‘We need to change’: Japan’s morning-after pill debate

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Tokyo (AFP) – When Megumi Ota needed the morning after pill in Japan, she was unable to get a prescription in time due to a policy campaigners call an attempt to “police” women’s reproductive rights.

“I wanted to take some but I couldn’t for a weekend”, when most clinics are closed, she explained to AFP.

Unable to get a date within 72 hours of sex when the drug is most effective, “I just had to leave it to chance and got pregnant.”

Emergency contraception cannot be purchased without a doctor’s approval in Japan and is not covered by public health insurance, so it can cost up to $150.

It is also the only drug that must be taken in front of a pharmacist to prevent it from being sold on the black market.

Abortion rights are equally restrictive, campaigners say, with consent required from a male partner, and surgery the only option as abortion pills are not yet legal.

A government panel was formed in October to study whether the morning after pill should be sold without a prescription, like in North America, most EU countries and some Asian countries.

Japan has world-class medical care, but is ranked 120th out of 156 countries in the World Economic Forum’s Gender Gap Index, which measures health among other categories. Philippe FONGAFP

But gynecologists have raised concerns that it could increase the spread of disease by encouraging casual, unprotected sex.

Ota decided to terminate her pregnancy after her partner, who had refused to use condoms, reacted coldly to the news.

“I just felt helpless,” said the 43-year-old, who was 36 at the time and now runs a sexual trauma support group.

Japan has world-class medical care, but is ranked 120th out of 156 countries in the World Economic Forum’s Gender Gap Index, which measures health among other categories.

“In the Japanese system, there is a perception that women can abuse what they have and do something wrong,” said reproductive rights advocate Asuka Someya.

“There is a strong paternalistic tendency in the medical world. They want to keep women under their control.”

Limited choices

The debate comes with reproductive rights in the global spotlight.

In the United States, the Supreme Court appears set to overturn a 1973 ruling guaranteeing abortion access nationwide, while Poland enacted a near-total ban on pregnancy terminations less than a month ago. two years.

An estimated 610,000 unplanned pregnancies occur each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo.

Abortion has been legal since 1948 and is available up to 22 weeks, but consent is required from the spouse or partner. Exceptions are only granted in cases of rape or domestic violence, or if the partner is dead or missing.

Last year, a British pharmaceutical company asked Japanese health authorities for approval of its abortion pill, which can be used in early pregnancy.

Reproductive rights lawyer Asuka Someya says Japan's approach needs to change
Reproductive rights lawyer Asuka Someya says Japan’s approach needs to change Philippe FONGAFP

But until a decision is made, those requesting a termination must undergo an operation to remove tissue from the uterus with a metal or plastic instrument.

The procedure costs around 100,000 to 200,000 yen ($800 to $1,500), with later abortions sometimes even more expensive.

Someya, who had an abortion as a student, said she was “terrified” and wished she could “choose more comfortably between different options”.

“I was told of the risk that the operation would leave me sterile, but I thought I would be guilty,” said the 36-year-old, who now sees abortion as medical care that women deserve to have access.

Contraceptive choices are also limited in Japan, where condoms are by far the preferred method and alternatives are rarely discussed openly.

Birth control pills were approved in 1999, after decades of government deliberation – compared to just six months for Viagra.

These days, they are used by only 2.9% of women of childbearing age, compared to a third in France and almost 20% in Thailand, according to a 2019 UN report.

Meanwhile, IUDs, which sit inside the womb to prevent pregnancy, are used by 0.4% while implants and injections are not available at all.

– ‘It must change’ –

Gynecologist Sakiko Enmi, a leading member of the campaign for better access to the morning after pill, said the government should not drag its feet.

Levonorgestrel, a drug used in emergency contraception to delay or prevent ovulation, has been legal in Japan for more than a decade.

But “it doesn’t reach those who really need it, due to poor accessibility and price,” Enmi said.

Women can see a doctor online, but still have to take the morning after pill in front of a pharmacist – the only Japanese medicine that has this requirement as standard, according to the Tokyo Pharmaceutical Association.

An estimated 610,000 unplanned pregnancies occur each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo.
An estimated 610,000 unplanned pregnancies occur each year in Japan, according to a 2019 survey by Bayer and the University of Tokyo. Philippe FONGAFP

A previous government panel rejected making emergency contraception available over-the-counter in 2017, and many doctors remain opposed to the change.

In October, a survey by the Japanese Association of Obstetricians and Gynecologists found that 40% of its members were against the proposal.

Overall, 92% said they had concerns, with the report saying “this country needs to improve sex education before it considers making the emergency contraceptive pill available over the counter.”

Enmi, however, is adamant about what needs to happen.

“We have to change,” she said. “Women should be allowed to make decisions for themselves.”

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