Abortion in Japan

Memorandums and information about abortion situations and problems in Japan

Abortion care guideline Web Annex A. Key international human rights standards on abortion

忘備録:中絶ケアガイドライン Web 付属文書A 中絶に関する主な国際人権基準

Abortion care guideline Web Annex A. Key international human rights standards on abortion
Web Annex A. Key international human rights standards on abortion. In: Abortion care guideline. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris

他の情報源も貼っておきます。

Sexual and Reproductive Health and Research (SRH)
Web Annex B. Technical meetings during guideline development. In:
Abortion care guideline. Geneva: World Health Organization; 2022. Licence: CC BY-NCSA 3.0 IGO.

Sexual and Reproductive Health and Research (SRH)

Beyond numbers: database brings to light quality of care for women and their babies at a national scale


HRP Annual Report 2020


Supplementary material 1: Evidence-to-Decision frameworks for the law and policy recommendations

Abortion pills in Japan

English news articles you can read online

I contributed an article to the newsletter of the International Campaign for Women's Rights to Safe Abortion.

Japan: How Japanese doctors who do abortions see the introduction of medical abortion pills in Japan

How Japanese doctors who do abortions see the introduction of medical abortion pills in Japan

by Kumi Tsukahara, 12-13 January 2022,


The situation of abortion in Japan is really not well known to the rest of the world, hidden as it is behind the wall of language, and conversely, most Japanese doctors don't know about the situation of abortion provision overseas. As was reported in the ICWRSA newsletter on 9 January 2022, Linepharma has applied for approval of combined mife-miso medical abortion pills.


In response to this, the Japan Association of Obstetrics and Gynecology (JAOG) released a comment: "For the time being, prescriptions [of these pills] should be made only by doctors who are qualified to perform abortions at medical institutions where hospitalization is possible.” The president of JAOG said: "Doctors should not only prescribe the medications, but also perform subsequent management such as surgical operations in case of failure to expel the uterine contents, so a reasonable management fee is necessary.” He also said that it would be desirable to set the fee for the prescription of the pills at the same level as that for surgical abortion (D&C in Japan), which costs about 100,000 yen (= ± US$ 876).


On 28 December 2021, I appeared on a popular online Japanese TV debate programme and was confronted with an Ob-Gyn doctor who supported the JAOG's position above. However, this doctor was not even a "designated abortion doctor", as represented by JAOG, and when he made a strong defence of the abortion procedure he had performed 25 years ago (D&C) as a resident – saying that aspiration alone would not clean the uterus so curettage was always necessary – I decided to laugh in response; otherwise, I might have shouted at him.


What this doctor said, however, shows that at least some Japanese obstetricians have learned nothing. Instead of learning how to do aspiration abortions with simple training, which can be done on an outpatient basis and are almost always completed by aspiration alone, some of the "designated doctors" use " aspiration followed by curettage" or "curettage followed by aspiration", describing this as “their preference" or "the way they were taught in residency” without reference to evidence of any kind.


The recommendations of the World Health Organization related to methods of surgical abortion, based on comprehensive evidence, were published in Safe Abortion: Technical and Policy Guidance for Health Systems, 2nd edition, 2012, p.31-32 and expanded on p.40-42, as follows:


Dilatation and curettage (D&C) is an obsolete method of surgical abortion and should be replaced by vacuum aspiration and/or medical methods.


For pregnancies of gestational age more than 12–14 weeks, the following surgical method is recommended: dilatation and evacuation (D&E).


Medical abortion with pills is also a recommended method of abortion in the second trimester, with a different regimen and dosage than in the first trimester, even up to 24 weeks of pregnancy.


I also exposed another important fact in that online debate. At one well-known hospital, they charge 210,000 yen (= US$1,840) for an early abortion of up to 12 weeks’ gestation, but 51,000 yen (= US$447) for a mid-term abortion (12-15 weeks’ gestation). The lower price for the mid-term abortion is because those who have undergone mid-term abortions are entitled to a maternity allowance of about 400,000 yen, the same as for childbirth or stillbirth. On top of that, the particular hospital was charging at least 90,000 yen as a "burial fee" for the fetus. Thus, by inducing an abortion at 12-15 weeks, the hospital makes a very large amount of money.


Last summer, a clinic that had set similar prices actually advertised that it could provide cheap abortions if women waited until the mid-term period for the abortion. That clinic was criticized for running an unscrupulous "abortion business" and made the news. But it seems that the well-known hospital is doing almost the same thing.


Another large clinic that specializes in abortion boldly states on its website: "We perform D&C safely" because "in a clinic like ours that does a large volume of abortions, it is easier and safer to clean the curettage instruments than to clean the aspiration tubes”. No concern is expressed for how women will feel and nothing is said about whether this is ethical. It all focuses on efficiency and money. In these circumstances, women's reproductive health and rights are violated.


The following are statements that were made by another ob-gyn doctor working in a chain of clinics on why he uses D&C (usually called the SOUHA method in Japan, literally meaning curettage):


“I will give my opinion by comparing the SOUHA method with the aspiration method. There is no difference in the degree of risk of the surgical operation between these two methods. However, the aspiration method is more likely to leave some blood and tissue in the aspiration instrument for the suction method, and it is more likely to be unclean and carry infection, so most doctors in Japan tend to use the SOUHA method.”


“Whether the SOUHA method or the aspiration method is better for abortion surgery makes no difference in terms of the occurrence of surgical sequelae if the doctor is experienced. The reason one of the two surgical methods is being used and not the other is customarily determined by the university you graduated from.


“The main surgical method used in most university hospitals is the SOUHA method. The abortion procedure itself is not so difficult that it makes a difference, so it is difficult to make a difference based on the surgical method. Since both procedures are simple, it is impossible for the differences in the procedures to cause problems such as post-abortion sequelae or difficulty in conceiving in the future. If there is a problem, it is usually caused by incomplete disinfection of the instruments.


“In principle, we use the SOUHA method. This is because many doctors are accustomed to this method, and because the number of surgeries is so large. If you use the aspiration method with limited disinfection and sterilization of instruments, it is not suitable in a clinic with a large number of surgeries.


“There is no difference in after-effects or side effects between the different surgical methods, but rather it depends on cleanliness. All the instruments used in the SOUHA method are cleaned and sterilized after each surgery, but with the aspiration method, the instruments are collected in a bottle through a long tube. Since there is a high rate of blood and tissue remaining in the connection between the bottle and the tube, as well as the instruments (since the aspirator is not cleaned or sterilized every time), it is impossible to deny the unclean condition.”


In sum, the designated doctors for abortion in Japan always say that the method they are used to is the safest, or that experienced doctors can safely use curettage. But WHO evidence says D&C should be obsolete because it requires general anaesthesia and hospitalisation and carries greater risks.


Clearly, much more related to abortion care in Japan must be changed alongside the introduction of medical abortion pills.

Currently we're also currently running a signature campaign on Change.org!

Reduce burdens imposed on women to get abortion!!


One out of every four women in the world has experienced an unwanted pregnancy. In other countries, abortion is considered a natural medical treatment that protects women's mind and bodies.


In Japan, the application for the approval of abortion pills is currently underway. In order to respect the health and rights of all women living in Japan, we demand the following 5 points.


1. Promptly approve the abortion pills as an option for women who have an unwanted pregnancy.

2. Provide abortion pills at a reasonable price and make them available to all who need them regardless of their financial situation.

3. Descriminalize abortion under the Penal Code and abolish the spousal consent requirement under the Maternal Body Protection Law as both misogynistic and patriarchal laws unfairly hurt women and prevent them from accessing abortions.

4. Lift the ban on online medical treatment and home administration of the abortion pills in order to secure the access to abortion for everyone regardless of where she lives and in order to protect her privacy.

5. Increase the number of occupations that can handle the abortion pills in order to improve access and lower the price of abortion.


The UN Human Rights Covenant clearly stipulates access to information and means of safe abortion for all who need one as the social right and the ability to choose abortion for themselves as the liberty right.


In approximately 30 countries including the UK, France, and New Zealand the abortion pills are all covered by public insurance or other kinds of subsidies. Online prescribing has been implemented in Australia, the UK, France, and other countries as well. The International Federation of Obstetrics and Gynecology has decided to encourage online prescription and home use of abortion pills during the pandemic in March 2020. In March 2021, they added, "After 1 year of the operation, the safety and effectiveness of the system has been confirmed. This method should be permanent so that all women can have a safe abortion in privacy.''


As you can see, abortion in Japan imposes heavy physical burdens on women compared to other countries. In addition, Japan has stigmatized abortion by suppressing women from speaking out for abortion. Are you aware that abortion is still criminalized in Japan? Although abortion seems to be freely available in Japan, The Penal Code (Article 212) criminalizes a woman ending her own pregnancy by taking drugs.


However, many countries around the world are now trying to decriminalize abortion. Even countries like Ireland, a predominantly Catholic country has eliminated the criminalization of abortion in a referendum in 2018.


In addition, the Maternal Body Protection Law which allows women to seek legal abortion under exceptional circumstances gives husbands the right to make decisions regarding their wives' bodies. Even if the wife does not want to continue her pregnancy, her husband can force her to do so.


Currently, in other countries, forcing a woman to continue an unwanted pregnancy is considered torture and a violation of human rights. Only 11 countries require spousal consent for abortion while the other 192 countries don't.


The Eugenic Protection Law enacted in 1948 stipulated that only "designated physicians" that had been trained in obstetrics and gynecology should be allowed to perform Dilatation and Curettage procedure, a surgical procedure in which the cervix is dilated so that the uterine lining can be scraped with a spoon-shaped instrument called curette to remove abnormal tissues as the medical field was not as advanced and developed as it is now.


As a result, suction abortion which is actually considered safe enough to be performed by midwives has not been widely performed in Japan.


The WHO points out that D&C cause more pain than aspiration and made it clear that the old-fashioned perforation is not a safe way to end a pregnancy and should be switched to safer methods in their 2012 guidelines, "Safe Abortion, Second Edition."


9 years later, in July 2021, the Ministry of Health, Labor, and Welfare (MHLW) finally asked the Association of Obstetricians and Gynecologists to inform its members about the aspiration. However, whether the method had been properly switched or not is still unclear.


Thanks to women's movements since 1960s, abortion has been legalized and the suction method was introduced around 1970.

In the 1980s, the abortion pills were developed and by the beginning of the 21st century, they had been legalized and available in most of the developed countries.


However, for a long time, Japan did not opt for these safer methods and continued to use the old-fashioned method of curettage, which has caused heavy physical and emotional burdens on women.

The punishingly high cost of abortion in Japan is also a hardship for women. In a survey conducted in 2010, some medical institutions said that the price of a mid-term abortion at their clinic was up to 600,000 JPY (about 5,250 USD). The number of women cannot have abortion due to the lack of money and are accused of having isolated births in the restroom, which deeply connects to the social structure of Japan that disregards women.


According to some survey, 80 countries around the world provide free abortion, the three quarters of those have full or partial insurance coverage for abortion costs.


The abortion pills are chosen as essential medications by WHO and proven as only because safe and effective. The pills are also quite inexpensive, whose average price is 730 JPY (about 6.5 USD) worldwide.


However, some doctors in Japan have suggested that prescribing the abortion pills should be as expensive as the conventional abortion procedure (around 100,000 yen).


The women with financial difficulties would continue to have the same difficulties affording abortion if the price was set like that.


We need your support in order to make our country a place where all women can live safely and peacefully with fundamental human rights to control their lives, bodies and destinies without physical and mental burdens.


Worked with Kumi Tsukahara, Megumi Hayashi, and Manami Fushimi from the RHR Literacy Laboratory.

News Navigator: How do abortion pills work, and will Japan approve them?
January 21, 2022 (Mainichi Japan)

Mifepristone pills, marked "MF," and misoprostol pills, marked "ML," which have been used widely outside Japan as induced abortion medication, are seen in this photo provided by Tokyo University professor Yutaka Osuga.


The Mainichi Shimbun answers some common questions readers may have about abortion pills used in medical abortions to terminate unwanted pregnancy via oral medication.

Question: First of all, what is an induced abortion?

Answer: It's the artificial stopping of a pregnancy and the removal of a fetus and placenta, administered when a pregnant person cannot give birth for various reasons. About 145,000 were done in Japan in 2020.

Q: What procedures are available in Japan?

A: Currently, only surgical abortion is allowed. One is curettage, in which a metal instrument is used to scoop out the contents inside the uterus. The other is suction abortion, in which a tube providing a gentle vacuum is used to empty the uterus. The former has a high risk of complications -- including uterine injury in rare cases -- and many women experience mental shock. Surgery isn't cheap either, and costs around 200,000 yen (roughly $1,750).

Q: Does the abortion pill cause a burden on the maternal body?

A: The impact on body and mind cannot be underestimated. By taking the medication, the fetus and placenta that have not yet grown will naturally exit the uterus, but it takes more days than surgery would. Painkillers are also needed for the bleeding and pain.

Q: Is abortion by medication allowed overseas?

A: Over 80 countries permit it. In many countries, abortion pills are free or cost just hundreds of yen. Some allow online consultations to take the medication at home. The idea is that abortion is an important medical service for women's health and lives. However, some countries and regions entirely prohibit abortion.

Q: Will it be available in Japan?

A: In December 2021, a U.K. pharmaceutical company applied for approval to the Ministry of Health, Labor and Welfare. The examination procedure takes about a year. If approved, it will be Japan's first abortion pill.

(Japanese original by Satoko Nakagawa, Lifestyle and Medical News Department)

Approval sought for first abortion pill in Japan, report says
Pharmaceutical company Linepharma International plans to seek approval for Japan’s first abortion pill next month. | GETTY IMAGES (Japan Times)
Nov 21, 2021


Pharmaceutical company Linepharma International plans to seek approval for Japan’s first abortion pill next month following successful trials in the country, the Yomiuri newspaper reported.


Linepharma, which received its pharmaceutical license in Japan in July, will seek approval for a combination of two drugs called mifepristone and misoprostol to terminate pregnancy, the paper said. Approval for the drug combination could be forthcoming within a year, Yomiuri said, citing sources familiar with the matter.


About 140,000 abortions were carried out in Japan in 2020, according to the newspaper, all via surgical procedures. By contrast, medication-induced abortion was introduced in France in 1988 and is available in more than 70 countries, the report said.

Expanding access to safe abortions in Japan
In Japan, a surgical procedure is currently the only option for women choosing to end a pregnancy. The introduction of a medication-led solution would offer a cheaper, safer alternative. | GETTY IMAGES (Japan Times)

BY MAGDALENA OSUMI
STAFF WRITER


May 2, 2021
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.

U.K. company will seek to offer Japan’s first abortion pill
By MIREI JINGUJI/ Staff Writer(Asahi Shinbun)

April 30, 2021 at 15:45 JST

Photo/Illutration
Mifepristone and Misoprostol, abortion pills widely used overseas (provided by Yutaka Osuga, professor at the University of Tokyo)


British pharmaceutical company LinePharma is expected to soon apply to the health ministry to have its abortion pill approved for use in Japan.


The drug company has concluded the final phase of clinical trials in Japan and confirmed that the pill aborts the pregnancy more than 90 percent of the time.


As soon as the company completes an additional clinical trial, it will file the application.


If approved, it will be the first abortion pill in Japan.


Some experts, though, have expressed concerns over the use of such emergency contraception.


According to the company, 120 women between the ages of 18 and 45, who were in the ninth week of their pregnancy or earlier and wished to terminate the pregnancy, participated in the clinical trial.


They took one tablet of Mifepristone, which suppresses the progestational hormone needed to sustain pregnancy. Two days later, they took four tablets of Misoprostol, which constricts the uterus.


Yutaka Osuga, a professor of obstetrics and gynecology at the University of Tokyo, oversaw the clinical trial and presented the results at an April conference of the Japan Society of Obstetrics and Gynecology.


Osuga said the data was “either equating to or surpassing the data from overseas.”


It came amid a growing need for access to sexual and reproductive health care around the world.


“There has been growing demand in Japan for abortion pills that are widely used and considered safe and effective around the world,” he said.


If the drug is approved, Osuga said women will have more options for abortion according to their own needs.


LinePharma said the company is currently conducting an additional clinical trial for a comparative analysis between Japanese and international patients that examines how the drug differs in participants’ blood concentration.


Abortion pills were first approved in France in 1988. Currently, more than 70 countries and regions have approved the use of this kind of drug with a doctor’s prescription.


The World Health Organization in 2012 issued a guideline that recommended the abortion pill as one of the safest and most effective ways to end a pregnancy.


In Japan, however, abortions can only be performed through operations.


Drug-induced abortions are still illegal in Japan, partly due to the lack of discussion on the subject matter.


According to the health ministry, 156,430 abortion operations were conducted in fiscal 2019.


But amid reports of illegally imported abortion pills causing harmful health effects, such as heavy bleeding, the health ministry responded in 2004 by introducing new import restrictions.


But people continued to purchase the drugs over the internet. In 2018, a woman in her 20s in Miyagi Prefecture took an abortion pill made in India that she bought online and then suffered from heavy bleeding and spasms.


Health care workers and women have urged the ministry to approve abortion pills under the control of doctors based on guidelines by expert bodies such as the WHO.


Kunio Kitamura, an obstetrician-gynecologist who chairs the Japan Family Planning Association, said the public should be educated about bleeding and stomachaches caused by the drug and ways to protect the patient’s health.


To put the drug into practical use, Kitamura said, those who consider taking it should see a doctor to confirm the pregnancy and ensure the completion of abortion, as well as to ensure they are choosing the right option for them and to learn how to take the pill.


The ministry needs to establish detailed rules for the procedure and measures to respond to emergency cases, such as a patient feeling ill while taking the pill, Kitamura said.

How Japanese doctors who do abortions see the introduction of medical abortion pills in Japan

NEWSLETTER of International Campaign for Women’s Rights to Safe Abortion on January 21, 2022

Japan, Madagascar, Kenya, FIGO Videos, Sedation, SAAF - Newsletter - 21 January 2022


By Kumi Tsukahara

The situation of abortion in Japan is really not well known to the rest of the world, hidden as it is behind the wall of language, and conversely, most Japanese doctors don't know about the situation of abortion provision overseas. As was reported in the ICWRSA newsletter on 9 January 2022, Linepharma has applied for approval of combined mife-miso medical abortion pills.

In response to this, the Japan Association of Obstetrics and Gynecology (JAOG) released a comment: "For the time being, prescriptions [of these pills] should be made only by doctors who are qualified to perform abortions at medical institutions where hospitalization is possible.” The president of JAOG said: "Doctors should not only prescribe the medications, but also perform subsequent management such as surgical operations in case of failure to expel the uterine contents, so a reasonable management fee is necessary.” He also said that it would be desirable to set the fee for the prescription of the pills at the same level as that for surgical abortion (D&C in Japan), which costs about 100,000 yen (= ± US$ 876).

On 28 December 2021, I appeared on a popular online Japanese TV debate programme and was confronted with an Ob-Gyn doctor who supported the JAOG's position above. However, this doctor was not even a "designated abortion doctor", as represented by JAOG, and when he made a strong defence of the abortion procedure he had performed 25 years ago (D&C) as a resident – saying that aspiration alone would not clean the uterus so curettage was always necessary – I decided to laugh in response; otherwise, I might have shouted at him.

What this doctor said, however, shows that at least some Japanese obstetricians have learned nothing. Instead of learning how to do aspiration abortions with simple training, which can be done on an outpatient basis and are almost always completed by aspiration alone, some of the "designated doctors" use " aspiration followed by curettage" or "curettage followed by aspiration", describing this as “their preference" or "the way they were taught in residency” without reference to evidence of any kind.

The recommendations of the World Health Organization related to methods of surgical abortion, based on comprehensive evidence, were published in Safe Abortion: Technical and Policy Guidance for Health Systems, 2nd edition, 2012, p.31-32 and expanded on p.40-42, as follows:

Dilatation and curettage (D&C) is an obsolete method of surgical abortion and should be replaced by vacuum aspiration and/or medical methods.

For pregnancies of gestational age more than 12–14 weeks, the following surgical method is recommended: dilatation and evacuation (D&E).

Medical abortion with pills is also a recommended method of abortion in the second trimester, with a different regimen and dosage than in the first trimester, even up to 24 weeks of pregnancy.

I also exposed another important fact in that online debate. At one well-known hospital, they charge 210,000 yen (= US$1,840) for an early abortion of up to 12 weeks’ gestation, but 51,000 yen (= US$447) for a mid-term abortion (12-15 weeks’ gestation). The lower price for the mid-term abortion is because those who have undergone mid-term abortions are entitled to a maternity allowance of about 400,000 yen, the same as for childbirth or stillbirth. On top of that, the particular hospital was charging at least 90,000 yen as a "burial fee" for the fetus. Thus, by inducing an abortion at 12-15 weeks, the hospital makes a very large amount of money.

Last summer, a clinic that had set similar prices actually advertised that it could provide cheap abortions if women waited until the mid-term period for the abortion. That clinic was criticized for running an unscrupulous "abortion business" and made the news. But it seems that the well-known hospital is doing almost the same thing.

Another large clinic that specializes in abortion boldly states on its website: "We perform D&C safely" because "in a clinic like ours that does a large volume of abortions, it is easier and safer to clean the curettage instruments than to clean the aspiration tubes”. No concern is expressed for how women will feel and nothing is said about whether this is ethical. It all focuses on efficiency and money. In these circumstances, women's reproductive health and rights are violated.

The following are statements that were made by another ob-gyn doctor working in a chain of clinics on why he uses D&C (usually called the SOUHA method in Japan, literally meaning curettage):

“I will give my opinion by comparing the SOUHA method with the aspiration method. There is no difference in the degree of risk of the surgical operation between these two methods. However, the aspiration method is more likely to leave some blood and tissue in the aspiration instrument for the suction method, and it is more likely to be unclean and carry infection, so most doctors in Japan tend to use the SOUHA method.”

“Whether the SOUHA method or the aspiration method is better for abortion surgery makes no difference in terms of the occurrence of surgical sequelae if the doctor is experienced. The reason one of the two surgical methods is being used and not the other is customarily determined by the university you graduated from.

“The main surgical method used in most university hospitals is the SOUHA method. The abortion procedure itself is not so difficult that it makes a difference, so it is difficult to make a difference based on the surgical method. Since both procedures are simple, it is impossible for the differences in the procedures to cause problems such as post-abortion sequelae or difficulty in conceiving in the future. If there is a problem, it is usually caused by incomplete disinfection of the instruments.

“In principle, we use the SOUHA method. This is because many doctors are accustomed to this method, and because the number of surgeries is so large. If you use the aspiration method with limited disinfection and sterilization of instruments, it is not suitable in a clinic with a large number of surgeries.

“There is no difference in after-effects or side effects between the different surgical methods, but rather it depends on cleanliness. All the instruments used in the SOUHA method are cleaned and sterilized after each surgery, but with the aspiration method, the instruments are collected in a bottle through a long tube. Since there is a high rate of blood and tissue remaining in the connection between the bottle and the tube, as well as the instruments (since the aspirator is not cleaned or sterilized every time), it is impossible to deny the unclean condition.”

In sum, the designated doctors for abortion in Japan always say that the method they are used to is the safest, or that experienced doctors can safely use curettage. But WHO evidence says D&C should be obsolete because it requires general anaesthesia and hospitalisation and carries greater risks.

Clearly, much more related to abortion care in Japan must be changed alongside the introduction of medical abortion pills.

Japan court awards damages to victims of forced sterilisation for first time

The Guardian, Justin McCurry in Tokyo, Wed 23 Feb 2022 12.05 GMT

Japan court awards damages to victims of forced sterilisation for first time
Three plaintiffs who suffered under eugenics law to get payouts after judge overturns lower court decision

www.theguardian.com

Related stories:

THE Guardian 2022.2.23
Japan court awards damages to victims of forced sterilisation for first time
https://www.theguardian.com/world/2022/feb/23/japan-court-awards-damages-victims-forced-sterilisation-first-time-eugenics-law


the Japan times 2022.2.23
Japan court orders damages over forced sterilization for first time
https://www.japantimes.co.jp/news/2022/02/23/national/crime-legal/osaka-court-forced-sterilization-damages/


PIME asianews 02/26/2022, 14.51JAPAN
Osaka High Court rules in favour of compensation for victims of forced sterilisation
https://www.asianews.it/news-en/Osaka-High-Court-rules-in-favour-of-compensation-for-victims-of-forced-sterilisation-55238.html


INDEPENDENT Thursday 24 February 2022 15:21
Japan court awards damages up to £175,600 to those forcibly sterilised to prevent birth of ‘inferior children’
https://www.independent.co.uk/asia/japan/japan-court-damages-forced-sterlisation-b2022301.html


The Diplomat 2022.3.8
Can Japan Face Up to Its Legacy of Forced Sterilization?
The state has appealed a landmark verdict ordering the Japanese government to pay compensation to victims of forced sterilization.
https://thediplomat.com/2022/03/can-japan-face-up-to-its-legacy-of-forced-sterilization/


SWI swissinfo.ch 11 marzo 2022 - 10:20
Japonés esterilizado a la fuerza gana un recurso para obtener indemnización
https://www.swissinfo.ch/spa/jap%C3%B3n-esterilizaciones_japon%C3%A9s-esterilizado-a-la-fuerza-gana-un-recurso-para-obtener-indemnizaci%C3%B3n/47423114


KYODO NEWS 2022.2.22
Japan court orders damages over forced sterilization for first time
https://english.kyodonews.net/news/2022/02/897bd239f196-japan-court-orders-damages-over-forced-sterilization-for-first-time.html


ASAHI shinbun February 22, 2022 at 19:22 JST
High court orders Japan to pay damages for sterilizations
By YUTO YONEDA/ Staff Writer
https://www.asahi.com/ajw/articles/14555333


ASAHI shinbun March 12, 2022 at 15:25 JST
Court opens way for victims of sterilization to get redress
By YURI MURAKAMI/ Staff Writer
https://www.asahi.com/ajw/articles/14570668


ASAHI shinbun March 16, 2022 at 13:32 JST
EDITORIAL: Victims of forced sterilization now able to win proper redress
https://www.asahi.com/ajw/articles/14572948


NHK WORLD 2022.2.22
apanese court first to order damage payment over eugenics law
https://www3.nhk.or.jp/nhkworld/en/news/20220222_26/


NHK WORLD  Monday, March 7, 21:05
Government appeals ruling ordering damages payout over eugenics law
https://www3.nhk.or.jp/nhkworld/en/news/20220307_40/


NHK WORLD  Tuesday, March 8, 21:24
Japan government to ensure eugenic law victims receive lump-sum payments
https://www3.nhk.or.jp/nhkworld/en/news/20220308_27/


NHK WORLD Friday, March 11, 20:59
Tokyo court orders damage payment over eugenics law
https://www3.nhk.or.jp/nhkworld/en/news/20220311_28/


JAPAN TODAY Mar. 12 06:00 am JST
High court awards damages over forced sterilization in 2nd case
https://japantoday.com/category/national/japan-court-awards-damages-over-forced-sterilization-in-2nd-case


The Mainichi March 11, 2022 (Mainichi Japan)
Tokyo court orders state pay damages to man over forced sterilization under ex-eugenic law
https://mainichi.jp/english/articles/20220311/p2a/00m/0na/024000c


The Mainichi March 15, 2022 (Mainichi Japan)
Editorial: Japan gov't must compensate forced sterilization victims, not appeal rulings
https://mainichi.jp/english/articles/20220315/p2a/00m/0op/012000c

How do abortion pills work, and will Japan approve them?

mainichi.jp

News Navigator: How do abortion pills work, and will Japan approve them?
January 21, 2022 (Mainichi Japan)

Japanese version

Mifepristone pills, marked "MF," and misoprostol pills, marked "ML," which have been used widely outside Japan as induced abortion medication, are seen in this photo provided by Tokyo University professor Yutaka Osuga.
The Mainichi Shimbun answers some common questions readers may have about abortion pills used in medical abortions to terminate unwanted pregnancy via oral medication.

Question: First of all, what is an induced abortion?

Answer: It's the artificial stopping of a pregnancy and the removal of a fetus and placenta that have not yet grown, administered when a pregnant person cannot give birth for various reasons. About 145,000 were done in Japan in 2020.

Q: What procedures are available in Japan?

A: Currently, only surgical abortion is allowed. One is curettage, in which a metal instrument is used to scoop out the contents inside the uterus. The other is suction abortion, in which a tube providing a gentle vacuum is used to empty the uterus. The former has a high risk of complications -- including uterine injury in rare cases -- and many women experience mental shock. Surgery isn't cheap either, and costs around 200,000 yen (roughly $1,750).

Q: Does the abortion pill cause a burden on the maternal body?

A: The impact on body and mind cannot be underestimated. By taking the medication, the fetus and placenta will naturally exit the body, but it takes more days than surgery would. Painkillers are also needed for the bleeding and pain.

Q: Is abortion by medication allowed overseas?

A: Over 80 countries permit it. In many countries, abortion pills are free or cost just hundreds of yen. Some allow online consultations to take the medication at home. The idea is that abortion is an important medical service for women's health and lives. However, some countries and regions entirely prohibit abortion.

Q: Will it be available in Japan?

A: In December 2021, a U.K. pharmaceutical company applied for approval to the Ministry of Health, Labor and Welfare. The examination procedure takes about a year. If approved, it will be Japan's first abortion pill.

(Japanese original by Satoko Nakagawa, Lifestyle and Medical News Department)

Abortion Pills Are Coming to Japan. Doctors Are Pushing Back.

Leading doctors are pushing for the abortion pill to be as expensive as the surgery, a procedure that’s not covered by health insurance.

www.vice.com


By Hanako Montgomery
January 13, 2022, 8:21pm

JAPAN IS POISED TO LEGALIZE ABORTION PILLS, BUT LEADING DOCTORS FEAR WOMEN MAY ABUSE THEM. PHOTO: KYODO VIA AP IMAGES


For Aoyama, abortion was the only choice she felt she had, after her fiance raped and impregnanted her.

As a victim of domestic violence, Aoyama knew she wasn’t in the right mental state to raise a child. She loved the baby, of course. But who was to know whether she might scapegoat the child, directing pent-up anger at her kid? She was scared of herself. And though guilt engulfed her, she terminated her pregnancy. “I felt I had killed my baby,” she told VICE World News.


“I couldn’t protect myself and in the end, I had to kill my kid in this way,” she said, requesting the use of a pseudonym to discuss intimate matters.


She recalled how the abortion left her bleeding for days. “After the surgery, I couldn’t walk or even stand—I had to lie down on the taxi ride home,” she said. Remembering the pain from over 12 years ago, she said she wished the abortion pill—what she called a less invasive termination method—was an option.


“We need to have this in Japan.”
“It felt like torture. Not only was it a difficult time, but the surgery itself was so painful. If there’s an option to opt out of the surgery, then it should be available—we need to have this in Japan,” she said.


In December, British pharmaceutical company Linepharma applied to the Japanese government for approval of their abortion pill. If endorsed, the pill would be the first medical abortion drug in the country, which abortion rights activists have said would make reproductive healthcare a lot more accessible and affordable.


But even before the pill has been formally approved, a process that’s expected to take up to a year, leading health experts worry that greater access could lead to abuse.


Katsuyuki Kinoshita, the head of the Japan Association of Obstetricians and Gynecologists, a powerful industry group that represents a majority of doctors, said if the pill was deemed safe after clinical trials, then Japan has no choice but to approve it. “However, I am concerned that people will think this medicine can make abortions easier,” he said in an interview with Japanese broadcaster NHK.


He added that only qualified doctors should be allowed to prescribe the pill, as heavy bleeding, a rare side effect of taking the medicine, could occur. “It’d be best to set the price of the abortion pill to how much the surgery costs—about 100,000 yen ($861),” he said. In some nations, the abortion pill is provided free of charge by the government.


But Kumi Tsukahara, a reproductive health and rights researcher and activist, called the push to make abortion pills as expensive as surgeries “unbelievable,” accusing Kinoshita and other doctors of trying to hold on to their effective monopoly on carrying out abortions. “These doctors are only thinking about their business,” she told VICE World News.


“In Japan, surgical abortions are already so expensive and unaffordable for some women,” she said. Abortions and contraceptives are not covered by national health insurance.


To price the abortion pill so high defeats the purpose of medical abortions, which help widen access to lower income women, Tsukahara added.


As a medication, the abortion pill is used to end early pregnancies, or within 70 days of the first day of a person’s last menstrual period. It requires taking a combination of two pills: mifepristone, a hormone blocker, and misoprostol, which causes miscarriage-like contractions that help push out the embryo. After taking both medications, it takes about two to 24 hours for the pregnancy to be removed and is usually accompanied by cramping and vaginal bleeding.


Since China became the first country to approve the two abortion-inducing drugs in 1988, this nonsurgical method is now available in over 80 countries. It’s been listed as a safe and essential medicine by the World Health Organization from 2005. In the United States, where the hormone blocker mifepristone was approved in 2000, about 42 percent of all abortions were medically induced in 2019.


But in Japan, where abortions have been legalized since 1948, dilation and curettage remains one of the most popular abortion methods. This procedure, also known as uterine scraping, accounts for over 50 percent of all abortions nationally, though it’s been deemed “obsolete” by the WHO since 2012. (The rest were carried out by manual vacuum aspiration, which uses suction to remove the pregnancy tissue, or dilation and evacuation, which is a combination of both methods.) The procedure requires dilating the cervix and using sharp metal curettes to scrape the walls of the uterus, posing significant pain and risk of blood loss for the patient.


In Linepharma’s most recent clinical trials, the drugs ended 93 percent of its recipients’ pregnancies within 24 hours, with most reporting mild side effects.


But for reproductive rights activist Tsukahara, who has had an abortion herself, what was of greater concern was how doctors encouraged people to wait to terminate their pregnancies after 85 days—when they’d be eligible for a lump-sum payment for childbirth—to afford high abortion costs.


In Japan, pregnant people covered by public health insurance receive 420,000 yen ($3,691) to cover the medical costs of childbirth. People who experience premature births, stillbirths, miscarriages, and abortions—including terminations for financial reasons—are still qualified for payment, so long as they reach 85 days.


Tsukahara said she knew she wanted to abort after confirming her pregnancy at five weeks, but was encouraged to wait an additional three weeks by her doctor. “I cried every day for those last few weeks,” she said.


“I thought of that fetus as a baby, and I knew that the baby was getting bigger and bigger. I kept thinking, ‘I’m going to have to kill that baby,’” Tsukahara said.


Activists note that in addition to introducing a cheaper abortion method, Japan also needed to offer greater access to contraceptives and sex education to prevent unwanted pregnancies.


“The reality is that there are women who want to use birth control pills but are unable to, due to high costs,” Kazuko Fukuda, a sexual and reproductive health rights activist, told VICE World News.


Currently, condoms are the most widely available form of birth control in Japan, which are on average 82 percent successful in preventing pregnancy.


Birth control pills, which are 91 percent effective and a common method in Europe and parts of Southeast Asia, are only used by 2.9 percent of Japanese people of reproductive age. Low use is often attributed to high costs—one month’s worth of pills costs about 2,500 yen ($21.82)—and concerns about side effects. The pill was only approved in 1999 in Japan, nearly four decades after it was authorized for use in the United States.


In addition, Japan is one of at least 12 countries that still require people to get spousal consent for abortions. Though the law changed last year to exclude domestic violence victims, activists say requiring third-party permission treats women’s bodies as public property.


Aoyama recalled being rejected by multiple hospitals for an abortion because she was unable to get spousal consent from her abusive partner. “Even after explaining I was being abused by my fiance and was unable to get the consent form signed, doctors would ask me, ‘But you’re living together right? You’re engaged, aren’t you?’” she said.


Had it not been for her family and boss, who allowed her to work shorter hours as she recovered from her abortion surgery, Aoyama said she might have ended her life.


“That’s how depressed I was. But because I had their support and they told me not to blame myself, I was able to overcome this difficult point in my life,” she said.


Though she described her abortion as a pain she’d have to carry with her to her grave, Aoyama said she was glad she made the choice to terminate her pregnancy. She wished all women had the freedom to choose.


Correction: A previous version of this story misstated how long after Tsukahara became pregnant did she want an abortion, the name of the industry body of Japanese obstetricians and gynecologists, and the amount of insurance payout for pregnant people. We apologize for the errors.

LINEPHARMA INTERNATIONAL FILES FOR MANUFACTURING, MARKETING APPROVAL OF THE ABORTION PILL IN JAPAN

BioSpace, Published: Dec 22, 2021

LINEPHARMA INTERNATIONAL FILES FOR MANUFACTURING, MARKETING APPROVAL OF THE ABORTION PILL IN JAPAN | BioSpace

LINEPHARMA INTERNATIONAL FILES FOR MANUFACTURING, MARKETING APPROVAL OF THE ABORTION PILL IN JAPAN
Published: Dec 22, 2021


LONDON and TOKYO, Dec. 22, 2021 /PRNewswire/ - Linepharma International Ltd., a global leader in medical abortion, announced today that its subsidiary Linepharma KK has applied for manufacturing and marketing approval in Japan for its oral drug MEFEEGO™ for the medical termination of pregnancies of up to 63 days of gestation. The medication is recognized as the international gold standard for first trimester medical abortioni and is on the World Health Organization (WHO) list of essential drugs for abortion.ii

A successful submission in Japan would signify the first approved medical abortion drug in Japan and would follow launches in Australia and Canada and most recently in South Korea, where a submission to health authorities will be made later this year. Available in 80 countries, the abortion pill has maintained an outstanding safety record throughout the world.iii

The drug combination of mifepristone and misoprostol, the first combination pack worldwide, will be known in Japan as MEFEEGO™. The application to the Pharmaceuticals and Medical Devices Agency (PMDA) is based on the results of a Japanese Phase III clinical trial consisting of 120 women aged 18 to 45 years old. If the drug is approved, the 156,430 Japanese women who had surgical abortion procedures in 2019 alone will have another therapeutic option based on their individual need.

"Linepharma is a global pioneer in abortion medicine and is dedicated to improving sexual and reproductive health including the discovery, development and distribution of innovative health solutions including a combination abortion medication. We are equally committed to working closely with health regulators, healthcare professionals, patient groups and other stakeholders to ensure access to safe and effective options", said Marion Ulmann, Linepharma International's General Manager. "Our drug application for MEFEEGO in Japan is a very significant milestone for Japanese women who, for the very first time, will have an entirely new option for abortion."

Around 73 million induced abortions take place worldwide each year. Global estimates demonstrate that 45% of all induced abortions are unsafe.iv According to the WHO, abortion is a simple and safe healthcare intervention that can be effectively managed by a wide range of healthcare professionals using medication or a surgical procedure.v

About Linepharma International Ltd.
Linepharma International Ltd. was established in 2010 and currently operates in more than 25 countries in North and South America and the Asia-Pacific region. In line with the most current scientific data and World Health Organization's recommendations, Linepharma supplies products for medication abortion in Canada, Latin America, Asia, and Australia. For more information visit www.linepharma.com

Linepharma KK
Linepharma KK was established in May 2020 and acquired a license as a pharmaceutical company in July 2021. Linepharma KK is committed to improving women's health through products and solutions focused on unmet medical needs including an oral drug for the medical termination of pregnancy.

REFERENCES

i JOGC 2019 Barriers and Facilitators to the Implementation of first Trimester Medical Abortion with Mifepristone in the Province of Québec: A Qualitative Investigation Marie-Soleil Wagner, MD, MS; Sarah Munro, PhD; Elizabeth S. Wilcox, MA; Courtney Devane, RN, MN; Wendy V. Norman, MD, MH Sc; Sheila Dunn, MD, MSc; Judith A. Soon, RPh, PhD; Edith Guilbert, MD, MSc

ii www.who.int/news-room/fact-sheets/detail/abortion

iii www.actioncanadashr.org/resources/factsheets-guidelines/2019-04-06-faq-abortion-pill-mifegymiso

iv Bearak J, Popinchalk A, Ganatra B, Moller A-B, Tunçalp Ö, Beavin C et al. Unintended pregnancy and abortion by income, region, and the legal status of abortion estimates from a comprehensive model for 1990–2019. Lancet Glob Health. 2020 Sep; 8(9):e1152-e1161. doi: 10.1016/S2214-109X (20)30315-6

v www.who.int/news-room/fact-sheets/detail/abortion

Cision View original content:https://www.prnewswire.com/news-releases/linepharma-international-files-for-manufacturing-marketing-approval-of-the-abortion-pill-in-japan-301449883.html

SOURCE Linepharma International Limited

www.nippon.com

British firm to seek approval for abortion pill in Japan

The Japan News, 3:19 pm, November 21, 2021

The Yomiuri Shimbun
British pharmaceutical company Linepharma plans to apply to the Health, Labor and Welfare Ministry for approval of the abortion pill in late December, according to sources familiar with the matter.


Approval is expected within a year if the review process goes smoothly. It would be the first orally consumed abortion pill, or medication abortion, available in Japan, and is expected to help reduce the related physical and mental burden on women.


The application will be for mifepristone, a drug that suppresses the function of progesterone, which maintains pregnancy; and misoprostol, a drug that causes the uterus to contract. The two drugs are taken in combination to expel the contents of the uterus.


The abortion pill was approved in France in 1988 and is already in use in more than 70 countries around the world. Due to the negative image of abortion in Japan, in-depth discussions about its introduction have not been held in this nation and it remains unapproved.


A clinical trial conducted by Linepharma in Japan found the abortion pill caused 93% of 120 pregnant women at up to nine weeks gestation to have an abortion within 24 hours.


Of these women, 60% had symptoms such as abdominal pain and vomiting, but most symptoms were mild or moderate. Less than 40% of the side effects were believed to result from the drugs.


About 140,000 abortions were conducted in Japan in 2020. Abortions in this nation have so far been limited to surgical procedures: the dilation and curettage (D&C) method in which the contents of the uterus are scraped out with a metal instrument, and the dilation and evacuation (D&E) procedure in which the contents are sucked out with a tube.


These procedures are not covered by insurance, therefore the cost is between ¥100,000 and ¥200,000. In contrast, data from the World Health Organization shows the average price of an abortion pill overseas is only about ¥740.


The WHO recommends abortion pills and D&E as they are less harmful to the body. It has said the D&C procedure, which risks damaging the uterus, is “outdated and should not be performed.”

British firm to seek approval for abortion pill in Japan

Yomiuri Newspaper, November 21, 2021

British firm to seek approval for abortion pill in Japan

3:19 pm, November 21, 2021

The Yomiuri Shimbun
British pharmaceutical company Linepharma plans to apply to the Health, Labor and Welfare Ministry for approval of the abortion pill in late December, according to sources familiar with the matter.

Approval is expected within a year if the review process goes smoothly. It would be the first orally consumed abortion pill, or medication abortion, available in Japan, and is expected to help reduce the related physical and mental burden on women.

The application will be for mifepristone, a drug that suppresses the function of progesterone, which maintains pregnancy; and misoprostol, a drug that causes the uterus to contract. The two drugs are taken in combination to expel the contents of the uterus.

The abortion pill was approved in France in 1988 and is already in use in more than 70 countries around the world. Due to the negative image of abortion in Japan, in-depth discussions about its introduction have not been held in this nation and it remains unapproved.

A clinical trial conducted by Linepharma in Japan found the abortion pill caused 93% of 120 pregnant women at up to nine weeks gestation to have an abortion within 24 hours.

Of these women, 60% had symptoms such as abdominal pain and vomiting, but most symptoms were mild or moderate. Less than 40% of the side effects were believed to result from the drugs.

About 140,000 abortions were conducted in Japan in 2020. Abortions in this nation have so far been limited to surgical procedures: the dilation and curettage (D&C) method in which the contents of the uterus are scraped out with a metal instrument, and the dilation and evacuation (D&E) procedure in which the contents are sucked out with a tube.

These procedures are not covered by insurance, therefore the cost is between ¥100,000 and ¥200,000. In contrast, data from the World Health Organization shows the average price of an abortion pill overseas is only about ¥740.

The WHO recommends abortion pills and D&E as they are less harmful to the body. It has said the D&C procedure, which risks damaging the uterus, is “outdated and should not be performed.”Speech

(c)Yomiuri Shinbun

Japan's abortion rule: Get consent from your sexual predator Requirement forces rape survivors to relive trauma

Nikkei Asia, NATSUKI OSHIRO, Nikkei staff writer October 20, 2020 23:23 JST

FUKUOKA -- When a woman in western Japan visited a hospital several years ago to seek an abortion after being sexually assaulted, she heard a shocking response from her doctor: "We cannot proceed without consent from the father."

She had noticed she was pregnant about a month and a half after she was assaulted by an acquaintance. She was so shocked that she did not report the incident. She explained her situation over and over again, but the doctor refused to budge.

"You know him, so you should be able to get him to sign off," the doctor said.

The woman searched for other medical facilities that were more understanding, but received a similar response every time. It was only a month later, with the recommendation of a support group for women like her, that she was able to finally receive an abortion.

By that point, her case was considered a second-term abortion -- a significantly riskier and costlier procedure, which she was required to report to the government as a stillbirth.

She said the process was physically and emotionally traumatizing. "Why do victims have to suffer again and again?" she said.


A consultant answers a call on a hotline for sexual violence victims in Fukuoka.
The woman is one of many sexual assault survivors denied abortions across Japan by hospitals that require consent from their attackers. Support groups have made some headway toward overturning these requirements that retraumatize victims, though they face a long road ahead.

At the end of June, the Lawyer Forum for Victim Support submitted a written request to the Japan Medical Association to stop requiring sexual predators' consent for an abortion. The document included four case studies where sexual assault survivors were blocked from the procedure due to this requirement.

The controversy is rooted in the Maternal Health Act, which requires consent from both the mother and her "spouse" to perform an abortion. Critics argue that the law pushes some doctors to seek a signoff from the male party, even in potential sexual assault cases.

Many hospitals model their paperwork for abortions on a template provided by the Japan Association of Obstetricians and Gynecologists, which has a dedicated field to be filled by a "spouse."

"The template is a big part of the problem," said attorney Sakura Kamitani, a member of the Lawyer Forum for Victim Support. "Doctors may seek consent from the attackers because they don't want to leave part of the form blank."


A consent form template provided by the Japan Association of Obstetricians and Gynecologists has a dedicated field to be filled by a "spouse."
Japanese law permits abortions for various reasons, including for pregnancies caused by rape. But doctors on their own cannot determine whether a sexual assault has taken place. At a December workshop in Tokyo, the Japan Medical Association instructed gynecologists to request documentation like a bill of indictment or a court sentence from sexual assault victims seeking an abortion.

There are also cases where the perpetrators do not recognize that they assaulted their victims.

"We want to perform the abortions, but we can't rule out the possibility that we will be sued by the male party," said JAOG Vice Chair Isamu Ishiwata.

Many sexual assault survivors are reluctant to contact the authorities. According to the White Paper on Crime published last year by the Ministry of Justice, only about 14% of sexual asault victims had brought their case to the police in the five years prior.

"Being denied an abortion at the hospital could be a form of 'second rape,'" or a secondary victimization, said Hisako Ura, head of the Fukuoka Victim Support Center.

In response to growing scrutiny over the issue, the Ministry of Health, Labor and Welfare in August sent a letter to the Japan Medical Association clarifying that the Maternal Health Act does not require consent for abortions from rapists.

Still, Kamitani believes this does not go far enough. "Doctors on the ground could keep asking for a signoff unless they are explicitly told that they must not do so," she said. Her organization is urging the Japan Medical Association to conduct a nationwide survey to assess the situation.