My report
In Japan, the Mefeego Pack, a combi-product of one Mifepristone and four Misoprostol tablets, was launched on May 16, 2023, and the Japan Women's Foundation's Dr. Miho Uchida's clinic began offering "oral abortion pills" for the first time in Japan on Thursday, May 25, 2023.
As far as we could confirm on May 27, 11 hospitals or clinics joined the providers listed on the website of the manufacturer Linepharma K.K. as institutions that can handle this drug, however on Monday morning, all the other clinics that followed the lead of Dr. Uchida's Fides Ladies Clinic disappeared from the list.
As of the time of our review over the weekend, there was no detailed information on the abortion pill offerings on the websites of these ten medical institutions, so we assume that either Linepharma has decided to withhold the listings until they provide more detailed information, or that each of the clinics, aware of their lack of preparation, has voluntarily suspended their listings.
Anyway, because abortion pills are provided outside the insurance system and not covered by any public funds, women must pay the equivalent of the most expensive legal surgical abortion in the world. At Dr. Uchida’s clinic, the total fee for medical abortion is the same for the surgery is set at 99,000 yen.
In Japan, written consent of the spouse is still legally necessary as a pre-condition for any method of abortion. In addition, the patients cannot take abortion pills very early in the pregnancy, as the doctor prescribes the medications only after they could confirm the pregnancy in the uterine by transvaginal ultrasound which means usually after 6th week. However, according to Dr. Christian Fiala of Austria, who spoke at the #Action for Safe Abortion Japan online event on May 28, taking abortion pills very early is effective when an echo test is unavailable. If nothing happens, he says, then one should suspect an ectopic pregnancy and go to a higher-level medical facility. Very early MA also serves as a screening for ectopic pregnancy.
Japanese abortion patients should take both medications in front of a physician, and after taking the misoprostol, they are forced to stay in the medical institution until the pregnancy expels. Many obstetrics and gynecology facilities in Japan are not dedicated to abortion services and often house expectant mothers, new mothers with babies, infertility treatment, and gynecology patients in the same waiting room, which is an uncomfortable place for abortion patients to be. Now, however, abortion patients are required to remain in the hospital for up to eight hours (doctors say 90 % of the cases finish in 8 hours, but what about the remaining 10%!?) after taking the misoprostol. The Ministry of Health, Labor, and Welfare and the Japanese Association of Obstetricians and Gynecologists state that this in-hospital waiting rule is "temporary" and will be lifted once safety is sufficiently confirmed, but the criteria for lifting are unclear.
The JAOG also states that patients who come to the hospital to take Mifepristone on the first day at any time, and Misoprostol two days later at 9:00 a.m. should remain in the hospital until the pregnancy expells and that if the expulsion is not completed by 5:00 p.m., surgery will be performed next day or later. However, whether the patient will be hospitalized for a fee or sent home at their own risk is not explained clearly.
Because the Japanese health insurance system or any public funds do not cover abortion costs, women must pay the equivalent of the most expensive legal surgical abortion in the world. Some people may have to pay for hospitalization, backup surgeries, and multiple hospital visits out of their pocket.
"The approval of the abortion pills in Japan means that women now have more options," says Dr. Uchida. ”From now on, Japanese women no longer have to risk their lives to use foreign abortion pills by self-determination. Now a qualified doctor can fully explain the options and risks of abortion and make the best choice for her is a step forward for Japan from the perspective of 'reproductive rights'."
But it will likely take a little longer for Japan to achieve reproductive rights that guarantee women themselves to make the best choices for themselves.
