With the government having pledged to boost support for couples undergoing fertility treatment, deputy health minister Junko Mihara believes her participation in policymaking can help amplify the voices of women on addressing the nation’s infertility problems.
The 56-year-old lawmaker doesn’t want the current public aid program or social stigma to dash the hopes of younger women who face challenges similar to those she has encountered herself.
In an interview last week with The Japan Times, Mihara confided that a well-established fertility support landscape in the years before she started her political career could have changed her life.
Mihara was diagnosed with a disorder affecting her fallopian tubes and had an abscess there surgically removed, which presumably affected her fertility, she said. Neither the so-called calendar or rhythm method, used to determine fertile days, nor other treatment methods she tried over a span of months seemed sufficient to increase her odds of having a baby.
In general, infertility is defined as not being able to conceive after 12 months or more, despite having regular unprotected sex.
Then, finally, Mihara did fall pregnant — only for it to end in a miscarriage.
Her hopes crushed, she stopped trying to conceive in her 30s because she knew that repeated procedures required more time and energy than she could afford.
On top of that, infertility at that time was stigmatized as a badge of shame, to the extent that discussing the topic openly was still taboo, Mihara recalled.
In the years since, her personal experiences have led her to take an active role in looking for ways to improve the quality of women’s health care.
“I was unsure of how long my attempts would need to go on until they brought about any effects … but I knew that continuing treatment would have affected my work, and I decided to choose my career,” the former singer and actress said.
Mihara, who was appointed as deputy health minister in September, said she has set a high priority on the government’s policies aimed at boosting support for infertile couples, proposed by Prime Minister Yoshihide Suga when he stepped into his new leadership role.
Suga has pledged to expand public insurance coverage for expensive fertility treatments. In his first Diet policy speech Monday, Suga acknowledged that under the current program even dual-income couples seeking fertility treatment need to sacrifice a significant part of their earnings, at times up to half of the household’s income.
Mihara views the expansion of insurance coverage as one of the most pressing issues to address during her tenure, and vowed during the interview to work toward revising the current arrangements “as early as possible.”
Mihara has been calling for greater support for infertile couples as part of her fight for women’s health since starting her political career a decade ago. She has publicly revealed that after being diagnosed with cervical cancer in 2008 she had to have her uterus removed. Her experience became the turning point of her life, prompting her to find her second career in politics with the aim of addressing shortcomings in the nation’s health care system.
During the interview she acknowledged that the financial burden remains the biggest challenge faced by couples struggling to conceive.
With clinics allowed to set their own prices for procedures other than those covered by insurance, costs for fertility treatment can exceed ¥500,000 per round.
According to nonprofit organization Fine, which provides support for people dealing with infertility, a growing number of infertile couples have spent more than ¥3 million on such treatment.
The nation’s public health insurance currently covers only drug therapy with ovulation inducers, nonsurgical and surgical treatments for fallopian tube blockages and surgical therapy for infertile men with seminal tract obstruction. More advanced reproductive techniques are not covered by public health insurance.
Since 2004, the government has been offering subsidies for fertility treatment. But with an income cap in place, the program is not accessible for many couples, despite the high quality and wide availability of such treatments being offered by some 600 clinics and hospitals across the country.
In October, the health ministry launched a survey aimed at reviewing the state of fertility provision across the nation.
According to the most recent available data from the National Institute of Population and Social Security Research, based on a 2015 study on fertility, 1 in every 6 couples in Japan had undergone tests or some kind of treatment for infertility.
But the government’s push to expand public insurance coverage for fertility treatment has been met with opposition from the Japan Medical Association, a medical organization dedicated to keeping up with the latest international medical techniques. The association’s President Toshio Nakagawa has expressed concern that expanding insurance coverage could adversely affect the quality of and access to currently available fertility treatments.
If treatments are covered by health insurance, the options offered by doctors may be restricted. Currently, treatment is tailored to infertile patients’ individual needs. The group is also worried that limits on the range of available treatments could result in financial losses for clinics.
“Suga’s pledge is, indeed, heartening news for people struggling to cope with the high cost of fertility treatment, and is a great strategy to boost the nation’s fertility,” Nakagawa said during a regular news conference in September regarding Suga’s plan. “However, such a move will require thorough adjustments to maintain the effectiveness of such treatments and ensure safety, by reviewing rules such as age limits on access to treatment options under the financial aid scheme.
“I want the government to proceed with boosting support by consensus, after discussions among experts on this issue, instead of rushing to expand insurance coverage,” Nakagawa stressed.
Mihara is aware of such concerns, and said the ministry is taking into consideration the situation of all parties involved in fertility treatment, hoping the envisioned solution will help reduce costs while maintaining the current quality of care.
She agrees that fetal safety and the health of women who are struggling to conceive should be prioritized when revising infertility support policies.
Mihara hinted that the expansion of insurance coverage may come with age limitations, given that women undergoing pregnancy at an advanced age are more likely to experience certain complications, including miscarriage and having babies with birth defects. To avoid such risks, under the nation’s existing financial subsidy system, the recipient must be under age 43.
“Our goal is to help women conceive while protecting mothers’ lives,” she said.
Women seeking fertility treatment are advised to do so by age 35, the deputy minister added, as fertility decreases with age. But she acknowledges that combining child-rearing and work is challenging for many women.
Mihara worries that expanding financial support won’t be enough to address the problem, stressing that the government will also need to push work-style reforms that would allow infertile couples to undergo treatment while working.
“Women aren’t only juggling fertility treatment and work. In today’s society, women also take care of housework and sacrifice their time to take care of their husbands, children and parents,” Mihara said. She lamented that despite government efforts to facilitate gender equality within households, men don’t spend enough time on parenting or other domestic responsibilities. The deputy minister believes women’s voices need to be amplified in policymaking, especially when deliberating on women’s health.
In Suga’s male-dominiated Cabinet, Mihara is one of only eight women appointed as parliamentary officials and one of three vice ministers, alongside only two women in ministerial level positions.
“I believe that nothing beats experience. And making women’s voices count is vital in implementing these policies,” she said. “I’ve always thought that representation of women should be higher in such debates and that their voices should be reflected — they’re the ones who know best the challenges faced while trying to juggle work with child-rearing, chores and caring for family members, and how these challenges affect their life and health.”
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