日本語

In Japan, about 150,000 abortions are performed annually (about 400 abortions per day). To have an abortion in Japan costs about 100,000 to 200,000 yen at one's own expense, and often involves a curettage method, where the inside of the uterus is scraped out with a metal instrument.

The curettage method is used not only for abortions, but also for miscarriages where the fetal heartbeat has stopped, so the number of women who have undergone the curettage method in Japan is quite large. Miscarriage occurs in about 15% of all pregnancies (about 40% depending on age), and in Japan, the only options are to wait for the baby to spontaneously expel or to undergo surgery. (A surgery for miscarriage is covered by insurance and costs about 10,000 to 30,000 yen).

In fact, the situation of abortion and miscarriage in Japan is far from the international standard. The WHO has recommended that the curettage method is "outdated and should not be used" because of its extremely rare complications such as uterine perforation and infertility, and recommends "medical abortion" (so-called oral abortion pills) or "vacuum aspiration" as safe abortion.

The WHO states that "access to safe abortion protects women's health and rights" and recommends that abortion must be integrated into health systems as a public service or a publicly funded, non-profit service to protect women and health care workers from discrimination and stigma. Currently, abortion is covered by public funds in about 31 countries, and in some countries abortion is free.

In Japan, on the other hand, there have been incidents where abortions could not be performed because women could not afford the high cost, or unmarried women was asked to acquire an unnecessary consent from their male partner, leading to the abandonment of newborn.

Therefore, in order to ensure that all women who need "safe abortion or miscarriage" in Japan have access to appropriate information, medical care and treatment, we request the following

(1) Approve safe and inexpensive abortion pills and provide them in accordance with international recommendations.

(2) In addition to induced abortion, abortion pills should also be available for miscarriage（spontaneous abortion）.

(3) Replace the outdated and unsuitable curettage method with the safer vacuum aspiration method.

(4) Address the situations where access to safe abortion is hindered by barriers such as high costs and the requirement of a third party's consent.

5) Provide post-abortion care, including contraceptive methods, care and education that does not create prejudice and stigma.

Manual vacuum aspiration method is considered to be more protective of the uterus than the curettage and electric aspiration methods that use metal instruments. In Japan, it was only approved in 2015 and is not yet widely used. 

The oral abortion pill, which is not approved in Japan, has been used since 1988 overseas and is currently approved in about 77 countries. An increasing number of countries are providing telemedicine for the safe use of these drugs through self-administration.

It is designated as an essential medicine by the WHO, and a combination of two drugs, mifepristone and misoprostol, is recommended, with an average price of about 740 yen.

 In most cases, discharge is completed in about one day after taking the two drugs, but in some cases, it may take more than one to two weeks to discharge, and additional doses are administered according to the wishes of the woman. Methods of administering misoprostol alone has been established oversea, and misoprostol is approved in Japan as well, but it is indicated only for gastric and duodenal ulcers (about 30 yen per tablet), and patients are warned not to use it off-label, and it is not generally used for abortion or miscarriage.

(*Essential medicines: safe, effective, high-quality medicines that meet the priority medical needs of the population and are intended to be readily available at affordable prices)

In April this year, there was a report that an application for approval of an oral abortion drug in Japan is expected this year. However, there have been reports that the price may be the same as that of surgery from the perspective of hospital management, and that the patient will be hospitalized until the completion of the abortion is confirmed. There are concerns about whether the service and price will be accessible to the women involved, and whether it will be based on scientific evidence and international recommendations.

I am an obstetrician who has performed curettage on many women, and I am also a patient who has undergone curettage. I am keenly aware of the need to increase safe abortion and miscarriage options to protect women's physical, mental and social health. A few years ago, when I attended an international conference, I was asked by participants from other countries, "Why do you still practice curettage methods which look like a punishment at a price like a fine in Japan?

I was not able to give a clear answer to this question, but now that there is a move to apply for approval of an oral abortion pill, I feel that delivering our voices for safe abortion and miscarriage based on international standards will lead to a significant change in the situation in Japan, which is many lapses behind.

We have Sexual Reproductive Health and Rights (SRHR), to decide for ourselves about our bodies. Let's raise our voices together to increase the options for "safe abortion". Please support us and spread the word.