was usually less than ¥1,000.

The Japanese Society of Obstetrics and Gynecology recently reported that 41% of gynecologists were against the introduction of abortion pills, although the group does not want to commit to making these drugs freely available.

“The company said one pill would cost around ¥100,000,” Fukuda explains. “No one will be able to afford such drugs at this rate. It has to be accessible. »

The Ministry of Health is currently preparing a new survey on contraceptive needs in Japan.

Reproductive rights advocates, however, say they already have data from multiple sources and such measures just kick the box unnecessarily.

British pharmaceutical company Linepharma applied to the Department of Health for approval of two abortion pills in December – mifepristone and misoprostol – but warned the approval process could take at least a year.

Fukuda worries about the practical impact of such delays on women in Japan, especially since it took more than 40 years for authorities to approve birth control pills.

“As everyone continues to discuss the issue, I see tons of women who don’t have access to these pills,” she says. “We talk about the glass ceiling as a way to change people’s minds, but it feels more like stone than glass. It’s incredibly hard to break through.”

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