Japanese Women Now

Reproductive Health/Rights:
The Present Situation of Japan and Its Problems

By ASHINO, Yuriko
Deputy Executive Director, Family Planning Federation of Japan

Since the International Conference on Population and Development (1994, Cairo Egypt), the words "reproductive health / rights (RH/R)" have been gaining recognition in Japan although slowly. These words now appear even in the government's official documents. However, the true meanings of these words have not yet gained sufficient understanding of the public. Therefore, it is a priority need in Japan to raise public awareness of the concept of "reproductive health / rights" in order to achieve better RH/R of Japanese women.

Reproductive health / rights implies the concept that all couples and individuals, particularly women, have the basic human right to decide freely and responsibly the number and spacing of their children, and the right to have the information, education and means to do so. Reproductive health / rights also covers a wide range of sexual and reproductive health issues throughout one's lifecycle such as infertility, sexually-transmitted infections (STIs), HIV/AIDS, gender-based violence, commercial sex, cervical cancers and other so-called women's diseases, and harmful traditional practices including FGM(female genital mutilation). The Japanese government, however, has long been focusing primarily on maternal and child health, lacking the lifecycle approach. In recent years the government has been putting a great deal of effort into measures aimed at the increase in the birth rate, as the aging of the society with the decrease of fertility continues.

Due to the limited space, this paper will only present an overview of the present situation and problems of reproductive health / rights in Japan, focusing on fertility control.

Contraception

There had long been only limited options available for contraception in Japan. The oral contraceptive pill had not been approved for a long time, for it was considered to cause not only side effects and acceleration of sexually transmitted infections (STIs), but also deterioration of women's sexual morality. Behind it may have also been a worry about decreasing birth rate. It was in 1999 the low dosage oral pill was finally approved. In the same year, the copper-bearing IUD (intra-uterine device) and the female condom were also approved, but 80% of contraception remains the use of condoms, followed by withdrawal (Table 1). Insufficient information keeps many women away from using the oral pill as they have long been taught that it was a dangerous drug. Another cause for low prevalence of the oral pill is that doctor's prescription is required. Many women still hesitate to see a doctor for gynecological problems. Financial burden is another hindering factor. Not only the pill but also all the contraceptive methods are not covered by the national health insurance system, so that users must cover expenses individually. This implies that the government does not consider contraception as an important health issue.

Sex education is not enough to teach the importance of gender equality and self-determination either at home or at school. . Besides, there are few institutions such as family planning clinics and women's clinics, which we can visit for information, counseling, and services. In order to meet the need for reproductive health/rights, it is essential to improve both sex education and to enrich facilities to make information, counseling, and services easily available to all individuals . In recent years, some doctors started to provide services of emergency contraception.

Table 1 Distribution of Contraceptive Methods Used in Japan, 2000

Note. Target, married women. Multiple answer.
From The 25th National Survey on Family Planning (Mainichi Newspaper, 2000)

Abortion

There are many cases in Japan where women get pregnant against their wills due to inadequate sexual / reproductive education and contraceptive services or due to gender-based power relation between men and women. 340,000 abortions were reported to have been performed in 2000 (Table 2), and the abortion rate (per 1000 women) was 11.7 (the actual number is estimated to be slightly higher than the reported number). The number of abortions is generally decreasing, but it is on the increase among women in their teens and twenties (Figure 1). In the background of this tendency is the fact that young people including adolescent boys and girls have become more sexually active in the Japanese society, while the prospering sex industry and a flood of sex information are widely available. Furthermore, the increasing ratio of unmarried people in their twenties also contributes this trend, because the percentage of children born out of marriage remains no more than 1 % in Japan. According to the survey conducted by the Mainichi Newspaper, about one third of married women have had an abortion. An abortion performed in the first trimester of pregnancy and in the second trimester respectively costs about 80,000-100,000 yen (USD 620-770) and about 400,000 yen (USD 3,080). It is a heavy financial burden for women as abortion is not covered by the national health insurance, either. Assistance with public funding is strongly sought for not only contraception but abortion.

From the legal point of view, an abortion is illegal and a crime regardless of reason under the Criminal Abortion Law (1907- ), whereby both the woman and the doctor are to be punished. The Eugenic Protection Law enacted in 1948 legalized abortions conditionally, and the criminal law was made virtually ineffective ever since. The Eugenic Protection Law was partly amended in 1996 to delete the eugenics sentences and clauses. Presently, it is called the Law for Protection of Mothers' Bodies. After the amendment of the law, medical and economic reasons or pregnancy by rape have become major conditions for legitimating an abortion. Other necessary conditions include doctor's authorization, husband's consent. The upper time limit is less than 22 weeks of gestation. The age or marital status of the woman is not considered.

Because of a guilty conscience, not a few women do Mizuko kuyo or memorial rites for aborted fetuses. Mizuko literally means a 'water child', now referring mainly to aborted fetuses. Mizuko kuyo brings about a large income to temples that specialize in the memorial rites. Although not many, there are also anti-abortion groups in Japan that carry out a campaign as distributing anti-abortion videos in schools. Some parliamentarians have been involved in the campaign. Presently, however, the power of anti-abortionparliamentarians in the Diet seems not so strong as before.

In March 2000, an organization of designated gynecologists who are permitted to perform abortion services publicized a proposed amendment to the Law for the Protection of Mothers' Bodies, including legalization of partial reduction of multiple pregnancies (an operation to terminate a part of multiple pregnancies). This proposal, however, is far from sufficient from the viewpoint of guaranteeing women's reproductive health / rights. A voice has been raised by women's health activists, calling for scrapping both the Law for Protection of Mothers' Bodies and the Criminal Abortion Law, then enacting a new law concerning contraception and abortions.

Table 2 Abortion and Abortion Rate by Age Group, 2000

Note. From 2000 Statistical Report on Maternal Protection, Ministry of Health and Welfare, 2001.

Figure 1 Abortion Rate by Age Group (per 1000)

Note. From 2000 Report on Maternal Protection, Ministry of Health and Welfare, 2001.

An environment discouraging women to have children

Statistics show that the desired numbers of children of the Japanese couples are slightly higher than the actual numbers. The biggest reason why they do not have as many children as they wish is the financial burden of bringing up children, including high educational expenses. Other popular reasons include mental and physical burden on women in raising children, and incompatibility of work and childcare responsibilities. Despite the Japanese government's advocacy for the gender-equal society, the traditional gender role of "men work, while women do housekeeping" is still persistent even in the present society, although women are now forming about 40% of workforce. In 1991 the law was enacted so that parents could take a childcare leave, however, the percentage of men who have taken the leave is less than 1%. The government is required to take more positive measures to enable couples to have a job and raise children at the same time, such as improving nurseries and guaranteeing both women and men to take leaves on occasion of children's illness. The government should also make more efforts to promote understanding / behavioral change of people towards gender-free society.

Advanced reproductive technologies

There currently is no law in Japan that regulates the use of advanced reproductive technologies. Approximately 50,000 children have been born with the technology of in vitro fertilization. It was also reported that a woman gave a birth to a child as a surrogate mother for her infertile sister. Prenatal diagnoses, are also becoming popular. The Japan Ob/Gyn Society conditionally approved the gene diagnosis of fertilized ovum before implantation. Activists for the rights of people with disabilities and women's health activists have voiced that prenatal diagnoses could lead to selection of lives, strengthening the idea of eugenics in the society, which may aggravate discrimination against the people with disabilities. The advanced reproductive technology involves various bio-ethical problems such as the use of women's bodies as a child-bearing tool, selection of lives, who are (is) the parent(s) of a child, and the child's right to know her/his real parent(s). The government is placing an increasing emphasis on infertility treatment, which is apparently part of the countermeasures against low fertility

In a climate in which there is a persistent view that an infertile woman is imperfect as a woman, advanced reproductive technologies often enhance a sense of deficiency of infertile women even more. It is reported that the government is to enact a law concerning advanced reproductive technologies in the foreseeable future. It is considered necessary to enact such a law after careful deliberation, but what is also important is to make our society free from discrimination against infertility.

Sexually transmitted infections (STIs) and HIV/AIDS

In recent years high-risk sexual behavior has been causing an increase of sexually transmitted infections (STIs) prevalence, including chlamydia and others, especially among the youth in Japan. The officially reported number of people living with HIV/AIDS has not been so large, but rapid and serious (delete)increases of STIs indicate that HIV/AIDS might be spreading far more widely than reported. The government is required to put a great deal of effort into educating the general public of prevention of STIs and HIV/AIDS, improving medical treatment systems for HIV/AIDS as well as eliminating discrimination against people living with HIV/AIDS.

ASHINO, Yuriko:Deputy Executive Director, Family Planning Federation of Japan; engages in promotion of family planning and reproductive health/rights from the viewpoint of women's human rights; awarded an educational prize of the 1994 Avon Woman of the Year Prize; and participated in feminist movement aiming at establishing a new law for contraception and abortion; and author or co-author of many books, such as The Future of a Population Crisis (Iwanami Junior Shinsho, 1996), Reproductive Health/Rights (Medica-shuppan, 1999), and Health and Gender (Akashi-shoten, 2000).

Family Planning Federation of Japan: A private organization founded in 1954; its basic idea is that the individual decision to have or not to have a child is part of fundamental human rights; with family planning as the main concern, it carries out activities such as advocacy of reproductive health/rights, training of family planning workers, and lobbying; and a Japanese member of the International Planned Parenthood Federation.

Related Links
Karada to sei no horitsu wo kangaeru onna no kai (Women's Group to Enact a New Law concerning Contraception and Abortion )
*Japanese text only

Sei to kenkou wo kangaeru josei senmonka no kai (Women’s Coalition for Sexuality and Health All)
*Japanese text only

Finrrage no kai (Finrrage: Self help group for infertily)
*Japanese text only

Pureisu tokyo (Place Tokyo: Gay Friends for AIDS)
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WOM has been working on the initiative Japanese Women Now in order to provide information about contemporary legal/social environment surrounding Japanese women. It is our hope that information on this page help readers gain further understandings on gender issues in Japan.

Authors of articles contributed to this initiative are active and knowledgeable members of the respective fields of selected topics. The contents are based on the fact available as of late 2001, when these articles were written. The original Japanese articles are also available on our Japanese Home Page.

Topics selected in this initiative are: Domestic Violence, Compulsory Selection of a Family Name for a Married Couple, Elderly Care and Women, Women and Work, Sexual Harassment in Working Place, Sexual Harassment on Campus, Equal Employment Opportunity Law, Single Mothering, Child Abuse, Women and Medical Care, and Reproductive Health/Rights. ===＞GO to Index

This initiative was made possible by the grant from Asian Women's Fund.