August 2022 | Japan Media Watch

Japanese access to abortion is limited by disinformation and lack of sex education

Artwork by Julio Shiiki (sky image: Unsplash Jeremy Bezanger)

On June 24, the U.S. Supreme Court overturned its 1973 decision that said the Constituion guaranteed a woman's right to an abortion. A majority of the current justices found that the Constitution confers no such right and therefore each state can decide for itself whether abortion is legal within its borders. The reversal has since reverberated internationally, with many countries saying that abortion is a health issue and, as a result, should be available to any woman who wishes to undergo the procedure. In Japan, abortion is widely available, but, technically at least, it has been illegal for 110 years due to the Abortion Crime Law, which has never been repealed.

After World War II, the government changed the Eugenics Law to the Maternal Body Protection Law, which allowed for abortions under certain conditions, one of which is a pregnancy that is deemed harmful to the mother. Another condition is if the mother is financially incapable of raising the child.

The vast majority of abortions in Japan – the health ministry reported about 140,000 in 2020 – are likely allowed under this economic dispensation, but it's not clear how rigorous abortion providers are in checking the financial situations of their patients or, in fact, if they check at all.

There is a certain irony here, since abortion is not covered by national insurance, so women who undergo the procedure have to pay the full amount, which can be anywhere from ¥100,000 to ¥500,000, depending on how far along the pregnancy is, who the provider is, and what other services the provider offers or advises. In addition to medical charges, there are other costs, such as filing death reports if the fetus is older than 11 weeks, and cremation. 

This lack of legal clarity makes for a precarious situation. On March 16, Japanese Communist Party lawmaker Taku Yamazoe questioned several government officials about abortion in a House of Councilors Legal Committee meeting. Noting that no one had been prosecuted in recent memory for having an abortion under the Abortion Crime Law, he asked Justice Minister Yoshihisa Furukawa why such a law was still on the books at a time when women's autonomy has supposedly been guaranteed. Furukawa answered that the purpose of the law was to safeguard the life of a fetus and therefore it was inappropriate to abolish it. Yamazoe later remarked that the Maternal Body Health Law states that for an abortion to be performed, the woman's “spouse” must consent to it. A health ministry official told Yamazoe that this condition was a holdover from the old Eugenics Law, which also allowed abortion under certain circumstances. Yamazoe then asked if it wasn't “strange” that a woman who decides by herself to terminate her pregnancy can be punished under the law, but as long as a man grants his permission, it is allowed. In response, the official said only that in order to change the law there should be “discussions among a wide range of people”.

As Yamazoe pointed out, if the spouse cannot be contacted, then consent can be waived. However, few people, including abortion providers themselves, seem to know this. He cited the example of a 24-year-old unmarried student in Aichi Prefecture who attempted to have an abortion at two clinics but was told by both that she needed the consent of the father. The father had said he would sign the consent form, but disappeared before doing so. The woman was unable to contact him. After her child died after she gave birth in a public toilet, the woman was arrested and sentenced to three years in prison, suspended for five years. Yamazoe wanted to know why the government had not publicized to gynecologists that the consent requirement could be waived. According to a recent article in The Washington Post, the health ministry itself said in 2013 that the consent provision does not apply to unmarried couples, and in 2021 they said it could be waived for married women due to domestic violence or other factors that have effectively ended their marriages.

Spousal consent was among the topics discussed by Kumi Tsukahara, a lecturer at Kanazawa University, and Kazane Kajiya, a reproductive health rights activist, during a press conference at the FCCJ in June. As representatives of Action for Safe Abortion Japan, they wanted to focus on abortion restrictions in Japan in the wake of the U.S. Supreme Court decision. Kajiya said that in a survey she recently carried out among women who had sought abortions, 80% said they had been told they had to get written consent from a spouse or partner, while 30%  said they had given birth because they did not get consent. Some of these women said they had been the victims of sexual violence. 

Tsukahara and Kajiya advocate for more widespread use of the so-called abortion pill, which, according to reports, will be legalized in Japan by the end of the year. However, the high cost of the pill in Japan and the fact that spousal consent will also be necessary to obtain it will make it difficult to access. According to Tsukahara, the Japan Society of Obstetrics and Gynecology wants to ensure the livelihoods of its members, who provide surgical abortions and set whatever price they want. This is also why the prescription-only “morning-after pill”, an oral contraceptive that must be taken within 72 hours of sexual intercourse to be effective, is expensive and difficult to obtain.

To justify these restrictions, the government, which has close ties to the gynecology society, and the media keep up a steady flow of disinformation about what they say are health problems associated with medications related to reproductive health. The World Health Organization, on the other hand, classifies them as “essential” medications, meaning they should be available to all.

Another way the government limits reproductive rights, according to Tsukahara, is by discouraging sex education in schools. The centrality of sex education to the issue of abortion access was the subject of a June 20 article in Toyo Keizai Online. The author, novelist and researcher Mari Ako, says that the spousal consent requirement for abortion should be eliminated, since it effectively places the decision to terminate a pregnancy in the hands of men. When she asked the ministry about this, she was told that such changes can only be made after evaluating the public’s understanding. But Ako argues that before the public can have an informed opinion about women's reproductive rights, they have to have a firm knowledge of sex and reproduction. 

In the Gender Equality Plan outlined by the government in 2000, reproductive health is cited as a “basic right for women,” but there is little general knowledge about those rights because sex education is not really taught in Japanese schools. Ako interviewed sex education instructor Noriko Higami, who lectures on a freelance basis at the request of junior high schools and other educational institutions. When she talks about abortion, she doesn't frame it as being good or bad, but simply explains the process to students, including what rights they have. But before talking about abortion, she says, she needs to explain sexual intercourse and pregnancy, and many schools balk at having these matters discussed with children in a clinical manner. She says many educators think it best to delay talking about intercourse and pregnancy until high school, but by then it's too late. Students are already thinking about sex, but their knowledge has been informed by the media and the internet, and is therefore incomplete and often wrong. 

Higami said she had once given a lecture at a university about sexual health attended by about 400 students. She surveyed them and discovered that most had never taken a sex education class or course. She believes the possibility of unwanted pregnancy and contracting sexually transmitted diseases is higher among young people whose knowledge of the sexual act and contraception comes from friends and the media. That's why they must learn about these matters as early as possible. Of the students who attended her lecture, less than 20% even knew what an abortion was and what it entailed. 

The politician who has been the most vocal about limiting sex education in public schools is Toshiaki Koga, a Liberal Democratic Party member of the Tokyo assembly who, in 2003, attacked a school for students with special needs that was teaching sex education using visual aids and explicit terminology. The purpose of the class was to prevent the school’s adolescent students, many of whom had learning disabilities, from falling into problematic sexual situations.

The class was cancelled, but the school sued Tokyo Prefecture and the Sankei Shimbun newspaper for characterizing it as “obscene”. The school won its case, but that didn't stop Koga from complaining publicly in 2018 about a junior high school in Adachi Ward for conducting a survey asking students their opinions about sex, the purpose of which was to determine if contraceptive use should be taught in special health science classes. Koga specifically objected to the use of terms like “sexual intercourse,” “contraception,” and “artificially induced pregnancy interruption”. School officials replied that they wanted to prevent unwanted pregnancies. Adachi is one of the poorest wards in Tokyo and unplanned pregnancies contribute to the cycle of poverty. According to a health ministry survey conducted ten years ago, 25% of all brides in Japan are pregnant on the day they register their marriage. Among brides between the ages of 15 and 19, the proportion rises to 80%, and to 60% for those between 20 and 24. Moreover, the divorce rate among couples who marry when the woman is under 20 is 80%. The lack of proper sex education in schools is not just a factor behind the rise in unplanned pregnancies. In the wake of the #MeToo movement, fundamental knowledge about sex is essential for young people to understand the concept of mutual consent in sexual relationships.

In the World Economic Forum's latest Global Gender Gap Report, published last month, Japan dropped to 116th place among 146 countries studied. In an essay published on July 15 in The Asahi Shimbun's Koron column, reproductive rights advocate Asuka Someya wrote that the report's findings with regard to Japan's performance in terms of women's health were, in fact, too generous, and pointed to the difficulty in obtaining the morning-after pill to illustrate her point. “If you're a woman born in Japan,” she says, “you're at a serious disadvantage compared to women in many other countries.” She also blames the lack of sex education in Japan, but thinks that it must be taught in conjunction with making birth control accessible to students. She was once invited to a study session held by the health ministry to discuss the availability of the morning-after pill, but most of the participants were men, either “experts” or executives of pharmaceutical companies. It is this kind of “organizational discrimination” that has prevented women in Japan from gaining full reproductive rights. After all, it took 30 years for the government to approve the use of the low-dose birth control pill, but only six months to approve Viagra. The spousal consent condition, which places the decision on whether to perform an abortion in the hands of men, remains part of the law. Women are still waiting for permission to make decisions about their own bodies.

Philip Brasor is a Tokyo-based writer who covers entertainment, the Japanese media, and money issues. He writes the Japan Media Watch column for The Number 1 Shimbun.