Female contraception in Japan: human right or social stigma?

The question on female contraception is not debated in Japanese society at all. A question arises immediately: do Japanese women avoid contraception as a choice and the State regulation simply follows this trend; or don’t Japanese women really have a choice because they don’t even know about its existence? Disinformation, misinformation and social stigma deeply contribute to not perceive contraception itself as a right.

Kazuko Fukuda and #Nandenaino project: contraception is a right

We interviewed Kazuko Fukuda, founder of “#Nandenaino” project, which literally means “why don’t we have it?”, born in 2018 to raise awareness among Japanese women on contraception and sexuality.

Kazuko Fukuda, founder of #Nandenaino Project
Kazuko Fukuda, founder of #Nandenaino Project

Kazuko told us her story, as woman, worker and activist. She studied at the International Christian University of Mitaka (Tokyo) specialising in Public Policy, including sexual education and gender studies. In 2016 she had the possibility to study in Sweden for one year and it’s in a youth clinic that everything changed. “The only option I knew was the contraceptive pill. When the doctor at the clinic gave me the informative brochure and listed all the contraceptive options, I was shocked“. A student who dedicated years of studies on gender issues, sexual education included, was not even aware of any contraceptives beyond the pill.

It’s becoming more and more evident  that female contraception in Japan is not even considered a right. Japanese women don’t know that they have a choice and that they may claim for cheaper prices and for health insurance coverage and they don’t even know what kind of contraceptive to ask for approval for trade in Japan, such as ring, patch, contraceptive injection, spermicide, diaphragm and subcutaneous hormonal implant.

If you look for information in English you find thousands of websites. But if you look for websites written in Japanese, results are few and it’s rare to find images of contraceptive, apart from the classic pills’ pack. Something is happening on the other side of the planet [referring to Sweden]… All the selection in one place, for free, overwhelmed by information, I didn’t even know what to think“. Most of the websites refers mainly to emergency contraception and solely to the approved devices in commerce in Japan.

 Kazuko Fukuda at the 25th anniversary of the International Conference on Population and Development (2019), Nairobi Summit
Kazuko Fukuda at the 25th anniversary of the International Conference on Population and Development (2019), Nairobi Summit

Costs not accessible to all

The emergency pill cost lies around 10.000 yen (approximately 100 euros). The pill costs around 3.000 yen monthly (25 euros), depending on the brand and on the clinic which fixes the price, not considering the additional costs in case the doctor prescribes blood test exams (in some cases the pap-test too) to verify the compatibility to the pill, which can exceed 80 euros plus the first time visit fee. The IUD (Intrauterine Device) costs more than 400 euros, medical services included.

The health insurance doesn’t cover these costs, which are at the expense of women in case they want to use contraceptives to birth control purpose. However, if the woman requests the contraceptive to regulate the menstrual cycle or to reduce the pain, the health insurance covers the costs. “In Sweden people react very positively on contraceptive requests, considered as a responsible choice. You are simply seen as a woman who wants to protect herself and who just wants to decide when it’s the right moment to have a child“. A virtuous gesture of awareness of your own body and sexuality. Which is completely missing in Japan.

Sexual education is not considered positively and most teachers just explain puberty and pregnancy phases but avoid to talk about sex and sexual awareness“. Kazuko mentions the case of a teacher in a school for students with developmental disabilities (more likely to be victims of abuses), who was transferred to another school because he explained them parts of body in which is inappropriate to be touched, with the support of puppets. A lesson on prevention of sexual harassment and abuse not appreciated by the authorities.

Few contraceptives, many abortions

An issue strongly connected with the lack of contraceptives is the high number of abortions, around 168.015 per year. According to The Japan Times this practices is commonly used as “replacement” of contraceptives.

Abortion is not covered by health insurance and requires parents’ signature if the woman is minor and the one of the partner if adult.” The practice is legal up to 24 weeks of gestation and can only be practiced if certain criteria are satisfied, including: preserving the life of the woman, her physical and mental health, for economic or social reasons, in case of rape or incest. The criteria are not strict and theoretically do not preclude the woman from abortion, but abortion pill (RU-486) is also not approved to use, so all abortions are done by surgery and 80% of them are done by Dilation and Curetage (D&C), which has been recognized as ‘outdated’ by WHO. Because it is done by surgery, in fact the prices are very high, at least 1000 euros, without health coverage and respect for privacy.

Kazuko reports some testimonies of young women who “don’t go to clinics for fear of being discovered by parents or the partner and for this reason keep the pregnancy secret, until the birth of the child“, pointing out that in many cases newborns do not even survive the first day of life, abandoned or killed by the mothers themselves.

Although some clinics are beginning to offer discounts on contraceptives only for students, there’s not a price fixed at national level, which is  set by the clinics, not guaranteeing easy access for all. Women living in rural areas or small towns have an even more difficult access to contraceptives.

#Nandenaino at the National Diet in Japan (2019)
#Nandenaino at the National Diet in Japan (2019)

Something is changing

The government has recently decided to let women to get counseling with doctors online, a step forward to make it possible for women to protect their privacy. “In theory it should be reserved solely for women with geographical difficulties in reaching their own doctor and to women victims of abuses, but it’s increasingly been used by many other women” highlighting that, however, “when the woman takes emergency contraception, she basically must do it in front of the pharmacist or doctor, to prevent the sale of contraceptives on the black market, which certainly does not guarantee privacy at all“.

A virtuous example is given by a clinic in Osaka where abortion surgery is carried out under anaesthesia and women are followed even after the surgery, for psychological support and rehabilitation. Many of the women who make this decision don’t have their family or partner’s support and they keep it secret to avoid social stigma; in this case the support of the clinic becomes fundamental. 

The practice of abortion is not a mere choice, it leads to physical and mental trauma for women. That’s why this kind of examples should be subject of public policies by the State, to raise, first of all, awareness among the entire society and to support and protect vulnerable women’s rights.

The concept of human rights as intended in Western countries does not exist in Japan. Society always comes first, never the individual“. And this refers not only to the lack of adequate public policies, but to the society itself, including women, who don’t even perceive contraception as a right, but as a shame. As Kazuko points out, “our goal is not to have contraception at all costs. It’s about starting to make it clear that this is a right that we should start to perceive as ours and to finally claim it. It’s okay to want to be responsible and to want to protect yourself. There’s nothing wrong with being aware of your own sexuality. It’s our right, and we want it to be recognised“.

Cristina Piga

All the photos were provided by the interviewee.

Cover photo: VectorStock


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