This is an English translation of a question raised by a female member of the House of Councillors, Representative Mizuho Fukushima, to the Japanese Diet Committee on Health, Labor, and Welfare on May 20, 2021, regarding the abortion pill.
Mizuho Fukushima Rep.:
I would like to ask you about the oral abortion pill.
There are reports that it is expected to be approved by the end of the year, but I would like to know how it will be handled, whether it will be used by individuals at home with a doctor's prescription or not.
Government (Mr. Kamata):
Of the so-called oral abortion medicines that you mentioned, Mifepristone and Misoprostol are currently undergoing clinical trials and additional testing by the companies that are developing them. Therefore, once the companies submit their applications to the pharmaceutical affairs bodies, we will conduct an appropriate review, including whether or not the safety management measures you mentioned are necessary. In the future, we will consider insurance approval and application based on that.
Fukushima Rep.:
What will happen to insurance coverage?
Government (Mr. Kamata):
In the case of oral abortion medicines, they will be covered by insurance in cases where abortion is necessary for treatment, such as miscarriage due to the death of the fetus. In the case of miscarriage due to death or other reasons, abortion will be covered by insurance.
Fukushima Rep.:
In other countries, such as the U.K., France, the Netherlands, and Sweden, there is no charge. I think it is very important to consider whether or not this will become a free medical treatment, and how much it will cost.It is recommended that two types of oral abortion medicines be used in combination: Mifepristone, which suppresses the action of the progestin that maintains pregnancy, and Misoprostol, which stretches the uterus. In Japan, Mifepristone is not approved at all, and Misoprostol is approved as Cytotec, a drug for the treatment of gastric and duodenal ulcers, with a drug price of about 33 yen per tablet. It is not approved for abortion or miscarriage. It is prohibited for use in pregnant women, and people are warned not to use it for other purposes.
Isn't it possible to expand the application of Cytotec, which costs 33 yen per tablet?
Government (Mr. Kamata):
As I mentioned earlier, this drug is currently under development and testing, so the content of the pharmaceutical approval will change depending on what kind of application the company submits, and we will consider insurance coverage based on that.
In addition, there are various views on the price of the product when it is covered by insurance, but as I mentioned earlier, this will be discussed by the Central Council of Medical Practitioners depending on the content of the application for approval and the content of the approval.
Fukushima Rep.:
FIGO has published a resume on safe abortion and miscarriage using Misoprostol and Cytotec alone. FIGO has stated abortion.FIGO, of which the Japanese Society of Obstetrics and Gynecology is a member, believes that reproductive autonomy, including access to safe abortion, and the right to sexual and reproductive self-determination are fundamental human rights that should not be violated under any circumstances. Abortion is a critical, time-sensitive medical service and should be provided by the wishes of women and girls, giving top priority to safety, privacy, and dignity. FIGO calls on all governments to remove barriers to access to safe abortion and to ensure that all girls and women have access to safe abortion during and after the COVID-19 epidemic.
FIGO's statement on abortion very much encourages the use of telemedicine as a means of improving accessibility. What do you think?
Government (Mr. Kamata):
You have made many points.
For example, the price of the medicine and the cost of the abortion as a whole, I mentioned earlier that the price of the medicine when it is covered by insurance will be discussed in the future. As for the public subsidies for abortion when it is not covered by insurance, as you pointed out, there are various opinions on respect for life and the right to self-determination, and it is a difficult issue that is deeply related to ethics and morality, so I think it is important to deepen the discussion among all segments of the public.
Also, you mentioned remote medical treatment. I think that telemedicine itself needs to be discussed from the perspective of medical care, but concerning these oral abortion drugs, Mifepristone and Misoprostol, there is a question of how to manage the medication. As you mentioned, we will have to decide based on the ideas of the companies that are applying for the drug, including the health management when we first use Mifepristone to stop the pregnancy and then use Misoprostol to remove the substance from the woman's body.
In addition to the above, many other issues need to be addressed.
Fukushima Rep.:
I think it is very important to change the situation where women in Japan are unable to obtain safe, secure, accessible, and inexpensive abortion medicines, as the International Federation of Gynecology and Obstetrics has suggested.In the Maternal Protection Law, there is a requirement for a spouse to perform an abortion. I had discussions with various people about this.
In other words, it's not something that two people can discuss and decide on together. If the husband objects, the abortion cannot be performed. If the husband objects, he is forced to have the baby. The wife has no right and the husband has the right to consent. This means that even if a woman does not want to have a baby and thinks that it would be a huge change in her life, she cannot have an abortion without the consent of her husband.
This means that the husband has the right to refuse the abortion and the right to force the birth. I don't think this is in the best interest of women in terms of reproductive rights and health.
Government (Ms. Watanabe)
As you pointed out, the provisions of the Maternal Protection Law, on the one hand, have to do with reproductive health rights or the right of women to self-determination, but on the other hand, there is also the other major issue of respecting the life of the unborn child.In this context, I believe that there are various opinions among the public on this issue, and although we have recently presented interpretations on the cases of rape and domestic violence, I believe that it is necessary to take a cautious approach in reviewing the issue of spousal consent. I believe that we need to be very careful in reviewing the spousal consent.
Fukushima Rep.: Respect for the life of the fetus is irrelevant. What I mean by "irrelevant" is the issue of the husband having the right of consent. It is not the wife who decides, but the husband who has the right to decide, and if she does not give consent, she is forced to give birth. This is a problem between the husband and the wife, isn't it? How can a husband force a woman to give birth? I think this is extremely problematic. Because it is the woman who gives birth.
I strongly believe that the spousal requirement in the Maternal Protection Law should be abolished, and I hope that the government will do so.
Currently, in Japan, a signature campaign has been launched to call for the elimination of the spousal consent requirement for abortion. We are planning to set up an English signature site soon, so please support our petitions from overseas.
