Staff writers

Yoko, 54, remembers how alone she felt during her abortion 19 years ago.

At the time, she was married with two children, aged 5 and 7, and she and her husband agreed that they could not afford a third child.

“But the one who has to be there by herself, in the operating room, is the woman,” she said. “It’s important for women to have more say about their own birth control.”

But Yoko, who asked that her last name not be used, said she would not go on the pill because of the nausea she felt when she tried oral contraceptives in the United States in the 1970s.

Many women in Japan share Yoko’s ambivalence about using low-dosage oral contraceptives, which are expected to be available at clinics this fall.

Yuriko Ashino, deputy executive director of the Family Planning Federation of Japan, says she doubts that birth control pills will catch on quickly in Japan.

“That’s because of the trouble of going to the doctor, the financial burden and the fact that you have to take the pill every day,” Ashino said.

Oral contraceptives will only be available by prescription, as in the United States and Europe. Furthermore, the Health and Welfare Ministry has advised doctors to test women asking for the pill for sexually transmitted diseases and other maladies.

In a country where it is uncommon to visit a doctor to discuss birth control options, this may dissuade some women from trying it, she said.

Health insurance does not cover birth control pills, which Ashino estimates will cost around 70,000 yen a year, including fees for tests and about 3,000 yen a month for the drug itself.

Condoms are by far the most common method of birth control in Japan, and are easily available at convenience stores and in vending machines outside pharmacies.

According to a 1998 study cited by the Professional Women’s Coalition for Sexuality and Health, only 7.2 percent of women surveyed said they would use the pill after its approval.

Pharmaceutical companies, which are not allowed to advertise prescription drugs to the public, have modest expectations.

“We have absolutely no idea how large the market is,” admitted Satoshi Kamisonoda, a spokesman for Yamanouchi Pharmaceutical Co., one of the nine companies applying for the Health and Welfare Ministry’s approval to sell oral contraceptives. “Part of the reason approval took so long is that there was no large movement among women for the pill,” he said.

Even foreign manufacturers of birth control pills are cautious when describing the Japanese market’s potential. “We want to develop the market gradually,” said Hideo Suzuki, head of public relations at Nihon Schering, the Japanese unit of a major German producer of the pill.

In addition to inconvenience and cost, another reason observers are predicting slow sales is memories of the high-dose version from the 1960s, which was a fairly dangerous drug with strong side effects, including blood clots.

But excessive worries over side effects are inappropriate, said Kunio Kitamura, director of the Japan Family Planning Association’s clinic. “No other drug has been researched as much to reduce side effects,” he said. “The high effectiveness of the pill in preventing unwanted pregnancy should outweigh worries over minor side effects.”

Akiko Domoto, an Upper House member who has been fighting for women’s rights and health issues, said, “If the pill’s side effects were that strong, 100 million women in the world would have stopped taking it.”

Whether or not Japanese women will actually use the pill, the important thing is that they have gained the right to choose low-dose birth control pills as a contraceptive, Domoto said.

To educate the public about the low-dose pill, the Health and Welfare Ministry has issued guidelines on its prescription and use. The ministry says it will also post the information on the Internet.

“We will make sure that accurate information will be in the hands of the users when they visit doctors,” said Toshiki Hirai, a Health Ministry official in charge of the pill’s approval.

But Japan’s medical system is ill-equipped to provide personalized advice concerning pill use, said Seiichi Matsumoto, a professor emeritus of medical science at Jichi Medical School in Minamikawachi, Tochigi Prefecture.

In a three-year test of the low-dosage pill begun by the government in 1987, doctors sometimes failed to give information on the correct use of the pill, he said.

“One woman would stop taking the pill for three days at a time,” he said. “Nobody explained to her that this was enough to make the pill ineffective, and she became pregnant.”

If a woman forgets to take the pill for one day, she should take two the next day. If the pill is not taken for two days in a row, the woman should stop using the pill, use another form of contraceptive and consult her doctor about resuming use of the pill, Matsumoto said.

But because doctors are usually very busy, medical institutions should put more effort into training medical staffers who can explain the effects of the pill in detail, he said.

Ashino of the Family Planning Federation agrees. “Women need places where they can get information, counseling and contraceptives — places they feel comfortable visiting,” she said.

“Approval of the pill is only the first step.”

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