By Rupert Wingfield-Hayes
BBC News, Tokyo
Image source, Getty Images
Image caption, Japan is set to approve an abortion pill manufactured by British pharmaceutical company Linepharma
While debate still rages in the US over the repeal of Roe v Wade, a much less noisy argument is unfolding in Japan over the legalisation of so-called medically induced abortions.
In May, a senior health ministry official told parliament it was finally set to approve an abortion pill manufactured by British pharmaceutical company Linepharma International.
But he also said that women will still need to “gain the consent of their partner” before the pills can be administered – a stipulation pro-choice campaigners have called patriarchal and outdated.
Medical abortions, using pills rather than surgery, were made legal in France 34 years ago. Britain approved them in 1991, and the US in 2000.
In many European countries this is now the most common form of terminating a pregnancy – pills account for more than 90% of abortions in Sweden, and around 70% in Scotland.
But Japan, a country with a poor record on gender equality, has a history of being extremely slow to approve drugs related to women’s reproductive health.
Campaigners here joke that it took the country 30 years to approve the contraceptive or birth control pill, but just six months to approve the Viagra pill for male impotence. Both became available in 1999, but the latter came first.
And the contraceptive pill still comes with restrictions, making it expensive and difficult to use. It all goes back to the way abortion became legal in Japan.
It was actually one of the first countries in the world to pass an abortion law, back in 1948.
But it was part of the Eugenics Protection Law – yes, it really was called that. It had nothing to do with giving women more control over their reproductive health. Rather, it was about preventing “inferior” births.
Article 1 of the law says: “To prevent birth of inferior descendants from the eugenics point of view and to protect the life and health of the mother as well.”
The Eugenics Protection Law was renamed and updated in 1996, when it became the Maternal Health Protection Law.
But many aspects of the old law remained. So, to this day, women who want an abortion must get written permission from their husband, partner, or in some cases their boyfriend.
Image source, EPA
Image caption, The reversal of Roe v Wade has sparked protests across the US
That is what happened to Ota Minami*.
She got pregnant after her boyfriend refused to wear a condom during sex. Condoms are still the primary form of birth control in Japan.
Ms Ota says he then refused to sign the document that would allow her to get an abortion.
“It’s strange that I had to ask him to use contraception,” she says. “And when he decided he didn’t want to use a condom, I needed his permission to get an abortion.
“The pregnancy happened to me and my body, but I need permission from someone else. It made me feel powerless. I couldn’t make a decision about my own body and own future.”
Unlike the US, Japanese views on abortion are not driven by religious belief. Instead, they derive from a long history of patriarchy and deeply traditional views on the role of women and motherhood.
“It goes very deep,” Ms Ota says. “When a woman becomes pregnant in Japan, she becomes a mother, no longer a woman. Once you are a mother you are supposed to give up everything for your child. It’s supposed to be a wonderful thing. It’s your body, but once you are pregnant, it’s not your body anymore.”
Getting an abortion pill could also prove difficult and costly – estimated to be about $700 (£500) as it is likely to involve being admitted to a hospital or clinic – something the medical establishment in Japan says is necessary to protect women’s health.
“In Japan, after taking the abortion pill you will have to be kept in hospital so we can monitor the patient. It will take more time than a traditional surgical abortion,” Dr Tsugio Maeda, deputy head of the Japan Gynaecological Association, told the BBC.
In many other countries, including the UK, it is now legal for women to administer the abortion pills themselves at home.
“The maternal health protection act says an abortion must be carried out in a medical facility. So unfortunately under the current law we can’t sell the abortion pill over the counter. It would be illegal,” Dr Tsugio added.
Female sexual health campaigners say this has less to do with medical science and more to do with the medical establishment protecting a lucrative business.
“I think a lot of decisions are made by men who are older and have bodies that will never carry a child,” says Asuka Someya, a sexual health campaigner who runs her own NGO.
Image caption, Sexual health campaigner Asuka Someya is pushing for greater autonomy for women on contraceptive decisions
Ms Asuka says there is still huge resistance from the male dominated Japanese establishment to making abortion easier.
The argument goes that if you make it easier for women to have abortions, then the number of women choosing to do so will increase. So, they make it a difficult and expensive process.
But, as evidence from other countries shows, this will only limit women’s choices and increase their suffering – it will not lead to less unwanted pregnancies.
Ultimately, Ms Asuka says, the answer lies in better sex education and in Japanese women taking control of contraception, rather than relying on men to use condoms.
In Europe, the contraceptive pill is the most common form of birth control. In Japan, it is used by just 3% of women.
Ms Asuka adds: “I want more policies to be made listening to the voices of young girls and women.”
*Some names have been changed to protect the identity of the contributors