Abortion in Japan

Memorandums and information about abortion situations and problems in Japan

Abortion Pill may be filed for approval this year in Japan

Something too awful to be true is happening in Japan.

An online conference of the Japan Society of Obstetrics and Gynecology was held yesterday, where it was announced that LinePharma's clinical trial was successful, and an application is expected to be filed for approval of the abortion drug by the end of this year.

However, the results of the study showed that more than half of the women complained of abdominal pain and nausea as if the abortion pills were dangerous, and as if to show the dangers of this drug to the Japanese people who have a strong bias against abortion pills.

At the same time, a survey of abortions conducted in 2019 by Japanese doctors designated under the Maternal Protection Law (a group of doctors who can legally perform abortions) was announced. Their report confirms that the safety of abortion in Japan (where D&C is heavily used) has increased even more than in previous studies.

The doctors designated by the Maternal Protection Law also conducted an abortion survey in 2012, but the content of the survey was self-serving, and it was clear that they conducted the survey to produce results that were convenient for themselves, as I revealed in a paper I published this spring.

Then, the results of the 2012 survey, which was funded by the Ministry of Health, Labor, and Welfare (and therefore must be disclosed to the public), suddenly disappeared from the MHLW database. This proves that not only the pharmaceutical companies and doctors but also the MHLW is in on it.

If this continues, even if the abortion pill is approved, women in Japan will only be able to get it at a ridiculously high price, or worse, they may be forced to take it in front of a doctor, or even worse, hospitalized, which some doctors have implied.

Under the pandemic of COVID-19 since last year, there have been a series of incidents throughout Japan where young women and poor foreign workers have given birth to their children in public toilets and abandoned them. In Japan, it costs a lot of money to have an abortion or to give birth.

At the end of March last year, Japan's former prime minister suddenly and single-handedly ordered a blanket vacation for elementary, junior high, and high schools, and around May, the number of calls from young girls for "pregnancy counseling" skyrocketed. Furthermore, the number of suicides among young Japanese women peaked in October. What this means can only be speculated, but I suspect that not a few of the young women who committed suicide were those who had unwanted pregnancies.

https://www3.nhk.or.jp/nhkworld/en/news/20210422_25/

Please refer to my English blog for more information, too.
https://okumi.hatenadiary.com/

UK pharma firm to seek first Japan approval for abortion pill, but challenges remain

April 22, 2021 (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.
TOKYO -- British drug company Linepharma is set to seek Japan's first ever regulatory approval for an induced abortion pill for practical use. However, though the pill has been in regular use in the United States and Europe for some two decades, there remain challenges surrounding drug pricing and abortion methods, among other factors.

"There are hardly any side effects, and it's extremely safe. Women will be able to have an abortion independently without surgery by a doctor," said Yutaka Osuga, an obstetrics and gynecology professor at the University of Tokyo who has been participating in clinical trials for the abortion medication.

Currently, abortions in Japan are surgical, performed by doctors designated under the Maternal Health Act and selected by prefectural medical associations. Abortions within the first trimester are done through the curettage method, in which metal instruments are used to scrape out the embryo, placenta, and other contents of the uterus. This method is used alongside evacuation, which entails sucking out the contents of the uterus through a straw-shaped instrument. According to the Ministry of Health, Labor and Welfare, 156,430 surgical abortions were carried out in Japan in fiscal 2019.

Abortions induced using medication are intended for women who are within the first nine weeks of pregnancy. First, an individual must take one mifepristone abortion pill, and then take four tablets of misoprostol two days later. The drugs block hormones that sustain a pregnancy, the uterine lining breaks down, and the womb empties as it contracts. Painkillers are needed as well, as women also experience bleeding and pain during the process. Surgical intervention is needed if the uterus does not empty completely.

According to Linepharma, the final stage of clinical trials in Japan was finished by the end of 2020, with successful abortions confirmed in 93.3% of cases. The firm said that once additional clinical trials comparing the shift of concentration levels of active pharmacological substances in the blood with that of non-Japanese are completed, it will file an application as early as this year with the government's Pharmaceuticals and Medical Devices Agency (PMDA) to have the drug approved for use.

France approved abortion medication in 1988, the first country in the world to do so. The abortion pill also became widespread throughout the United States, Europe, and China from 1990 to the early 2000s. The medication has now been authorized in over 65 countries.

In guidelines issued in 2012, the World Health Organization (WHO) stated that the curettage surgical method -- commonly used in Japan -- risks bruising the inside of the womb, and has safety issues. The WHO advised the use of the suction method or abortion medication, and specified the abortion pill as essential medication that should be distributed at affordable prices. Half of women who have abortions in the United Kingdom and France, as well as 70-80% of those in Nordic countries, are said to choose medication as their abortion method.

Meanwhile, in 2004, Japan's health ministry subjected induced abortion pills to restrictions on importation by individuals, claiming that health issues resulting from medication manufactured by overseas firms had been reported. In November 2010, a Tokyo woman in her 20s had her papers referred to prosecutors by the Metropolitan Police Department on suspicion of criminal abortion for allegedly having an abortion at home by taking pills she had imported personally. However, online sales of abortion pills showed no signs of abating, which prompted the National Consumer Affairs Center to issue a warning in March 2013 that "individual importation and usage of the pill without due consideration is dangerous."

Following a rise in demand, the Japan Association of Obstetricians and Gynecologists presented its views on induced abortion medication in September of the same year. The association said it was in favor of the national government starting discussion on the pill's approval. It has also been asking the government to consider conditions for managing the medication, such as only allowing doctors designated by the Maternal Health Act to handle the pills.

As to why authorization of abortion pills has been so late in Japan, professor Osuga commented, "The drug is not well known among the public, and doctors did not actively introduce it. There may also have been concern among conservatives that it would cause the number of abortions to increase."

Kunio Kitamura, director of the Japan Family Planning Association and a gynecologist who has pushed for domestic authorization of abortion pills for many years, said, "A massive amount of money, time, and coordination with concerned parties is necessary to introduce the new drugs. It may also be that pharmaceutical companies were worried about religious and profitability issues."

Japanese pharmaceutical companies have also begun clinical trials for induced abortion pills, so their introduction is becoming more realistic. However, how they will be introduced for regular use remains a challenge to be discussed moving forward.

It usually takes about one year from the time of filing to obtain health ministry approval for a new drug. In the meantime, the PMDA and a ministry deliberative body discuss how to safely manage, distribute, and take it. In other countries, the abortion medication is prescribed together with painkillers at medical institutions, and many countries also allow people to take the pills at home. However, due to the bleeding, it may be life-threatening for individuals with preexisting medical conditions, and some observers have said it should only be taken under medical supervision.

There are also many countries that require women taking induced abortion medication to visit the hospital several times: when confirming the pregnancy, when taking the pills, and when confirming a successful abortion. Some people have expressed concern that the pills in fact impose a greater burden on doctors and patients than the quick surgeries.

Kitamura said, "In addition to the safe management of the woman's body, the drug's effects, as well as methods to deal with bleeding, and other forms of education and emotional care are crucial. We must discuss and create rules for administering the drug."

There are also monetary challenges. In Japan, abortion is not covered by public health insurance. Normally, patients pay 100,000 to 200,000 yen (about $925 to $1,850) for surgical abortions. Osuga said, "It's possible that medication abortions and surgical abortions will be set at around the same cost from the standpoint of running hospitals. It's necessary to consider offering public assistance to make the price affordable."

When asked at a March 22 House of Councillors Committee on Health, Labor and Welfare session whether the government plans to cover abortion under public medical insurance, health minister Norihisa Tamura said, "If the mother's life and health are endangered, insurance will be applied, but I suppose this would not apply to general abortion, considering the objectives of insurance."

Meanwhile, Kumi Tsukahara, who researches abortion issues, said that in around 30 countries, including the U.K., France, and New Zealand, abortion pills are effectively prescribed free of charge, as they are covered by insurance or subsidized by the government. In Australia, the U.K., France and other countries, prescriptions for the pills can be obtained online.

The International Federation of Gynecology and Obstetrics (FIGO) issued a statement in March saying, "(online) telemedicine medical abortion service was proven to be effective, safe, inexpensive and satisfactory." FIGO stated that abortion should be provided by all governments "with safety, privacy and dignity at the forefront."

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

Japanese Women No Longer Need Spousal Consent for Abortions – If They Were Abused

VICE World News, Mar. 16, 2021

In Japan, a woman used to need her husband’s permission to have an abortion even if he had raped her.
By Hanako Montgomery
March 16, 2021, 9:04pm


Japan has announced new guidelines that allow women to get an abortion without their husband’s consent if they can prove their marriage has effectively collapsed due to domestic violence or other reasons.

Previously, women had to obtain written consent from the man who impregnated them to terminate their pregnancy. Exceptions are granted only if the women could prove the father of their future child was dead, missing, or had raped her. Additionally, if the husband was the rapist, a woman still needed his consent to carry out an abortion.



The new guidelines, announced on Sunday by the Japan Medical Association, came after growing calls from medical and rights groups for women to have more say over abortions.

The Crime Victim Support Lawyer Forum, or VS Forum, a group of lawyers defending the rights of abuse victims, was among several organizations that demanded a reform of Japan’s Maternal Health Act.

In June 2020, VS Forum requested the Japan Medical Association, Japan’s largest professional association of licensed physicians, to review how they grant abortions.


“Though the law states that when a woman is a victim of rape she doesn’t need spousal consent for an abortion, in reality, that was often not the case,” Masato Takashi, the executive director of VS Forum, told VICE World News. “Female victims were turned away at many medical institutions.

Doctors were afraid of getting sued by the female’s partners, if they performed abortions without spousal consent.”

Japan’s health ministry adopted the recommendations put forward by the physician association, the Mainichi Shimbun newspaper reported on Sunday.

Though domestic violence support groups have cheered the new guidelines, they’re unclear how it will work in practice.


“The government hasn’t sent us any guidelines about how to better implement these revisions. Do victims need to speak to police to be considered victims of domestic violence? Or can it merely be victims who came to us for help? Nothing is made clear,” said a spokesperson from Saitama Victim Consultation Center, who declined to provide her name out of privacy concerns.

Takashi, of VS Forum, said victims of domestic abuse could still be denied access to abortions because of the taboo around such violence.

“It’s common for a woman to keep her experiences of domestic violence a secret. She may feel shame, or embarrassment. So when she’s asked, ‘Did you report this to the police?’ Obviously, most women haven’t. This law helps, but it’s not enough,” he said.


In the past 25 years, laws concerning abortions have generally become more liberal globally, with 29 countries relaxing abortion laws since 2000.


Yet millions of women still live under restrictive laws. 41 percent of the world’s female population cannot terminate their pregnancies freely, according to the Center for Reproductive Rights, a global legal advocacy organization.


Japan is one of at least 12 countries that still require spousal consent for abortions. Some other nations include Turkey, Saudi Arabia, Kuwait, Morocco, Yemen, and Syria. 26 countries outright ban abortions.


Conversely, the Netherlands have some of the most lax laws around abortions. The United Nations has noted that “abortion is permitted virtually on request at any time between implantation and viability if performed by a physician in a (licensed) hospital or clinic.” For those living in the Netherlands, abortions are free of charge.

Heavy Burden of Abortion for Women in Japan

Abortion is not covered by the health insurance in Japan. Here is one of the proofs.

Although most of the services are covered by national insurance, some services, especially for non-diseases, cosmetic and luxury purposes, are not covered by health insurance and patients have to pay the full amount. A typical example is normal vaginal delivery, as childbirth is not considered as a disease....Other examples of direct payments include cosmetic surgery, orthodontics, abortions and infertility treatment.

Japan Health System Review, Asia Pacific Observatory on Health Systems and Policies, 2018

Why Japan Can't Shake Sexism

BBC By Mariko Oi, 9th April 2021

Gender equality keeps making headlines in Japan for all the wrong reasons. Why is that and what will it take for things to change?
A
A day after former Tokyo Olympics boss Yoshiro Mori made global headlines with his sexist comments, Momoko Nojo, 23, helped start a petition calling for action against him. “The aim wasn’t his resignation,” says Nojo, whose petition – co-created with 10 other women – took two days to collect 100,000 signatures. “I felt we needed to do something, because until now we, as a society, have accepted these kinds of comments.”

cont'd...
Why Japan Can't Shake Sexism

The reality of abortion legal system in Japan

The reality of abortion in Japan is very complicated and not well understood by people inside nor outside of Japan.

First of all, the Japanese Penal Code, which was enacted in 1907, includes the crime of abortion, and abortion is generally prohibited even now.

On the other hand, the Eugenic Protection Law, created in 1948, defines the grounds for dismissing the illegality of criminal abortion. The Eugenic Protection Law was reborn in 1996 as the Maternal Body Protection Law, which removed all eugenic provisions that were criticized as discriminatory and retained only the provisions on abortion.

The Article 14 of the Maternal Body Protection Law provides for legal abortion as follows:

Chapter III Maternal Health Protection
(Induced Abortion with Doctor's Approval)
Article 14　(1)　A doctor designated by a medical association that is a public interest incorporated association established for the area of a prefecture (hereinafter referred to as a "Designated Doctor") may perform an Induced Abortion on a person who falls under any of the following items after obtaining consent from the relevant person and the spouse:

(i)　a person for whom the continuation of pregnancy or delivery may significantly damage the person's physical health due to bodily or economic reasons; and
(ii)　a person who was raped in a violent or threatening manner or at a time when the person could neither resist nor refuse and becomes pregnant.

(2)　As for the consent provided in the preceding paragraph, the consent of the spouse is not necessary if the spouse is not known or cannot express an intention, or if the spouse no longer exists after the pregnancy.

The condition (i) is further divided into two categories: (a) the continuation of the pregnancy may significantly damage the woman's physical health due to bodily reasons, and (b) the continuation of pregnancy or delivery may significantly damage the person's physical health due to economic reasons.

The idea of (a) "the damage to the physical health due to bodily reason" is interpreted very narrowly, and is intended for cases in which the physical health is severely deteriorated (leading to death) for strictly medical reasons. In other words, very few abortions fall into this category, but they are covered by health insurance.

On the contrary, (b) "the damage to the physical health due to economic reasons" is interpreted very broadly. It is commonly referred to as the "economic clause", which allows a woman to have an abortion if her doctor deems it "economically difficult" for her to bear and raise a child. Even abortion on the grounds of fetal disability is also performed under this "economic clause". Naturally, abortions based on this reason make up the majority of abortions in Japan. And in this case, abortion is not covered by any public funds.

There are also very few abortions performed under the condition (ii), partly because the stigma against rape victims is so strong that few people report it to the police. If she can report it to the police, the abortion would be free of charge.

All of the above abortions are "legal", but most of them are not covered by public funds. More than that, there is a problem that abortion in Japan is very expensive. According to our 2010 survey, early abortions (<12weeks) cost 60,000-200,000 yen, and mid-term abortions (≥12weeks) cost 90,000-600,000 yen. Women and girls in Japan have to pay for these expensive abortions on their own.

Two separate studies have shown that D&C is still used in 80% of abortions in Japan, and VA only in 10-20% of procedures. For mid-term abortions, an expensive prostaglandin (a product called Preglandin) have been used since the 1980s. To use Preglandin for midterm abortions, doctors use expensive dilation materials such as Laminaria. This is another reason why midterm abortions in Japan are very expensive.

Mifepristone is unapproved and is currently undergoing clinical trials, but it's hard to expect it to be approved anytime soon. Japanese feminists are worried that the price will be high, as it was for low-dose pills, due to the very time-consuming and labor-intensive clinical trials. (In Japan, both the birth control pill and the emergency contraceptive pill are very expensive and very inaccessible because they can only be obtained through medical examination and numeral tests by a designated doctor.)

The abortion issue in Japan is so broad and deep-rooted that this is still just the tip of the iceberg.

No consent from spouse needed for abortion in broken marriages in Japan: ministry

The Mainichi

No consent from spouse needed for abortion in broken marriages in Japan: ministryMarch 15, 2021 (Mainichi Japan)

Translation from Japanese version

TOKYO -- Japan's health ministry has spelled out new administration guidelines to the Maternal Health Act, which would allow women whose marriages have effectively collapsed due to domestic violence and other reasons to undergo abortions without their spouse's consent.

There have been many cases in which women wanting abortions have been given the run around by multiple medical institutions or have been forced to give birth because they have been unable to provide their spouse's consent for an abortion. Because of this, support groups have been calling for a review in the administration of the law.

The Maternal Health Act stipulates that when carrying out an abortion, doctors must obtain the consent of the pregnant woman and her spouse. Even if the woman is not married, many medical institutions seek consent from the man believed to have impregnated the woman out of fear of lawsuits and other problems they may face with the man involved.

According to a 2017 survey conducted by the Cabinet Office, of 141 women who had been raped by men, 26.2% of the men were former spouses and 24.8% were former boyfriends. In response to the serious state of sexual domestic violence experienced by women, in February of this year the All Japan Women's Shelter Network, a nonprofit organization that assists domestic violence victims, submitted a request to the Japanese government seeking the elimination of the provision in the Maternal Health Act requiring the consent of the spouse for a woman to receive an abortion.

In June 2020, Victim Support Forum, comprising attorneys, lodged a request with the Japan Medical Association (JMA) that the implementation of the Maternal Health Act be improved after an unmarried woman who became pregnant after being sexually violated was denied an abortion at multiple medical institutions.


A Japanese abortion consent form is seen in this image. In the case of an unmarried woman, some medical institutions have a signature block for her partner or the man believed to have impregnated her. (Mainichi)
In response to such moves, the JMA and the Japan Association of Obstetricians and Gynecologists (JAOG) have engaged in debate over the issue of consent. According to a source tied to those discussions, the JMA on March 4 asked the Ministry of Health, Labor and Welfare whether it was "correct to assume that consent of the person getting the abortion is sufficient in cases where the pregnant woman is the victim of domestic violence from her husband, or the marriage has otherwise effectively collapsed, and it is difficult to obtain the consent of the spouse." The health ministry is said to have responded in writing dated March 10 agreeing with the JMA's interpretation.

The JAOG sent out a notice to obstetricians and gynecologists nationwide on March 14. As for determining whether a marriage has broken down or not, the association says that "it is ideal that based on the woman's statements, a doctor specified by the JAOG make the judgment, or a relative or a third party who knows the couple be asked to confirm the nature of the relationship." The association is also poised to request that the reason why the couple's marriage was judged as being broken be recorded in the women's charts.

"There have been countless cases in which victims of domestic violence give birth unwillingly because they have been unable to obtain the consent to abortion from their husbands," says Chisato Kitanaka, an associate professor at Hiroshima University who heads the All Japan Women's Shelter Network. "If such husbands found out that their wives had gotten an abortion without their consent, there's a chance that their attacks would increase in intensity, which is one reason why the women themselves and their doctors hesitate to go through with abortion. It is significant that the government is taking a clear position on this issue."

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

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