The Abortion Debate in Japan is Far from Over: It’s Barely Begun

Tokyo, Japan: 2019 Women’s March. Photo by Hossam el-Hamalawy. 

In the past decade, Japan has increasingly received backlash for its antiquated policies toward women’s rights. The 2019 #KuToo protests against widely implemented mandates forcing women to wear high heels in the workplace, the lack of female representation in politics, and the overwhelming expectation that women stop working to care for their children exemplify Japan’s conservative view of gender roles. The struggle for reproductive freedom in the United States initiated a spotlight on other countries’ policies toward abortion and contraceptives. Japan was one of the countries that, instead of being applauded for its progressive and accessible reproductive healthcare stance, was criticized for its restrictive policies. While this scrutiny will not likely yield change, Japan’s stance on reproductive rights must be reformed. 

In Japan, abortions are legal but only under stringent circumstances. Abortion rights in Japan operate under the 1948 Maternal Healthcare Act, which outlines the two instances in which an abortion can be conducted: if the continuation of pregnancy or delivery of the child will harm the carrier of the fetus, whether for physical or economic reasons, and in instances of rape. With only two instances where abortion is legal in Japan, abortion is incredibly restricted. There is no instance where a woman can choose to have an abortion because she simply does not want to care for a child. Unfortunately, the limitations do not end there. 

Further hindering accessibility to abortion care is the requirement that, in order for a woman to get an abortion in Japan, she must receive written permission from either her spouse or the father of the child. Japan is one of only eleven countries that require the partner’s consent. While the Japan Health Ministry issued a notice in 2013 no longer requiring a man’s consent, it still is up to the hospital and doctor’s discretion whether or not the partner’s signature is required. According to a member of the Center for Reproductive Rights, most hospitals continue to enforce the prior requirement of the partner’s consent. This enforcement has left many women scrambling to receive their partner's permission, for instance, the Washington Post included an anecdote of a woman in 2022 who had to travel across the country to receive written consent from her partner, risking her health and having to pay for the flight fare, as ordered by the hospital. Moreover, while the father of the child is arbitrarily included in the mother’s decision to have an abortion, men continue to demonstrate staggeringly low adherence to child support payments: only 10% to 20% of fathers pay the correct amount. Clearly, the requirement of the man’s written consent is not to ensure that the father will support the child once it is born but rather entrap women into not getting the abortion or care they need. 

Moreover, abortions in Japan are also expensive and unsafe, which serves as an additional restriction. Abortion is not covered under Japanese health insurance and can cost approximately ¥100,000 ($720) if performed prior to 8 weeks; if performed around or after the 12th week, the cost is likely to double. Comparatively, in the U.S., abortions usually cost around $550, and in the U.K., abortions are typically free with health insurance. Not only are abortions exorbitantly expensive, but Japanese hospitals use outdated techniques to conduct abortions. While most countries use oral abortion pills or the vacuum aspiration method—both of which are relatively safe—Japan primarily uses the dilatation and curettage surgical procedure. Japan’s method involves using a small instrument to open the cervix and then a curette to remove the uterine tissue, which results in significantly more health complications. 

In addition, contraceptives are not easily accessible. Birth control pills were first introduced in Japan in 1999 after 44 years of domestic debate. IUDs are used by only 0.4% of women in Japan, and implants and injections are unavailable. More restrictive yet,“morning-after” pills are available only through an appointment with a physician. Once an appointment is made, the woman must go to a clinic and go through an extensive questionnaire with a nurse before being given the pill. Not only is the experience tedious, but it is also expensive. The Plan B pill, or Levonorgestrel, costs around $150 in Japan, compared to the U.S. price of $50. While there has been some debate about making the pill an over-the-counter medication, it typically is quickly shut down. In October 2022, the Japan Association of Obstetricians and Gynecologists conducted a survey in which 40% of respondents were against making the pill more accessible and 92% expressed general concern over making the pill available more accessible. The lack of accessibility is indicative of Japan’s broader culture of sexual stigmatization and shame—normalizing reproductive health care is the first step in combating this detrimental aspect of Japanese culture. 

Gender discrimination is pervasive in Japan, and the fight, or lack thereof, for accessible reproductive healthcare is just one example. Some politicians go so far as to question whether abortion should be legal even within the current strict reproductive healthcare constraints due to Japan’s population decline and low birth rate. However, the only thing these stringent policies achieve is an extreme stigma surrounding reproductive freedom and high rates of infanticide/neonaticide. In 2017 alone, there were 28 known cases, and in 2023 so far, there have been six cases of abandoned newborns. Going forward, Japan needs to prioritize and shine light on how making reproductive health care more accessible will affect a plethora of other socio-economic issues. It is in politicians’ best interest to do so, in order to encourage more women to join and remain in the workforce, destigmatize sex, and generally combat pervasive sexism. Overall, Japan’s reproductive healthcare policies must be reformed: women should have the right to choose. 

Elise Wilson is a Staff Writer for CPR and a third-year at Barnard, studying Political Science and English with an intent to attend law school.