In Japan, Birth Control is Largely Out of Women’s Hands

In Japan, Birth Control is Largely Out of Women’s Hands

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Birth control pill
Despite reports to the contrary, Japan is still having sex - but Japanese women have little control over the outcome.

Japan has garnered a lot of attention (mostly lurid and “Weird Japan”-ish style reporting) about the decline in people having sex. Sensationalist headlines aside, people are still doing it (shocking!), and they still have to remain mindful of the risks involved, including sexually transmitted diseases and unplanned pregnancy.

Unfortunately, Japanese women have little control over the outcome of sexual encounters. As recent reports make clear, the use of contraception among heterosexual partners is almost entirely controlled by one’s male partner.

The statistics are jarring. In the US, according to the Guttmacher Institute, 99% of all women between ages 15 and 44 have used contraception, and some 60% of all women are currently using some method. Of those, only 14.6% of respondents say they rely on male condom use. By contrast, in Japan, according to a recent articles in Business Insider, condom use is the most prevalent form of birth control, at a whopping 82%. The next most popular form of birth control? Pulling out early, which is used by 19.5% of respondents.

What about female birth control? According to BI, only 4.2% of women report using the pill, compared to 25.3% of US women. And while some 20% of US women say they use an IUD, injectable, ring or similar method of birth control, less than 1% of Japanese women do. This, despite the fact that female contraceptive methods generally have an efficacy rate of 90% or higher, compared with an 82% rate for condoms.

(JP) Link: We’re Still Leaving It to Men? Why Doesn’t Japan Allow Women to Direct Their Birth Control?

A key issue is that birth control is either too expensive or too onerous to obtain. UIDs obtained for the purpose of preventing pregnancies aren’t covered by insurance, and the cost is typically several ten thousand yen (hundreds of dollars). The pill is easier to obtain, but still requires a prescription specifically issued by an Ob-Gyn. And again, the cost isn’t covered by insurance.

Indeed, when I asked women living in Japan on Twitter about their experiences with birth control in the country, cost was the number one complaint among all respondents. One woman reported having to pay around USD $500 out of pocket for a UID. And at least one respondent said that her doctor wasn’t what you would call receptive to the idea of helping her:

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What about the morning after pill, a.k.a. levonorgestrel? In the US, the morning after pill can be purchased from a pharmacy without a prescription. As a result it’s been used by almost 12% of American women. In Japan, however, the pill still requires a prescription from an Ob/Gyn, and thus usage has remained low.

Some women have had enough, and are pressing for change. A group of activists in Japan has made it their mission to expand the birth control options available to women, with a particular emphasis on relaxing the restriction on levonorgestrel. One group, PILCON, is leading a Change.org petition drive now demanding that the pill be available as an over the counter medication. In an interview with Asahi Shinbun (note: link no longer available), PILCON Chair Someya Asuka (染矢明日香) detailed why easy and affordable access to emergency contraception is important:

ピルコンで相談に応じる中で、こんな方がいました。10代の女性で、男の先輩の家に遊びに行きレイプされてしまいました。緊急避妊薬を紹介しましたが、「高い」などの理由で購入することができませんでした。価格面で購入に二の足を踏む子は高校生などでは特に多く感じます。

We had a person like that we consulted with at PILCON. She was a woman in her teens, and she’d been raped after going to a senior classmate’s house to hang out. We told her about emergency contraception, but she couldn’t buy it because, among other reasons, it was expensive. I feel there are a lot of high schoolers who flinch at buying it just because of the price.

Along these lines, Tsushima Ruriko, an Ob-Gyn at a clinic in Shinjuku, says she fills some 350 prescriptions a year, and at least 10% of those are for cases of rape. Women not only have few reproductive health options, says Tsushima – they’re also treated coldly when they visit a hospital for an abortion, or in cases of miscarriage. (I can’t help but think that this is part and parcel of the male domination of the medical profession, and the systemic attempt to keep women from becoming doctors.)

But the goal of making levonorgestrel an OTC med still seems far off. To date, Japan’s Ministry of Health, Labor and Welfare is considering an intermediary step: allowing women to obtain the morning after pill via an online consultation with an Ob/Gyn. Dispensation, however, will still be tightly controlled: the consultation would still be mandatory (though it could be done via computer or smart phone), and prescriptions would be limited to a single pill. The move also would do nothing to address concerns over cost.

(JP) Link: A Push to Repealing Ban on Morning After Pill Online Orders; Hopes of Preventing Unwanted Pregnancies

Why the run-around? The stated fear is that physicians will overprescribe the pill, and a black market in the drug will blossom. But politics undoubtedly also play a role. The administration of Prime Minister Abe Shinzo has no lack of male cabinet members and underlings who have repeatedly scapegoated Japanese women for the country’s declining population. So it’s no surprise that this crowd isn’t keen on empowering women to take control of their own reproductive health.

Hopefully, medical professionals and organizations such as PILCON can agitate for change even in the face of right-wing rhetoric.

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Jay Allen

Jay manages the technical writing practice for ercule, an SEO, content strategy and analytics firm. A lifelong geek, wordsmith, and language fanatic, he has level N1 certification in the Japanese Language Proficiency Test (JLPT).

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