HEALTH: Japan Slow to Heed Warning Signs on Abortions

By Suvendrini Kakuchi Reprint | | Print |

Suvendrini Kakuchi

TOKYO, Sep 23 2003 (IPS) - Japan may be an industrialised country, but lags behind many others when it comes to heeding the warning signs emerging in recent years – growing rates of abortion and unwanted births among teenagers and young women.

Effective reproductive health services are not easily available in this country, although government officials say they are now trying to devise new, more relevant ways of coping with the needs of young people.

Teenagers – girls between the ages of 16 and 19 – account for almost 47,000 abortions or 13 percent of the total number performed in the country a year, according to statistics for 2001, the latest compiled by the government. Among women between 20 to 24 years old, the figures were 80,000 for the same year.

Both groups recorded steady rises in abortions – almost double the numbers five years ago for teenagers and 40 percent among the older group.

A new programme was launched in April in collaboration with obstetricians and family planning experts to provide better contraception, education and choices about reproductive health.

But social factors, linked to changes in Japan’s traditional society into a more modern, cosmopolitan one, also lie behind earlier sexual activity and teenage pregnancies. ”The pattern among pregnant female schoolchildren is similar – many of them are from broken homes, lack self-esteem and live isolated lives,” says Yuko Ito, head midwife at Ashihara Hospital based in southern Osaka city and one of the few teenage-friendly hospitals in Japan.

”The government is alarmed at the situation,” adds Kiyomi Saegusa of the Ministry of Health, Labour and Welfare.

Teenagers account for about 10 percent of births made in the Ashihara Hospital – 10 times more than the national average.

Apart from the fact that women are being sexually active at a younger age – the estimates are 15 and 16 years old for girls and 14 and 15 for boys – the taboo on contraception has kept many away from using oral contraceptives and is a factor in the number of pregnancies among younger people.

There is also a clear link between high abortion rates and poor use of the contraceptive pill, says Dr Kunio Kitamura, gynaecologist and director of the Japan Family Planning Clinic, involved in the government project on reproductive health.

”Condoms and withdrawal are the most commonly followed contraception methods in Japan, which have often resulted in abortion because these methods carry high-risk rates,” he says.

These methods too reflect the fact that the reproductive health of women in Japan -where gender gaps remain big in a male-oriented society – continue to be controlled by men, he explains.

The high cost of the pill – 27 U.S. dollars for a month’s supply – and the need to visit a doctor to get a prescription to purchase it also makes it less accessible for teenagers who have less money and fear disclosing their personal lives to doctors.

After a long debate and decades after many countries in the world approved the use of oral contraception, the Japanese government approved the low-dosage pill in June 1999 and sales began in September that year.

However, the pill – not covered by health insurance – comprises less than one percent of contraception methods in Japan today. In contrast, it is the most popular means of contraception in the United States, where it was seen also a means of liberation.

Many Japanese women cite the fear of health problems for avoiding the pill.

Some activists also want a change in the law that requires parental consent for abortions by young people, saying this often results in delays that increase health risks for them if they opt to have it later.

Ashihara Hospital tries to break away from society’s traditional constraints and to allow an environment of openness where young people can try to take charge of their lives. It has a policy of encouraging young girls to recognise that they have the choice of giving birth over getting abortions.

”We believe in giving teenagers a choice when they find themselves pregnant. Often their parents and doctors give them no other option than getting rid of the foetus. We want teenagers to treated as individuals with a right to their bodies,” explains Ito.

She also says that many pregnant young women who go to Ashihara Hospital lack warm family, protection and support from their elders. Many had turned to sexual relationships to make up for that lack of warmth and belonging.

Several girls have said that their decision to go ahead with their pregnancies helped them take control of their lives, Ito maintains.

”(But) they face discrimination in Japanese society, which looks down on them for having babies while in school. They are expected to follow a rigid lifestyle – studying and working hard and marrying before having children,” says Ito, who advocates the use of oral contraception and wider use of condoms to address the rising number of young pregnancies.

There is also a need and desire by young people for relevant sex education. Boys, for instance, make up two-thirds of callers seeking counselling at the Japan Family Planning Clinic.

This lack of information stands out all the more in a society where explicit sex is easily accessible – and graphically described in comic books and weeklies or on the Internet – but whose schools do not give useful information about the topic.

Sex education is taught from middle school, where students are between 13 to 15 years old, but restricted to a scientific approach to reproduction and diseases such as HIV/AIDS. Condom use is not talked about openly.

"I know more about sex than the sex education taught in school, which is boring because it does not connect to my feelings,” a 16-year-old female student was quoted as saying in one of the surveys published in local media.

An 18-year-old boy said, ”I thought girls enjoyed being raped because that is the impression I get when I learn about sex from comic books.”

Calls by activists for more quality information on sex have received a backlash from officials and politicians, who say this would lead to earlier sexual activity.

”The older generation refuses to accept reality,” says Ito. ”Japanese youth are (already) beginning sexual activity early and urgent steps must be taken to raise awareness of the issues that accompany sex.”