Abortion is legal in Japan, but most women need their husband’s consent

Placeholder when loading item promotions

KUMAMOTO, Japan – The discreet way to a safe place for women experiencing unwanted pregnancy is marked with a nondescript sign: two smiling storks carrying a shamrock and a smiling baby in a basket.

Here, in Japan’s only “baby hatch,” women can anonymously hand in their babies to Jikei Hospital for adoption. It is a last resort for those unable or unwilling to raise a baby, with some women coming from across the country because they have nowhere or else to turn to.

With the U.S. Supreme Court on the verge of overturning a 1973 ruling that legalized abortion nationwide, reproductive medicine is in the global spotlight — including in Japan, which has some of the toughest abortion restrictions of any wealthy nation.

Japan is one of 11 countries – and the only one Group of the seven largest economies – which require women to get their spouse’s consent to have an abortion, with very few exceptions, according to the Center for Reproductive Rights, an international organization. In practice, proponents say, the requirement often extends to unmarried women as well, and has led to rare and tragic instances of women leaving their babies to die in public places — something Jikei Hospital’s baby hatch aims to address.

Japan’s women-led startups are merging menstrual cups and the pill

Abortions are legal, but only through expensive surgeries. Contraceptive use is low. The morning-after pill is expensive and only available with a prescription. Japan is considering making abortion pills available. The World Health Organization calls their use a safe and non-invasive way to terminate a pregnancy.

But in a male-dominated country that ranks low among developed economies in terms of women’s empowerment and advancement, Japan has been slow to provide reproductive options for women. For example, Japan didn’t introduce the birth control pill until 1999, becoming the last industrialized country to do so after 44 years of debate. That same year, the Department of Health and Welfare approved Viagra in six months.

“Is Japan in the Middle Ages or something? Abortions are expensive and access to hospitals is very difficult. That’s why there are more and more cases every year of people giving birth in toilets and then leaving them behind or killing them,” Mizuho Fukushima, a minority Social Democrat politician, said during a committee meeting last month. “What kind of country do we live in?”

In fiscal 2018 alone, there were 28 cases of infanticide involving children under the age of 1 year. Seven of them were killed on the day they were born, according to the Health Ministry. So far this year there have been at least six known cases of women leaving newborns in public places.

The lack of options can have dire consequences for women like Yuriko, 26, who found her hopes for the future dashed by an unwanted child. She had been on the pill for about a month when she met her baby’s father and thought she was taking the right precautions. But a few months later, she found out she was six weeks pregnant.

She had planned to pursue a college degree and was not yet ready to raise a child. But when she went to the hospital in Hokkaido, in northern Japan, where she lives, she was told she would have to wait two weeks for the procedure because her fetus was too small. Meanwhile, she was told to get the consent of the baby’s father, even though they weren’t married.

Between morning sickness and nervousness, an hour and a half Flying to Tokyo to get his signature was particularly disgusting, said Yuriko, who spoke on condition that only her first name be used out of concerns for her family’s privacy.

“I was really nervous about what could go wrong and worried that the dad might not even show up when I get there. I was afraid of having to pay for an expensive plane ticket with a piece of paper in my hand that I had to sign,” she said. “I feared the worst: having to go home with the paper without a signature.”

The Global Stakes Behind America’s Abortion Fight

By taking the pill, Yuriko was already among the minority of women in Japan who chose oral contraception rather than relying on the man to use or pull out a condom.

According to a 2019 UN report on contraceptive use and estimates by the Japan Family Planning Association, use of the pill has hovered at just about 3 percent in recent years. This low percentage has been attributed to a lack of awareness and education, as well as social stigma.

During those two weeks, she researched surgical abortion and it began to scare her — and she changed her mind about having one. She also no longer plans to attend graduate school. She reflects on her decision every day and the limited options she faced in those early, chaotic days as she struggled to process the news.

“I wake up every morning and think about abortion and what could have been different,” said Yuriko, who is due next month. “If less invasive ways like abortion pills were available like other countries, I might have been able to pull it off.”

The morning-after pill, the emergency contraceptive taken within 72 hours of unprotected sex, exists in Japan, but it’s expensive and only available by prescription, meaning women risk conceiving if they don’t see a doctor on time can visit.

Though Japan is now considering medicated abortion pills, which are booming globally and have been available in many parts of the world for decades, health officials have indicated they plan to continue requiring spousal consent for them, and they’re expected to cost around $740 costs.

“The law does not prevent women from having abortions. But when it comes to that consent, sometimes women can’t get it, and women can’t end up getting an abortion,” said Kazuko Fukuda, a reproductive rights activist who leads the Nandenaino Project (Why Don’t We Have It?). a advocacy group for contraceptives.

Under the Maternity Protection Act of 1948, women were required to obtain written consent from their husbands to terminate their pregnancy. In 2013, the Department of Health clarified that it doesn’t apply to unmarried couples, and last year exempted married women who can show their marriage essentially ended due to domestic violence or other reasons.

But as in Yuriko’s case, many hospitals enforce the requirement on unmarried women anyway. The Ministry of Health’s notice is not legally binding and allows clinics to create their own abortion practices and prices, said Kumi Tsukahara, founding member of Action for Safe Abortion Japan, a reproductive health advocacy group.

“There’s been a lot of discussion about abortion and considering reproductive rights as human rights in the UN and that the rights of a fetus cannot come before the rights of women,” Tsukahara said. “I hope that by watching these discussions, both in Japan and in the US, more people can understand this.”

Japanese lawmaker laughed at for comments on teenage exploitation

The 10 other countries that require spouse consent are Syria, Yemen, Saudi Arabia, Kuwait, Equatorial Guinea, the United Arab Emirates, Taiwan, Indonesia, Turkey and Morocco, according to the Center for Reproductive Rights. The UN Committee on the Elimination of Discrimination against Women has asked Japan to abolish the consent requirement for abortions. In 2020, South Korea lifted its spousal consent requirement, but activists say some doctors are still asking for it.

The Japan Society of Obstetrics and Gynecology declined to comment on the report, and the Japan Association of Obstetrics and Gynecology did not respond to a request for comment.

In recent years, some politicians have questioned whether women should even have access to abortion — or whether it matters — given the country’s declining population and low birth rate.

However, proponents claim that women’s reproductive and sexual health is vastly different from the nation’s demographic needs and see it as part of achieving broader gender equality in a patriarchal society with entrenched gender roles.

“When I go to politicians to talk about it [reproductive rights], they sometimes ask me, ‘why are you talking about birth control when we have so few babies?’ That’s not what it is about. But still, I think things about procreation are always thought of in the context of national profit, rather than women’s choice,” said activist Fukuda. “The discussion should really be about creating a societal system that can be more supportive of these women and destigmatizing women’s access to abortion.”

Meanwhile, Jikei Hospital in Kumamoto, a southern Japanese prefecture, is one of the few safe havens for women with unwanted pregnancy. The baby hatch opened in 2007 and has been an unusual and controversial option ever since. So far, 161 women have left their children here – an average of almost one a month.

According to the Ministry of Health, there were about 140,000 surgical abortions in 2020. They cost between $740 and $3,000 — and have become a profitable business for abortion providers, said Takeshi Hasuda, the director of Jikei Hospital.

Jikei Hospital also offers counseling for women, who sometimes return home with their baby when they learn about government support, such as welfare payments, he said. To help isolated mothers, the hospital also began confidential births in December and has since delivered three babies without registering the mother’s name.

“People who try to have an abortion often feel ashamed, so they feel they are unable to really claim rights, whether it’s to reduce costs or achieve other accessibility,” he said he. “And since these people aren’t really raising their voices, it’s difficult for issues like this to become real talking points like they are in the US.”

Although Japan is not a particularly religious country, it does have a strong sense of social responsibility, which has carried over into the abortion debate and the sense of shame among women considering the procedure.

Every now and then, nurses meet the women who abandon their babies. They find the women are struggling with their finances, have ethical questions about abortion, or worry about being re-traumatized after the stress of a previous abortion, he said.

“In Japan, there are many who are pregnant and isolated, unable to get help from anyone around them and afraid that others will find out about their pregnancy. Especially for these people, we are the last resort,” Hasuda said.

Comments are closed.