SNA (Tokyo) — The Basic Act for Gender Equal Society was enacted in 1999,  but no one can argue that gender inequality has actually been eliminated within Japanese society. When confronting this fact, observers tend to focus on the business world. But healthcare is also an important facet of gender inequality. Women’s healthcare is treated as a lower priority than men’s healthcare; in particular, women’s reproductive rights are neglected.

The problems include lack of insurance coverage for Plan B (emergency contraception) drugs, a sluggishness to adopt abortion pills, and the requirement of male consent for women to receive an abortion.

In regard to the first of these problems, Plan B is a contraceptive method used in the case of unprotected sex, condom breakage, or other failures to prevent pregnancy.

Although Plan B has been used for more than two decades in some countries, Japan was about a decade behind in allowing it.

Even still, Plan B costs between ¥6,000 (US$47) and ¥20,000 (US$155), and is not covered by Japanese national health insurance.

In comparison, Planned Parenthood reports that pharmacies in the United States sell these pills over the counter for costs ranging from US$10 to US$50.

However, not all drug adoptions in Japan occur so slowly. For example, Viagra, the erectile dysfunction drug, was adopted quite rapidly. It was originally offered in the United States in 1998, and it was already available in Japan the following year. The Japanese government approved it only six months after the application was submitted.

From this month, the Ministry of Health has added Viagra to national health insurance coverage for the purpose of infertility treatment. Under national health insurance coverage, a Viagra pill will cost just ¥450 (US$3.50).

While this is indeed welcome news for those in need of infertility treatment, it does stand in clear contrast to the way in which women’s reproductive rights have been neglected.

Another example is the abortion pill.

Abortion pills were first legalized in France in 1988, but decades later they are still not available in Japan.

However, a British pharmaceutical company called Linepharma finally applied for approval of its abortion pill last December, and so there is a prospect that abortion pills will come to Japan later this year.

Currently, the majority of abortions in Japan are still conducted using the dilation and curettage procedure, which uses spoon-shaped instruments to scrape out the fetus. Women who have never had a vaginal delivery sometimes have difficulty with the opening of their uterus during this procedure, and it is often painful, carrying the risk of complications.

The World Health Organization (WHO) recommends either the use of abortion pills or vacuum aspiration as the safest and most effective abortion methods. It can therefore be said that the abortions being conducted Japan today fall short of contemporary global best practices.

Abortion pills have been approved in more than eighty countries because they have a record of outstanding safety and efficacy. They are easy to handle, and their average price worldwide, according to the WHO, is about ¥780 (US$6), making them quite affordable to low-income women.

That may not prove to be the case in Japan, however.

The Japan Association of Obstetricians and Gynecologists (JAOG), a highly influential medical organization, says that abortion pills, once legally available, should only be prescribed by doctors qualified to perform abortions at medical institutions where hospitalization is available. Katsuyuki Kinoshita, president of the JAOG, told NHK last December that while the adoption of such pills is “inevitable,” doctors “need to be involved in post-management, such as surgery in cases of abortion failures.”

Kinoshita’s conclusion is that “a reasonable management fee is necessary” for abortion pills, which he thinks would be about ¥100,000 (US$775), more than one hundred times the global average cost.

He also stated that he is “concerned that the introduction of abortion pills may lead women to perceive abortion lightly.”

Kinoshita’s paternalistic attitude is immediately apparent, even as he may also be concerned about the economic impact of widely available abortion pills on the industry which he represents.

Finally, current law in Japan–specifically Article 14 of the Maternal Health Act–requires that married women gain the consent of their husbands in order to receive an abortion.

This provision is widely regarded as discriminatory. According to the Center for Reproductive Rights, spousal consent is required for abortion in only eleven countries, and no other G7 nation maintains such archaic rules. Indeed, the UN Committee on the Elimination of Discrimination against Women has been recommending for more than half a decade to the Japanese government to end this spousal consent requirement.

Moreover, even though this legal requirement applies only to married women, it also prejudices access to abortion for unmarried women as well.

A tragic episode highlighted the seriousness of the problem.

A couple of years ago, a young woman was arrested in Aichi Prefecture for negligence resulting in death and the illegal disposal of a corpse–her stillborn baby.

The story which later emerged was that she had tried on multiple occasions to receive an abortion, but had been turned away by at least half a dozen hospitals. Even though she was not married, and therefore not subject to the legal requirement, each hospital she contacted demanded the consent of the father in order to move forward with the procedure.

The father was a classmate from her elementary and junior high school who had broken off contact with her after he learned that she had become pregnant.

Essentially forced to carry the baby to term, she suffered labor pains one day on her way to school and painfully delivered the stillborn baby boy alone in a park bathroom. She left the body nearby, with umbilical cord still attached, in a plastic bag, and was later arrested. She was sentenced to three years in prison, suspended for five years.

Hospitals are wary of performing any abortions without male consent due to the possibility of trouble arising later, including lawsuits.

In these various ways, it is apparent that when it comes to healthcare and reproductive rights, Japanese women continue to suffer disadvantages in comparison to their male counterparts, whether it be due to an underdeveloped framework of legislative protections, lingering paternalistic attitudes, or a failure to reexamine obsolete customary practices.

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