Japan is set to legalize abortion pills, but leading doctors fear women are abusing them. Photo: Kyodo via AP Images
For Aoyama, abortion was the only choice she thought she had, after her fiancé raped her and got her pregnant.
As a victim of domestic violence, Aoyama knew she was not in the right mental state to raise a child. She loved the baby, of course. But who knew if she might become the child’s scapegoat, directing pent-up anger at her child? She was afraid of herself. And though guilt engulfed her, she terminated her pregnancy. “I felt like I killed my baby,” she told VICE World News.
“I couldn’t protect myself and in the end I had to kill my child that way,” she said, requesting the use of a pseudonym to discuss intimate matters.
She recalled how the abortion left her bleeding for days. “After the operation, I couldn’t walk or even stand. I had to lie down during the taxi ride home,” she said. Recalling the pain of more than 12 years ago, she said she wished the abortion pill – what she called a less invasive method of termination – was an option.
“We must have that in Japan.”
“It was like torture. Not only was it a difficult time, but the operation itself was so painful. If there is an option to opt out of the surgery, then it should be available – we have to have it in Japan,” she said.
In December, the British pharmaceutical company Linepharma asked the Japanese government for approval of its abortion pill. If approved, the pill would be the first medical abortion medication in the country, which abortion rights activists say would make reproductive health care much more accessible and affordable.
But even before the pill has been officially approved, a process that is expected to take up to a year, leading health experts fear greater access could lead to abuse.
Katsuyuki Kinoshita, the head of the Japan Association of Obstetricians and Gynecologists, a powerful industry group that represents the majority of doctors, said if the pill was found to be safe after clinical trials, Japan would have no choice but to to approve it. “However, I’m worried that people think this drug can make abortions easier,” he said in an interview with Japanese TV. NHK.
He added that only qualified doctors should be allowed to prescribe the pill because heavy bleeding, a rare side effect of taking the drug, could occur. “It would be better to price the abortion pill at the cost of the operation, which is about 100,000 yen ($861),” he said. In some countries, the abortion pill is provided free of charge by the government.
But Kumi Tsukahara, a reproductive health and rights researcher and activist, called the drive to make abortion pills as expensive as surgeries “incredible”, accusing Kinoshita and other doctors of trying to retain their effective monopoly on the practice of abortions. “These doctors are only thinking about their own business,” she told VICE World News.
“In Japan, surgical abortions are already so expensive and unaffordable for some women,” she said. Abortions and contraceptives are not covered by national health insurance.
The high price of the abortion pill defeats the purpose of medical abortions, which help expand access for low-income women, Tsukahara added.
As a medicine, the abortion pill is used to terminate early pregnancies, or within 70 days of the first day of a person’s last menstrual period. This requires taking a combination of two pills: mifepristone, a hormone blocker, and misoprostol, which causes miscarriage-like contractions that help expel the embryo. After taking both drugs, it takes about two to 24 hours for the pregnancy to be removed and is usually accompanied by cramping and vaginal bleeding.
Since China became the first country to approve the two abortion drugs in 1988, this non-surgical method is now available in more than 80 countries. It has been listed as a safe and essential medicine by the World Health Organization since 2005. In the United States, where the hormone blocker mifepristone was approved in 2000, around 42% of all abortions have been medically induced in 2019.
But in Japan, where abortions have been legal since 1948, dilation and curettage remains one of the most popular abortion methods. This procedure, also known as uterine scraping, accounts for more than 50% of all abortions nationwide, although it has been considered “obsolete” by the WHO since 2012. (The rest were performed by manual vacuum aspiration, which uses suction to remove the pregnancy or dilation and evacuation, which is a combination of the two methods.) The procedure requires dilating the cervix and using sharp metal curettes to scrape the walls of the uterus, causing significant pain and risk of blood loss for the patient.
In Linepharma’s most recent clinical trials, the drugs ended 93% of its recipients’ pregnancies within 24 hours, with most reporting mild side effects.
But for reproductive rights activist Tsukahara, who has had an abortion herself, what was of most concern was how doctors encouraged people to wait to terminate their pregnancies after 85 days – when they would be eligible for a lump sum payment for childbirth – to pay high abortion costs.
In Japan, pregnant women covered by public health insurance receive 420,000 yen ($3,691) to cover the medical costs of childbirth. People who experience premature births, stillbirths, miscarriages and abortions – including pregnancy terminations for financial reasons – are still eligible for payment, as long as they reach 85 days.
Tsukahara said she knew she wanted an abortion after confirming her pregnancy at five weeks, but was encouraged to wait another three weeks by her doctor. “I cried every day for the past few weeks,” she said.
“I thought of this fetus as a baby and I knew the baby was getting bigger and bigger. I kept thinking, ‘I’m going to have to kill this baby,'” Tsukahara said.
Activists note that in addition to introducing a cheaper method of abortion, Japan also needed to provide better access to contraceptives and sex education to prevent unwanted pregnancies.
“The reality is that there are women who want to use birth control pills but cannot, due to high costs,” Kazuko Fukuda, a sexual and reproductive health rights activist, told VICE. WorldNews.
Currently, condoms are the most widely available form of contraception in Japan, which is on average 82% successful in preventing pregnancy.
Birth control pills, which are 91% effective and a common method in Europe and parts of Southeast Asia, are used by only 2.9% of Japanese people of childbearing age. Low usage is often attributed to high costs – a month’s supply of pills costs around 2,500 yen ($21.82) – and concerns about side effects. The pill was only approved in 1999 in Japan, nearly four decades after it was approved in the United States.
Additionally, Japan is one of at least 12 countries that still require people to obtain spousal consent for abortions. Although the law was changed last year to exclude victims of domestic violence, campaigners say requiring third-party permission treats women’s bodies as a public good.
Aoyama remembers being rejected by several hospitals for an abortion because she couldn’t get consent from her abusive partner. “Even after explaining that I was being abused by my fiancé and that I was unable to get the consent form signed, the doctors asked me: ‘But you live together, don’t you? You are engaged, aren’t you? “, did she say.
If not for her family and her boss, who allowed her to work fewer hours as she recovered from her abortion, Aoyama said she could have ended her life.
“That’s how depressed I was. But because I had their support and they told me not to blame myself, I was able to get through this tough time in my life,” she said.
Although she described her abortion as a pain that she should take with her to her grave, Aoyama said she was happy that she made the choice to terminate her pregnancy. She wanted all women to have the freedom to choose.
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Correction: A previous version of this story incorrectly stated how soon after Tsukahara got pregnant did she want an abortion, the name of the Japanese Obstetricians and Gynecologists industry body, and the amount of insurance for pregnant women . We apologize for the errors.