Japan must provide safer and more accessible abortion

According to a survey, about 150,000 induced abortions are performed annually (about 400 abortions per day) in Japan. Although there are a few methods, depending on the pregnancy duration, abortion in Japan mostly involves sharp curettage. This method, which uses sharp metal curettes to scrape the walls of the uterus, is also used for miscarriages where the fetal heartbeat has stopped. While miscarriages are covered by health insurance, most abortion procedures cost between 100,000 to 200,000 yen at one’s own expense, which is more than half of the average monthly income of people in their 20’s. This has been a standard in Japan, however, it is far from the international standard.

How far is it from the international standard?

As reported by the WHO in 2012, vacuum aspiration and medical abortion are recommended as safe abortions. The WHO insists that sharp curettage is unsafe and should be replaced by vacuum aspiration or medical abortion. Even if the provider is trained, sharp curettage has higher risks of complications such as uterine perforation and infertility. Vacuum aspiration was approved in Japan in 2015, but it is still not widespread.

Even though abortion pills, which started spreading in 1988, are approved in 77 countries and have been selected as essential medicines by the WHO, they are still undergoing clinical trials in Japan. Strangely, one of the recommended abortion pills called misoprostol, is approved in Japan, but it is only permitted to be used for gastric and duodenal ulcers.

Additionally, while the recommended drugs for abortion or miscarriage cost about 740 yen overseas, there have been reports about the possibility that the pills may cost the same as a surgical treatment once approved in Japan due to hospital management.

Some patients are unable to afford an abortion financially. There have also been cases where unmarried patients have been unable to have an abortion due to doctors requiring consent from the partner, despite it not being legally required. Therefore, there have been cases where newborns have been abandoned.

Why are outdated methods still mainstream in Japan?

These issues may be related to stigma, stereotypes and a lack of understanding for sexual reproductive health and rights, as well as hospital management. With the deep-rooted idea that abortion is immoral and the view that it is the same as “killing” newborns, patients are frequently criticized regardless of their reasons for induced abortions. This idea also contributes to a lack of mental and physical care for patients after undergoing an abortion. As another example, some people argue that approving abortion pills at a reasonable price would promote disrespect for one’s life. Moreover, some fear sexual promiscuity as well as the risk of side effects.

To achieve safer and more accessible abortions, understanding and raising voices against these situations is necessary. Japan’s poor sex education, which is one of the causes of these stigmas and stereotypes, should also be improved. This is an essential process to achieve women’s wellness in Japan.