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In Japan, abortion is legal — but most women need their husband’s consent

Japan’s male-dominated society has been slow to grant women the reproductive rights taken for granted in many other developed countries

Takeshi Hasuda, the director of Jikei Hospital in Kumamoto, Japan, stands next to an area at the facility where women can anonymously drop off their newborns and put them up for adoption. (Michelle Ye Hee Lee/The Washington Post)

KUMAMOTO, Japan — The discreet path to a safe space for women with unwanted pregnancies is marked with an unassuming sign: two smiling storks, carrying a clover leaf and a smiling baby in a basket.

Here, at Japan’s only “baby hatch,” women can anonymously leave their babies at Jikei Hospital to be put up for adoption. It’s a last resort for those who are unable or unwilling to raise a baby, with some women coming from across the country because they have nowhere and no one else to turn to.

With the U.S. Supreme Court poised to overturn a 1973 ruling that legalized abortion nationwide, there is a global spotlight on reproductive care — including in Japan, which has some of the tightest restrictions on abortion among wealthy nations.

Japan is one of 11 countries — and the only one of the Group of Seven largest economies — that mandate that women get their spouse’s consent to obtain an abortion, with very few exceptions, according to the Center for Reproductive Rights, an international organization. In practice, advocates say, the requirement often applies to unmarried women, too, and has led to rare and tragic instances of women leaving their babies in public places to die — something the Jikei Hospital baby hatch is meant to address.

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Abortions are legal, but only with an expensive surgery. Contraceptive use is low. Morning-after pills are expensive and only available by prescription. Japan is weighing whether to make abortion pills available. The World Health Organization calls their use a safe and noninvasive way to terminate a pregnancy.

But in a male-dominated country that consistently ranks low among developed economies on women’s empowerment and advancement, Japan has been slow to provide reproductive options for women. For example, Japan only adopted birth control pills in 1999, becoming the last industrialized country to do so after 44 years of debate. That same year, the Ministry of Health and Welfare approved Viagra in six months.

“Is Japan in the Middle Ages or something? Abortion costs a lot of money, and access to hospitals is very difficult. That is why there is no end to the number of cases, year after year, of people giving birth to babies in toilets and then abandoning them or killing them,” Mizuho Fukushima, a female politician with the minority Social Democrats, said during a committee meeting last month. “What kind of country are we living in?”

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

Lack of options

The lack of options can have grave consequences for women such as Yuriko, 26, who saw her hopes for the future dashed by an unplanned pregnancy. She had been on the pill for about a month when she met the father of her baby 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 graduate degree and wasn’t ready to raise a child. But when she went to the hospital in Hokkaido in northern Japan, where she lives, she was told that she would need to wait two weeks for the procedure because her fetus was too small. In the meantime, she was told to obtain the consent of the father of the baby, even though they were not married.

Between her morning sickness and nerves, the 90-minute flight to Tokyo to get his signature was especially nauseating, said Yuriko, who spoke on the condition that only her first name be used out of concerns for her family’s privacy.

“I felt really nervous of what could go wrong, worried that the father may not even show up when I got there. I felt anxious having to pay for an expensive plane ticket, with a piece of paper in hand that I needed to get signed,” she said. “I feared the worst-case scenario: having to go home with the paper, without a signature.”

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By taking the pill, Yuriko was already in the minority of women in Japan choosing oral contraception instead of relying on the man to use a condom or pull out.

The use of the pill has hovered around just 3 percent in recent years, according to a 2019 U.N. report on contraceptive use and estimates by the Japan Family Planning Association. That low percentage was attributed to a lack of awareness and education, as well as social stigma.

During those two weeks, Yuriko researched surgical abortion and it began to terrify her — and she changed her mind about having one. She is also no longer planning to attend graduate school. She thinks about 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 thinking about abortion and what could have been different,” said Yuriko, who is due next month. “If less-invasive ways like abortion pills were available as they are in other countries, I think I might have been able to go through with it.”

Morning-after pills, the emergency contraceptives taken within 72 hours of unprotected sex, exist in Japan, but they are expensive and only available by prescription, which means women risk pregnancy when they can’t access a physician in time.

Although Japan is now considering medication abortion pills, which are booming globally and have been available for decades in many parts of the world, health officials have indicated that they plan to still require spousal consent for them, and they are expected to cost about $740.

“The law does not stop women from abortion. But when it comes to this consent, sometimes women cannot get it, and women cannot get the abortion in the end,” said Kazuko Fukuda, a reproductive rights activist who leads the Nandenaino (Why Don’t We Have It?) Project, a contraceptive advocacy organization.

Under the 1948 Maternal Protection Law, women were required to obtain written consent from their husband to terminate their pregnancy. In 2013, the Health Ministry clarified that it didn’t apply to unmarried couples, and last year, it exempted married women who can prove their marriage was essentially over because of domestic violence or other reasons.

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

“There have been a lot of discussions about abortion and looking at reproductive rights as human rights in the U.N., as well as how the rights of a fetus cannot come before the rights of the women,” said Tsukahara. “I hope that both in Japan and the U.S., looking at these discussions, more people can come to understand this.”

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The 10 other countries that require spousal 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 U.N. Committee on the Elimination of Discrimination Against Women has called on Japan to remove the consent requirement for abortions. In 2020, South Korea removed its spousal consent requirement, but activists say some doctors still ask for it.

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

Falling birthrate

In recent years, some politicians have questioned whether women should even have access to abortion — or whether it matters — given the nation’s population decline and low birthrate.

Advocates, however, maintain that women’s reproductive and sexual health is something entirely separate from the nation’s demographic needs and see it as part of achieving broader gender equality in a patriarchal society with deep-seated gender roles.

“When I go to politicians to talk about [reproductive rights], they sometimes ask me, ‘Why are you talking about contraceptives while we face such few numbers of babies?’ It’s not about that. But still, I think things about reproduction is always thought in the context of national profit, instead of women’s choice,” said Fukuda, the activist. “The discussion really should be about creating a societal system that can support these women more, and destigmatizing women’s access to abortion.”

In the meantime, the Jikei Hospital in Kumamoto, a southern Japanese prefecture, has become one of the few safe havens for women with unwanted pregnancies. The baby hatch opened in 2007 and has since been an uncommon and controversial option. So far, 161 women have left their children here — an average of nearly one every month.

There were about 140,000 surgical abortions in 2020, according to the Health Ministry. 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 provides counseling for women who sometimes end up returning home with their baby once they learn of government support, such as welfare payments, he said. To help isolated mothers, the hospital also started confidential deliveries in December and has since delivered three babies without registering the mother’s name.

“People who are trying to get an abortion often feel ashamed, so they feel that they are not in a position to really demand for rights, whether it’s to lower the cost or other accessibility,” Hasuda said. “And since these people don’t really raise their voice, it’s difficult for such subjects to become real talked-about issues as in the U.S.”

Even though Japan is not a particularly religious country, he said, it has a strong sense of social responsibility, which has carried over into the debate over abortion and the feeling of shame among women who consider the procedure.

Every once in a while, nurses meet the women leaving their babies. They find that the women struggle with their finances, have ethical questions about terminating a pregnancy or worry about being re-traumatized after the stresses of a previous abortion, he said.

“There are many in Japan who are pregnant and isolated, unable to receive help from anyone around them, afraid of others finding out about their pregnancy. For these people, especially, we are their last resort,” Hasuda said.