BY MAGDALENA OSUMI
Last week’s decision by the U.S. Supreme Court to overturn its landmark 1973 decision that deemed abortion a constitutional right has reignited the controversial debate over access to the procedure in the United States.
In Japan, where abortion is relatively accessible, it is rarely a political issue like in other countries. Nonetheless, there are various issues women face if they decide to have an abortion.
Experts and women’s rights advocates in Japan say that the nation’s abortion laws are problematic mostly on two counts: married women seeking an abortion need spousal consent, and the procedure used is unsafe and costly.
Is abortion legal in Japan?
Yes, albeit only under certain conditions. Under the Maternal Health Act, initially enacted in 1948 as the Eugenic Protection Act, abortion can be performed if the continuation of a pregnancy or the delivery of a baby will be harmful to the mother’s health for physical or economic reasons, if pregnancy endangers the child’s life or if they face serious impairment.
“Economic reasons” is defined by the health ministry as an instance in which childbirth would place a significant economic burden on the mother and her household, and damage the mother’s health.
Abortion can also be carried out when the fetus would not survive outside of the woman’s body, or when the pregnancy was caused by assault or intimidation.
But abortion must be carried out within 21 weeks of the first day of the last menstruation.
Also, married women seeking an abortion must obtain spousal consent. The only exceptions are when the spouse is dead, is unknown or cannot express an intention.
According to the Center for Reproductive Rights, a global organization seeking to ensure the protection of reproductive rights, Japan is among 10 countries and regions with this requirement.
While the health ministry has said the partner’s consent is not necessary for unmarried women and women who were impregnated by abusive partners or through rape, this policy is not well known. As such, doctors often demand a man’s signature for fear of getting into legal trouble, rights advocates say.
According to the health ministry, there were 145,340 abortions in 2020, down 7.3% from the previous year.
What methods are used in Japan?
With abortion pills still awaiting approval, a surgical procedure is still the most common method of terminating a pregnancy.
The cost of abortion is a big issue in Japan. Surgical abortions conducted in the first eight weeks of pregnancy costs around ¥100,000 ($740), while those performed beyond the 12th week can cost double that. The number of women who struggle to pay for the procedure has been on the rise since the pandemic started, according to the health ministry.
Abortion rights advocates say the high price of a surgical abortion — which is not covered by national health insurance, except in limited cases — has driven some women to seek other options, such as illegally importing abortion pills from overseas. Such practices can put a woman’s health at risk, experts say.
In contrast, a medical or surgical abortion in the first trimester in the U.S. costs about $550, but it could be triple the amount if the procedure is in the second trimester. Meanwhile, abortions in Britain are usually available free of charge under the country’s National Health Service.
Moreover, health experts question the safety of surgical procedures in Japan. The main method of choice of OB-GYN doctors in the country is dilatation and curettage, especially in cases less than 12 weeks into the pregnancy. A 2021 report by Kumi Tsukahara, an expert on reproductive rights associated with the Women’s Studies Association of Japan, pointed to a significantly higher rate of complications resulting from this method than when the vacuum aspiration method is used. The latter procedure, which is the main one used abroad, uses gentle suction to remove an embryo through the cervix.
In December, Britain’s LinePharma filed for approval of its oral abortion pills ー mifepristone and misoprostol ー with the health ministry. The medications, used in more than 70 countries, are considered a safe and affordable method of inducing an abortion in the early stages of pregnancy.
Is there an abortion debate in Japan?
Religious views have played a predominant role in the enactment of legislation concerning reproductive rights worldwide.
While not as high profile or politically charged as in other countries, Japan has had its own abortion debate. In the 1970s and 1980s, for example, religious groups and some members of the ruling Liberal Democratic Party tried to remove the “economic reason” clause from the Eugenic Protection Act, but their attempts failed due to resistance from women’s rights groups and opposition party members, according to a 1993 paper on the history of Japan’s abortion policy by Misako Iwamoto, then at Mie University.
Nonetheless, abortion continues to be stigmatized in society, as it is viewed as a woman’s sin or a sign of bad motherhood, or even equated with a mother’s killing of her baby.
“Usually in Japan, only women are held responsible for abortion,” Tsukahara explained in a 2014 paper that compared abortion methods and values among various countries.
“Therefore, abortion should be among the very critical problems targeted by efforts to end gender discrimination in this country, but this importance is rather unacknowledged among the Japanese people.”