Abortion in Japan is legal, but most women need their husband’s consent

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KUMAMOTO, Japan — The discreet path to a safe space for women with unwanted pregnancies is marked by an unassuming sign: two smiling storks, carrying a cloverleaf and a smiling baby in a basket.

Here, in Japan’s only “baby trap”, women can anonymously leave their babies at Jikei Hospital for adoption. It’s a last resort for those who can’t or won’t raise a baby, with some women coming from all over the country because they have nowhere and no one else to turn to.

As the United States Supreme Court is set to overturn a 1973 ruling that legalized abortion nationwide, reproductive care is in the spotlight, including in Japan, which enforces some of the strictest abortion restrictions among rich countries.

Japan is one of 11 countries — and the only one According to the Center for Reproductive Rights, an international organization, women must obtain consent from their spouse to have an abortion, with very few exceptions. In practice, say advocates, the requirement also often applies to single women and has led to rare and tragic cases of women leaving their babies to die in public places – what the hospital baby hatch Jikei is supposed to solve.

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Abortions are legal, but only through expensive surgeries. Contraceptive use is low. Morning after pills are expensive and only available by prescription. Japan is considering whether to make abortion pills available. The World Health Organization describes their use as a safe and non-invasive way to terminate a pregnancy.

But in a male-dominated country that consistently ranks at the bottom of developed economies when it comes to empowering and advancing women, Japan has been slow to provide reproductive options for women. For example, Japan only adopted the birth control pill in 1999, becoming the last industrialized country to do so after 44 years of debate. That same year, the Ministry of Health and Welfare approved Viagra in six months.

“Is Japan in the Middle Ages or what? Abortion is very expensive and access to hospitals is very difficult. This is why there is no end to the number of cases, year after year, of people giving birth to babies in toilets and then abandoning them or killing them,” said Mizuho Fukushima, a female politician from the social-democratic minority, during a commission. meeting last month. “What kind of country do we live in?”

In fiscal year 2018 alone, there were 28 cases of infanticide of children under the age of one. Seven of them were killed the day they were born, according to the Ministry of Health. So far this year, there have been at least six known cases of women abandoning newborn babies in public places.

The lack of options can have serious consequences for women like Yuriko, 26, who has seen her hopes for the future dashed by an unplanned child. She had been on the pill for about a month when she met her baby’s father and thought she was taking the right precautions. But a few months later, she found out she was six weeks pregnant.

She had planned to pursue higher education and was not ready to raise a child. But when she went to hospital in Hokkaido, northern Japan, where she lives, she was told she would have to wait two weeks for the procedure because her fetus was too small. In the meantime, she was told to get consent from the baby’s father, even though they weren’t married.

Between his morning sickness and his nerves, the hour and a half The flight to Tokyo to get her signature was particularly nauseating, said Yuriko, who spoke on the condition that only her first name be used out of concern for her family’s privacy.

“I felt really nervous about what could go wrong, worried that the father wouldn’t even show up when I arrived. I felt anxious about having to pay for an expensive plane ticket, with a piece of paper in my hand that I needed to get signed,” she said. “I feared the worst case: having to go home with the paper, without a signature.”

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By taking the pill, Yuriko was already among the minority of women in Japan who choose oral contraception instead of relying on the man to use a condom or withdraw.

Pill use has hovered around just 3% in recent years, according to a 2019 UN report on contraceptive use and estimates from the Japanese Family Planning Association. This low percentage has been attributed to a lack of awareness and education, as well as social stigma.

During those two weeks, she researched surgical abortion and it started to terrify her – and she changed her mind about having one. She also no longer plans to go to graduate school. She thinks daily about her decision and the limited options she faced in those chaotic early days as she struggled to process the news.

“I wake up every morning thinking about the abortion and what could have been different,” said Yuriko, who is due to give birth next month. “If less invasive means like abortion pills were available like they are in other countries, I think I could have done that.”

Morning-after pills, emergency contraceptives taken within 72 hours of unprotected sex, exist in Japan, but they are expensive and only available by prescription, meaning women risk pregnancy when they cannot. not see a doctor in time.

Although Japan is now considering medical abortion pills, which are on the rise globally and have been available for decades in many parts of the world, health officials said they still plan to require the spousal consent for them, and they should cost around $740.

“The law does not prevent women from having abortions. But when it comes to that consent, sometimes women can’t get it, and women can’t get the abortion in the end,” said Kazuko Fukuda, a reproductive rights activist who leads the project. Nandenaino (Why don’t we have it?), a contraceptive advocacy organization.

Under the Maternal Protection Act 1948, women had to obtain written consent from their husbands to terminate their pregnancy. In 2013, the Department of Health clarified that it did not apply to unmarried couples, and last year it exempted married women who can prove their marriage was essentially ended due to domestic violence or for other reasons.

But as in Yuriko’s case, many hospitals apply the requirement to single women anyway. The Health Ministry notice is not legally binding and allows clinics to create their own practices and rates for providing abortions, said Kumi Tsukahara, founding member of Action for Safe Abortion Japan, an advocacy group for reproductive health.

“There has been a lot of talk about abortion and reproductive rights as human rights at the UN, as well as how the rights of a fetus cannot come before the rights of women,” said Tsukahara. “I hope that in Japan and the United States, watching these discussions, more people can understand this.”

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The other 10 countries that require spousal consent are Syria, Yemen, Saudi Arabia, Kuwait, Equatorial Guinea, United Arab Emirates, Taiwan, Indonesia, Turkey and Morocco, according to the Center for Reproductive Rights. The UN Committee on the Elimination of Discrimination against Women has called on Japan to remove the consent requirement for abortions. In 2020, South Korea scrapped its spousal consent requirement, but campaigners say some doctors still ask for it.

The Japanese Society of Obstetrics and Gynecology declined to comment for this report, and the Japanese Association of Obstetrics and Gynecology did not respond to a request for comment.

In recent years, some politicians have questioned whether women should even have access to abortion – or whether it matters – given the country’s declining population and low birth rate.

Proponents, however, argue that women’s reproductive and sexual health is something entirely separate from the nation’s demographic needs and view it as part of achieving broader gender equality in a patriarchal society with entrenched gender roles.

“When I go to see politicians to talk about [reproductive rights], they sometimes ask me: ‘Why are you talking about contraceptives when we have so few babies?’ It’s not about that. But still, I think things about reproduction are always thought of in the context of national profit, instead of women’s choice,” said Fukuda, the activist. “The discussion really should be about creating a societal system that can support these women more and de-stigmatize women’s access to abortion.”

Meanwhile, Jikei Hospital in Kumamoto, a prefecture in southern Japan, has become one of the few safe havens for women with unwanted pregnancies. The baby hatch first opened in 2007 and has been a rare and controversial option ever since. So far, 161 women have left their children here, an average of almost one per month.

There were around 140,000 surgical abortions in 2020, according to the Ministry of Health. They cost between $740 and $3,000 and have become a profitable business for abortion providers, said Takeshi Hasuda, director of Jikei Hospital.

Jikei Hospital also provides counseling for women who sometimes end up going home with their babies once they hear about government support, such as social benefits, he said. To help single mothers, the hospital also started confidential deliveries in December and has since delivered three babies without recording the mother’s name.

“People trying to get abortions are often ashamed, so they feel like they’re not able to really claim rights, whether it’s to reduce the cost or other accessibility,” he said. . “And since these people don’t really raise their voices, it’s hard for such topics to become real talking points like in the United States”

Even though Japan is not a particularly religious country, he said, it has a strong sense of social responsibility, which has spilled over into the abortion debate and feelings of shame among women. who are considering the procedure.

From time to time, the nurses meet the women who leave their babies. They find that women struggle with finances, have ethical questions about terminating a pregnancy, or worry about being re-traumatized after the stress of a previous abortion, he said.

“There are many in Japan who are pregnant and isolated, unable to receive help from anyone around them, fearing that others will find out about their pregnancy. For these people, in particular, we are their last resort,” Hasuda said.

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