Issue:
May 2026 | Japan Media Review
In its rush to raise the birth rate, Japan’s government is ignoring women’s sexual and reproductive rights
During her February policy speech in the Diet, Prime Minister Sanae Takaichi talked about a government scheme to promote "preconception care" for women who were planning to have children someday. According to the Asahi Shimbun, the purpose of the scheme is to provide these women with "correct information about reproduction and maternal health in order to promote preconception care." Preconception care itself is defined as "health management prior to becoming pregnant".
The main aim of Japan's approach to maternal health in recent years has been to increase the birth rate, which for several decades has been lower than it needs to be to maintain the country's population. The idea of preconception care narrows the notion of maternal health down to health management for women who are not yet pregnant but thinking about having children. Preconception care addresses a "life design" that stresses "planning centered on becoming pregnant".
To that end, the ruling Liberal Democratic Party (LDP) has devised a five-year plan, starting this year, to train 50,000 people nationwide to be "preconception supporters". The stated viewpoint of the project is to help a woman "decide for herself" how she will approach reproductive health matters such as pregnancy and childbirth. The Asahi points out that the Takaichi administration takes a "paternalistic" stance toward connubial issues such as separate names for married couples and same sex marriage, since building a strong state is more important than creating a society where individuals can live as they please. The LDP considers the low birth rate a "national disaster" and "sexual self-determination" a low priority. Moreover, recent comments by the leader of the burgeoning Sanseito party to the effect that the government should reward younger women who become pregnant, since "older women cannot give birth", reinforce the belief that preconception care must start as early as possible.
For the last 10 years, the World Health Organization has highlighted the sexual and reproductive rights of women as a means of reducing maternal and infant mortality rates by improving the overall health of mothers and babies and preventing sexual abuse. Moreover, the United Nations Population Fund and the UN Human Rights Commission (UNHCR) say that comprehensive sex education for children and adolescents should include instruction that covers everything from sexual intercourse to giving birth. The UNHCR screens each member country's sex education policy in this regard. The Asahi reports that Japan has opted out of this screening, mainly because its public policy for sex education, which is formulated at the local level, does not include instruction about intercourse and contraception but instead emphasizes pregnancy and delivery; in other words, the Japanese authorities' sex education policy promotes pregnancy without teaching about sexuality. The worry among educators is that the government's message that women should become pregnant as early as possible is being promoted without mandating basic knowledge about sexuality and comprehensive reproductive health, which includes contraception and the termination of pregnancies. Social problems with regard to sexuality – unwanted pregnancies, sexual abuse, etc. – spring from a lack of proper sex education.
Coincidentally, on March 17 the Tokyo District Court rejected a suit brought by five women against the government regarding the Maternal Health Law. These women wish to undergo sterilization, namely tubal ligation, but the law prevents them from doing so. The women claim that the law's stipulation that healthy single women are prohibited from undergoing sterilization violates their right to self-determination and is therefore unconstitutional. The government argued that while the law restricts a woman's right in this case, there are contraception methods available. Moreover, once a woman undergoes sterilization it can't be reversed, a situation that could cause problems if the woman later regrets her decision.
The March 27 edition of Aera Digital includes an essay by Minori Kitahara, a sex paraphernalia retailer who often writes about feminist issues. Kitahara says that she has been following the lawsuit for the last two years "anxiously", and while she sympathizes with the plaintiffs she also, counterintuitively, derived some "relief" from the court's decision.
As Kitahara explains, the present Maternal Health Law "works to manage women's bodies", and voluntary sterilization can only be carried out by a woman who is married, has already given birth to several children, and receives approval from her spouse to undergo the procedure, which is irreversible. She says, "Simply not wanting to have a child cannot be used as a reason to undergo sterilization." Consequently, the law undermines Japanese women's sexual and reproductive rights, which are guaranteed by Article 13 of the Constitution. What the law implies is that as soon as a female person is born, she is considered a potential mother, and, conversely, if a woman does not become a mother, she is still thought of in those terms – a female person who is not a mother. This reasoning strikes at the heart of feminism, which asserts that a woman's body is hers and hers only. That's why Kitahara "shares these [plaintiffs'] pain".
The reason she feels relief at the court's decision to reject the suit is that none of the judges actually said the law was "not unconstitutional" and, in fact, stated it was "unreasonable", meaning it was open to immediate appeal. Kitahara's concern is that the law itself, and not just the part about sterilization, reinforces the notion that the government thinks of a woman's body only in terms of her potential to have children. She would prefer that the Maternal Health Law be attacked "in total" as a tool the government uses to control women's bodies. The plaintiffs' message is plain: It is no business of the authorities what I can and cannot do to and with my body.
While the law also prohibits single men from undergoing vasectomies and requires married men who want to undergo the procedure to gain permission from their spouses, as Kitahara points out, vasectomies are reversible, so the comparison with female sterilization is not appropriate. When she researched the removal of testes, either surgically or chemically, a sterilization procedure that is irreversible, she found there are a number of situations where it is allowed: when, for example, the subject feels "uncomfortable" in a male body, or is someone whose sexual impulses have been deemed pathological. In other words, a man can undergo such a "drastic procedure" of his own free will, but for a woman to do so requires her to successfully sue the government.
In a March 14 interview with the Asahi Shimbun, Hon. Prof. Miwako Iwamoto of Mie University said the Japanese government first became involved in reproductive matters during the Meiji Restoration with the formulation of criminal law based on contemporary European protocols. Previously, aborting or abandoning babies was fairly common in Japan, especially among peasant households with large broods. In recognition of recently introduced Christian dogma, the Meiji government made abortion and infanticide illegal. Subsequently, these laws were streamlined in order to augment the population for military and labor purposes.
In 1940, Japan passed the National Eugenics Act, which codified this policy of increasing the population for the national good. Abortion and sterilization were outlawed, but after the war, when defeat led to severe food and housing shortages, the policy was reversed in order to curtail population increases. In addition to promoting birth control, the Eugenics Protection Act of 1948 permitted compulsory sterilization of individuals the authorities deemed physically or mentally disabled. This policy continued until the 1990s, when compulsory sterilization was condemned globally. Japan rescinded the part of the law that recommended compulsory sterilization and changed the name of the Eugenics Protection Act to the Maternal Health Law; and then passed a separate law to compensate victims of compulsory sterilization. However, it retained the part of the law that prohibited voluntary sterilization, a move that Iwamoto finds contradictory. If the idea that compulsory sterilization violated a woman's right to have a baby then it should follow that voluntary sterilization is the right of any woman who does not want to have a baby.
A similar mindset has guided the status of abortion, which is technically illegal in Japan. Abortion can only be carried out under two conditions: when pregnancy and/or delivery threatens the life and health of the mother; or if it is determined that the mother is financially incapable of raising the child. The vast majority of abortions performed in Japan come under the latter condition, and in 1982, during an Upper House budget committee meeting in the Diet, a representative of the LDP, under pressure from certain interest groups including the Unification Church, proposed that the financial condition be removed from the law. Women's groups protested vehemently against the proposal and in the end no change was made. But as Iwamoto points out, the availability of abortion in Japan does not mean Japanese women are in control of their own reproductive destiny. The low-dosage birth control pill was not approved for sale in Japan until 1999, with most contraceptive methods, such as condoms, determined by the actions of male sexual partners. Abortion is in essence a last resort contraceptive method, but women (and girls) are still required by law to obtain the consent of their husbands or male partners, just as they need their husbands' permission to undergo sterilization.
The Asahi interviewed one of the plaintiffs, a graduate student named Reina Sato, who says she decided at a young age that she never wanted to have children and so doesn't see the point in having to endure menstruation every month until menopause. She decided to join the lawsuit after seeing social media posts that branded women who wanted to be sterilized as "terrorists" whose aim was to "destroy Japan".
Sato describes herself as asexual. She has never manifested sexual desire for anyone, and is not bothered by the notion that this feeling will never change. "Why do I have to have a body that's always preparing to create life that I don't want to create?" she asks. When she learned about voluntary sterilization she immediately wanted to undergo the procedure so as not to have to go through menstruation. (Experts, however, say that tube ligation does not, in fact, halt menstruation.) Japanese women wishing to have the operation must go overseas. Sato has explored this possibility but can't afford it. A 2019 UN survey found that 219 million women in the world have undergone voluntary sterilization for contraception purposes. According to Japan's health ministry, 4,518 sterilization procedures, which are not covered by national health insurance, were carried out in Japan in 2024. Sato called many hospitals in Japan, and all told her she was ineligible for the procedure. Instead of being discouraged, she has doubled down on her determination and studied the matter in detail. "Did you know that even rape victims who want to terminate their pregnancies have to gain permission from their rapists?" she said. A woman's decision regarding pregnancy and having a baby is not hers to make, but rather that of the male half of the reproductive equation.
The social environment in which preconception care is expected to take root is one where many women are not equipped with sufficient information. A March 8 article in the Tokyo Shimbun describes this environment by looking at how preconception care is being promoted in Akita Prefecture separate from the government's new scheme.
The prefecture distributes pamphlets to second-year high school students that explain how the eggs of a woman in her 30s are already considered weak and unreliable. The pamphlet explains this matter with a cartoon drawing of a "wrinkled" egg "crying" and saying, "Is it too late?" while an equally anthropomorphized spermatozoa approaches the egg, saying it is a "mature woman killer". The implication of the cartoon is that that eggs and sperm weaken with age and pregnancies after the age of 35 are riskier in terms of possible miscarriages and children born with genetic defects.
Miwako Miura, a writer who lives in Akita, told the Tokyo Shimbun that she was shocked by the pamphlet. "It provokes anxiety and pressures young people into having children without taking their feelings into consideration," she says. "It shows how the government just thinks of women as mothers' bodies and centers their lives on the production of ova." As it turns out, Akita Prefecture simply bought the pamphlets from the Japan Family Planning Association, which publishes another one for high school students that includes a "life chart" showing a typical young person living with their parents until graduating from university, getting a job, marrying, and then having three children. No other options are given. Meanwhile, Miura says, Akita Prefecture has no meaningful sex education program in its public school system. "What about sexual minorities, or people who prefer not to marry or have sexual partners?" she goes on to say. "[The program] completely ignores human rights and the diversity of families."
When the Tokyo Shimbun talked to people in the prefectural office who devised the program they admitted that it needed to be revised. But of all the prefectures in Japan Akita has had the lowest birth rate 30 years in a row, so they are desperate to reverse the trend with whatever means they have at their disposal.
In that regard, it will be interesting to see how the central government's preconception care plan unfolds. Upper House LDP member Junko Mihara, who was the special minister for children's policy until last October, has been put in charge of the preconception plan and announced that this year it has a ¥300 billion budget for education, an amount that will be doubled next year.
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.
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