JAPAN: Infertility Woes Place Spotlight on Law, Counselling

By Suvendrini Kakuchi Reprint | | Print |

Suvendrini Kakuchi

TOKYO, Feb 20 2003 (IPS) - Kazuko is 40, owns a furniture store and is depressed. In her quest to have a baby, she has visited six doctors in two years, looking for a treatment for infertility, but has yet to find a solution that works.

"Time is slipping by fast," sighed Kazuko. "I long for a child now because I feel lonely as my husband is always working."

Her circumstances are not uncommon in Japan – there are many women like Kazuko, and some couples are spending millions of yen trying to combat infertility. Yet experts point out that legal and support mechanisms that could help women, and couples, make better choices are lacking.

To Japanese couples wishing for a baby and to people like Yuko Ashino, director of Japan Family Planning Services, there is an urgent need for legislation on the matter, support services, and a national debate on the issue.

Ashino, whose organisation is a leading provider of reproductive health services, said that "Japan is finally waking up to the reality that infertility is major problem in this country" and added that there is "an urgent need to address the accompanying issues".

More than 11,000 babies were born via in-vitro fertilisation (IVF) techniques in 2000, which accounts for 15 percent of the worldwide number of such births, according to the Japan Society of Obstetrics and Gynaecology.

It is a startling figure for a country whose population that same year accounted for 2 percent of the world total. Infertility is big business in Japan.

The business opportunity proved attractive enough to lead South Korean entrepreneur Yun Gyonho to set up a new ovum bank in Tokyo this month. Yun’s DNA Bank is a branch of his Seoul-based service, and is the first such foreign company in Japan.

Yun saw the trend early and acted fast. "More than 10 percent of our patients in South Korea were Japanese, which is why we decided to set up in this country," he said in a recent interview. "The need for our services is obvious."

Equally obvious is how infertility looms over the lives of Japan’s couples, which can be gauged from the numbers – the Society of Obstetrics and Gynaecology counts 474 medical institutions (including privately-owned clinics) that offer fertility treatments. Compare this with the 350 recorded in the United States and 20 in Britain.

Although Japan’s case is not particularly unique, late marriages, older women trying to get pregnant, and men suffering from low sperm counts have contributed to a fertility rate that is already among the world’s lowest in this industrialised, fast-ageing country – 1.34 children per woman.

With survey data showing that one in 10 couples suffer from infertility, and that they must console themselves with only a 20 percent success rate from treatment, there are those like Ashino who want to see infertility dealt with sensitively at a societal level in Japan.

Japan’s tough laws, for instance, ban financial transactions involving IVF and surrogate pregnancies, although there are reports that these do take place. Donors – usually found through advertisements – are said to be paid close to 5,800 dollars per service.

Said a Japanese donor, who did not reveal her name: "Donors need to be paid for their services – there is a lot of mental stress and physical invasion into their bodies. Japanese laws that prohibit payment do not face reality."

Furthermore, companies like DNA Bank cannot under Japanese law buy or sell ova. It calls its business in Japan a promotional presence for the principal in Seoul. A spokesman explained that the company has registered both Korean and Japanese donors, and charges 1.9 million yen (16,000 dollars) per patient.

The bills are paid willingly. A woman in her forties who gave birth to a healthy girl last year, after paying for an ovum in South Korea, explained her desperation: "It was my last chance," she said on television, her identity concealed as a shadow. "I had tried all other fertility treatments which failed."

It is a combination of denial and hope, and Masahiro Shigemasa, director of infertility treatment at the Health, Welfare and Labour Ministry, says the government is recognising the needs of the growing number of couples who need medical help.

"The government is deliberating new laws that will be more lax in accepting various treatments," he said. These may allow artificial insemination using donated sperm, and perhaps payment to donors under very strict guidelines.

The ministry does in fact acknowledge that the ban on payment to donors is being violated in medical institutions.

Former midwife Kimiko Fukuda, head of the Japan Society for Infertility Counselling, adds that it is also important for men and women to be able to talk openly about their situation. She pointed out that doctors and officials do not take this factor into consideration.

But experts also say that laws alone will not solve the complex problems surrounding infertility. Informed choice is what Ashino advocates, especially as Japan has many technologies to help infertile couples.

"Against such a backdrop, it is high time the government starts programmes to help women educate themselves on the different aspects of infertility,” Ashino added.

It is instead veterans like Fukuda who have stepped in. She has counselled more than 3,000 women who seek her advice and care on issues like social stigma, painful treatments and depression.

"Most women believe they must have a baby to be accepted in Japanese society," she said. "This only leads to desperate choices which are not the answer to infertility."