National / Media | MEDIA MIX

Debating contraception and a woman's reproductive rights

by Philip Brasor

Contributing Writer

In May, the Sendai District Court dismissed a suit against the government filed by two women who underwent forced sterilization under the now-defunct Eugenic Protections Law because the statute of limitations had expired. However, the judges said that the law, which allowed the government to prevent people with intellectual disabilities from reproducing, was unconstitutional. As a precedent, the ruling was significant because it recognized a woman’s constitutional right to self-determination regarding pregnancy and childbirth.

This aspect of the decision has since become a media topic of discussion about contraception. As pointed out in a Sept. 23 article in the Asahi Shimbun, Japan is behind the global curve when it comes to reproductive rights. It wasn’t until 1996 that the eugenics law was rescinded, and condoms remain the No. 1 birth control method in Japan, whereas in the rest of the world they are mainly a means of controlling the spread of sexually transmitted diseases. Condoms’ use as a contraceptive is mostly dependent on a man’s initiative, thus downplaying a woman’s agency in her desire not to become pregnant.

The Asahi Shimbun article focuses on the Nandenaino (Why isn’t there any?) Project started by Kazuko Fukuda, who once studied at a school in Sweden where women had access to a number of contraceptive methods. The doctors would explain the merits, possible side-effects and efficacy of each method so that the patient could decide which was best for her. After returning to Japan, Fukuda launched her project to advocate for more choices.

For instance, the low dosage birth control pill was not approved for use in Japan until 1999, some 40 years after it was approved in many other countries. Even now it is used by a very small percentage of Japanese women of child-bearing age, mainly owing to its high cost (it’s not covered by national insurance) and hurdles in obtaining a prescription. Although there are possible side-effects, the pill outside of Japan is considered one of the safest and most effective forms of birth control.

The main concern for Fukuda is the status of the so-called morning-after pill, an emergency post-coital contraceptive method available without prescription in 76 countries. In Europe, the price is purposely kept low, and even free in some countries. In Japan, not only is a prescription required, but the price of one pill starts at about ¥10,000.

The dilemma is obvious: When a woman has intercourse without a condom and is not using some other form of birth control, the morning-after pill is the only solution if she doesn’t want to become pregnant. However, the most popular brand, NorLevo, should be taken within 72 hours of having sexual intercourse. That means she has to consult a doctor, obtain a prescription and visit a pharmacy to fill it. The whole point of a morning-after pill is its availability in an emergency, and Japan’s medical community complicates that purpose with restrictions. Consequently, many women who use it buy it online, which brings up further concerns about the speed of delivery and quality.

In July, a health ministry panel discussed guidelines for obtaining a prescription for the morning-after pill online. Tomoko Saotome, an obstetrician and gynecologist who audited the meeting, told the Asahi Shimbun that access to emergency contraception is fundamental to reproductive rights. However, the 12-member panel, which included only one woman, concluded that more effective sex education should be carried out before easing regulations regarding emergency contraception. It is still too “early” for such a discussion, the panel said.

Mutsumi Matsumura, a radiologist and medical journalist, went into more detail in an article for Business Insider. The health ministry did make it slightly easier to obtain morning-after pills by permitting women to obtain prescriptions from doctors online. However, given the alternatives for many women, Matsumura says the ministry was being way too cautious in its approach to contraception.

One of her main concerns is abortion. Although abortion is technically illegal in Japan, about 400 are performed every day, mainly owing to financial loopholes. And while Matsumura believes it isn’t appropriate to factor abortion into mortality rates, she notes that an enormous amount of money and medical resources go into lowering deaths from heart disease and cancer. By that logic, the morning-after pill should be made available to prevent the conception of unwanted fetuses that would otherwise be killed.

And she goes further. Child abuse has become a growing social problem, and one of the primary predicters of abuse is whether the child is the product of an unexpected pregnancy. In a 2016 health ministry study of deaths resulting from child abuse, more than 60 percent of the abusers were birth mothers, 49 percent of whom killed children who were products of unexpected pregnancies. Between 2012 and 2016, 73 percent of these children were killed the day they were born.

Abortions are expensive and generally not covered by insurance, so girls and women of limited means tend to bring their unwanted pregnancies to term without ever consulting a doctor. Access to the morning-after pill, or even the so-called abortion pill, which the World Health Organization has deemed safer than the abortion procedure commonly used in Japan, would prevent unwanted pregnancies, but neither is readily available. Dr. Sakiko Enmi, an obstetrician who has been a vocal advocate for better access to oral contraceptives, often criticizes the Japanese medical community, which believes such access will lead to greater promiscuity on the part of women.

The health ministry decision to provide easier access to online prescriptions, especially for sexual assault victims, even if it’s only “partial,” is a step in the right direction, says Dr. Ayako Shibata of Yodogawa Christian Hospital, although the Japan Association of Obstetricians and Gynecologists still objects to it. In a post to the British Medical Journal, Shibata complained about the obstetricians and gynecologists’ “paternalistic” attitude, which “inhibits evidence-based strategies.” It also denies a woman’s basic reproductive rights.