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Choosing to get an abortion is not an easy decision to make. But women in Japan who do so, due to a variety of reasons, may soon have a safer alternative to surgical procedures — currently the only option they have.

LinePharma, a British pharmaceutical maker, is planning to seek the Japanese government’s approval for the use of its first oral “abortion pills” in Japan as a safe and affordable method of inducing abortion in early stages of pregnancy.

The move comes amid an ongoing debate in Japan to offer safer, affordable abortion options for women who want to end their pregnancy.

It was reported that the drugmaker is expected to apply for regulatory approval of the medication by year-end. The regimen, which is used worldwide and is available in most developed countries, is considered highly effective and is recommended by the World Health Organization (WHO) as a “safe abortion” method.

How does the abortion pill work?

The abortion pill is the common name for a combination of two medicines ー mifepristone and misoprostol, which have been considered an affordable and a safe method for terminating a pregnancy even in the second trimester.

The patient first takes mifepristone, a drug to block the hormone progesterone that is released by the ovaries and is responsible for preparing the uterus for pregnancy, which stops the embryo from growing.

Then, 36 to 48 hours later, the patient takes the second pill containing misoprostol, a synthetic medication that is also used to prevent stomach ulcers. This induces contractions in the uterus and relaxes the cervix so the embryo and placenta can be expelled. While mifepristone in most cases may only be dispensed in clinics under medical supervision, misoprostol can be used either under clinical supervision or taken at home.

Side effects for abortion pills can include bleeding, vomiting, diarrhea, fever, pain or infection.

Globally, mifepristone was first approved in 1988 in China and France as an abortion pill. It was eventually replaced with a regimen of mifepristone and misoprostol, which together offered lower risk of an incomplete procedure.

Various surveys have shown that the medication works in more than 90% of cases in the first nine weeks of pregnancy, and its effectiveness was confirmed through clinical trials in Japan on 120 women in the first nine weeks of pregnancy. The results, which were disclosed at a meeting of the Japan Society of Obstetrics and Gynecology in April, showed that the drugs induced abortion for 112 women, or 93% of those surveyed, within 24 hours.

If the abortion is incomplete, which is more likely as pregnancy grows, the patient can take an extra dose of misoprostol.

However, the medication cannot be used in cases of ectopic pregnancy, adrenal failure, hemorrhagic disorders or other conditions including steroid-dependent asthma.

Why is medical abortion being considered in Japan now?

Women’s rights advocates and medical experts have long been calling for the government to grant better access for women to safe abortions. But amid the pandemic, more women are opting to terminate their pregnancies for financial reasons, with some trying out medication yet to be approved in Japan.

According to a recent study by the health ministry, some 8% of women who were pregnant between October and November last year decided to end their pregnancy for reasons linked to the COVID-19 pandemic.

Surgical abortion, which is usually conducted in the first eight weeks of pregnancy, costs around ¥100,000 while surgeries performed beyond the 12th week could cost double that. After 22 weeks, abortions cannot be conducted in Japan unless it is medically necessary.

The high cost of surgical abortion has also been prompting women to turn to medication from foreign websites, not only raising legal concerns but also increasing the risk of health issues if the procedure is performed incorrectly.

Safety concerns in particular have prompted women’s rights groups and medical experts to renew calls for the authorization of medical abortion in Japan.

The WHO has stressed that medical abortion places less physical and mental burden on women than surgical methods. Mifepristone and misoprostol have been used in more than 70 countries, but have remained unavailable in Japan.

What abortion methods are currently available in Japan?

As condoms remain the main birth control method in Japan and their use is often dependent on cooperation from their male partner, many women turn to emergency contraceptive medication to prevent unwanted pregnancies.

Birth control pills are used by a very small percentage of Japanese women mainly because of their high cost and difficulty in obtaining a prescription.

Medication known as the “morning-after pill” is aimed at suppressing ovulation to prevent pregnancy. However, it needs to be taken within 72 hours of unprotected sex to be effective. This method is often used by people who have had problems with their regular contraception methods, for example a broken condom or a missed birth control pill, as well as women trying to avoid pregnancy after being raped. Emergency contraception is not covered by national health insurance.

Amid calls for the emergency contraceptives to be made available over the counter, the government is looking to approve nonprescription sales of the morning-after pill this year.

Meanwhile, the only procedure to terminate a more advanced pregnancy in Japan is surgical abortion, which is performed in accordance with the Maternal Health Act at obstetrics and gynecology clinics.

Given the limited access to emergency contraception, surgical abortion is still the most common method of terminating a pregnancy.

According to the health ministry, in fiscal 2019 there were 156,430 abortions in Japan, or 6.2 per 1,000 women of child-bearing age. Since 1949, when surgical abortion was legalized, Japan has seen a decrease in the number of such procedures.

Why is Japan relatively late in introducing medical abortion?

Japan is not affected by pro-life movements based on religious grounds — unlike countries such as the United States, which have been entangled in a debate surrounding the moral, legal and religious status of induced abortion.

But the health ministry has warned against the drug’s easy use due to the risk of mass bleeding, which is listed as a possible side effect by the pharmaceutical company.

In fact, Japan’s health ministry banned imports of mifepristone by individuals without a doctor’s prescription back in 2004 out of concern the drug could be misused.

Japan’s stance, however, has been decried by activists and medical experts. In 2012, WHO pointed out that the surgical abortion common in Japan carries the risk of damaging the uterus, urging the nation to introduce medical abortion.

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