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Tuesday, Oct. 20, 2009
ABORTION AND THE PILL
Abortion still key birth control
By MARIKO KATO
People may be surprised to know abortion has been legal in Japan since 1949, more than a decade earlier than in other industrialized countries.
In subsequent years, abortion became socially accepted to the point that Japan drew international criticism for attracting foreigners seeking to terminate their pregnancies. Since the turn of the 21st century, around 300,000 abortions have been conducted in Japan each year.
Some commentators call Japan's approach to abortion contradictory, comparing it with the belated legalization of the pill, one of the few birth control methods that women can initiate that has a high success rate. This year marks the 10th anniversary of the introduction of the pill in Japan, and yet the majority of Japanese prefer using condoms, citing the drug's expense and side effects.
So what is the history of abortion and the pill in Japan, and what are the current issues regarding birth control? Here are some questions and answers:
How many abortions are performed in Japan every year?
There were about 256,000 abortions in 2007, or 9.3 per 1,000 women aged 15 to 49, the lowest figure so far, according to the Health, Labor and Welfare Ministry. The number had been decreasing steadily since the 1950s, when there were between 40 and 50 abortions per 1,000 women of child-bearing age.
One of the main reasons for this trend is the increasing use of the pill, according to a health ministry report on abortion.
The most oft-cited reason for terminating a pregnancy is that the couple are not married, accounting for 28 percent of the 122 women with experience of abortion who were surveyed for the report last year. Financial difficulties came second, with 16 percent.
Roughly 95 percent of abortions in Japan in 2007 took place in the first 11 weeks of pregnancy, and nearly 8 percent were conducted on women under age 20.
The 20-24 age bracket had the greatest number of abortions, at 62,500, while 18,600 abortions were performed on women above 40 years old.
Looking at other industrialized nations, there were 19.4 abortions per 1,000 women aged 15 to 44 in the United States in 2005, according to the think tank Guttmacher Institute, while in England and Wales there were 18.2 per 1,000 women in that age group last year, according to the British government.
How many women take the pill, and what other contraceptives are common?
Condoms are preferred by nearly 80 percent of married women in Japan, according to a survey conducted by the health ministry last year. Only 2.2 percent of women take the pill, while 16.7 percent prefer their male partner to ejaculate externally and 3.6 percent opt for the rhythm method.
Negligible numbers use other methods common abroad, including the intrauterine device or spermicide.
But use of the pill is on the rise. According to a report by the OC Information Center, operated by a group of firms that manufacture the drug, 657,000 women are now using the pill, three times as many as in 2001.
The percentage of Japanese women who take the oral contraceptive is still minimal compared with those in the West, where it is one of the most common forms of birth control.
According to a 2007 report by the U.N. on the types of contraception used by females aged 15 to 49 who are formally or de facto married, 18 percent of those in the U.S. use the pill, while the number is 44 percent in France and 52 percent in Germany.
What historic debates are there regarding abortion in Japan?
Abortion was criminalized in 1880 under the first penal code. Japan had a high birthrate at the time and infanticide was not uncommon.
But after World War II, overpopulation was considered a threat to economic progress in light of the postwar baby boom, and abortion was effectively legalized in 1948 under the Eugenic Protection Law. The government also accepted other contraceptives, including the diaphragm, condoms and spermicide. Previously they were mainly considered ways to prevent sexually transmitted diseases, writes Yasuko Tama in the book "Bosei Ai to iu Seido" ("The System Called Maternal Love").
Other reasons for legalization included concerns over back-alley abortions and pressure from doctors who saw abortion as a lucrative source of income.
Under the law, a woman qualified for abortion if she or her partner had a hereditary physical or mental illness or a nonhereditary mental illness. She was also eligible if she had been raped, if childbirth would seriously harm her health, or if she could not afford to raise the child.
The law was revised in 1996 to take out the eugenic component under pressure from advocates for the disabled, and was re-named the Maternal Protection Law.
Abortions may only be performed by a designated doctor who must obtain written consent from the woman and her partner, although in practice the partner's consent is not always available. Usually, only women who are less than 22 weeks pregnant are eligible.
Japan's abortion policy came under fire from other countries in the 1950s and 60s, damaging its reputation at a time when the nation wanted to join the ranks of other developed nations after the war. Whereas abortions were a religious taboo in the West, the practice had no similar constraints here.
"The number of tourists coming to Japan for abortions from other industrialized countries, such as the U.K, the U.S. and France, where abortion was strictly restricted, drew criticism as (Japan had been coined) an abortion paradise," Tama writes.
However, there was some resistance domestically from prolife groups and people who feared that the availability of abortion encouraged irresponsible sex and a deterioration of morals.
What about the pill?
By the time Japan introduced the pill in 1999, it had been the only U.N. member not to approve the contraceptive.
The health ministry was discouraged from legalizing the pill in the 1960s due to pressure from abortion doctors with vested interests, who also expressed concerns over prescription drug abuse and side effects. In 1989, the ministry's pharmaceutical advisory council began deliberating on the drug, but legalization was postponed for a number of reasons, including fear of decline in condom use amid growing numbers of HIV patients.
The government finally legalized the pill in 1999 because of its quick acceptance of the erectile dysfunction drug Viagra earlier that year based on foreign clinical data, observers say. Women's groups and some media reports criticized this as hypocritical, since the government had been debating the health risks of the pill even though it was considered safe abroad.
All contraceptive pills available in Japan are low-dose, according to the Clinic of Japan Family Planning Association, meaning the amount of hormones, and side effects, are kept to minimum levels. The pill is prescribed by an obstetrician, and costs around ¥3,000 a month.
It is not covered by health insurance, and there are extra expenses for initial health tests and regular checkups.
Why were individuals in Japan unenthusiastic about the pill?
The reason lies partly in the availability of abortion, writes Ayako Matsumoto in her book, "Piru wa naze Kangei sarenainoka" ("Why the Pill is not Welcomed").
When the pill became available in many parts of the West in the 1960s, abortion was still illegal there, so the pill symbolized the liberation of women as it was a reliable form of contraception that they could control. In comparison, the drug drew criticism in Japan from women themselves who said it burdens them with physical and emotional stress while men escape the responsibility of using contraception, Matsumoto said.
Some also insisted the pill could not be compared with Viagra, saying that medicine like Viagra is used to cure a disorder, whereas the pill distorts the natural patterns of a healthy body.
What are some of the current issues surrounding abortion and the pill?
Observers say the number of abortions among young people could be reduced if information on the pill became more widespread.
There is also concern that the drug's side effects are often misunderstood and exaggerated, and that the expense and regular examinations discourage women.
Even among those who take the pill, 60 percent are worried about side effects and 18 percent are concerned about the cost, according to the OC Information Center.