The Abortifacient Pill Debate Comes to Japan
A Japanese friend and colleague who studies history and historiographical epistemology sometimes remarks that cultural battles in the United States break out in Japan five or ten years later. That analysis is proving true once again in the case of abortifacient pills. In recent months, pro-life friends have been fighting to keep abortifacients from killing unborn babies (and possibly some of their mothers along with them).
The fight intensified last December when Japanese public broadcaster NHK and other outlets covered the story of British pharmaceutical company Linepharma’s application to the Japanese government to have mifepristone and misoprostol approved for prescription and use in chemical abortions.
But earlier that year, when news of the pending application was first made public, there had been a spate of articles about the abortifacients. On April 22, 2021, for example, the English-language version of the national daily Mainichi quoted Yutaka Osuga, “an obstetrics and gynecology professor at the University of Tokyo who has been participating in clinical trials for the abortion medication.” Dr. Osuga, the paper reported, said “There are hardly any side effects, and it’s extremely safe. Women will be able to have an abortion independently without surgery by a doctor.”
The Mainichi story included Linepharma’s claim that “the final stage of clinical trials in Japan was finished by the end of 2020, with successful abortions confirmed in 93.3% of cases.” But the December NHK report provided more context: According to NHK,
Of 120 women as far along as nine weeks pregnant who participated in the trials,112 women, or 93%, aborted their pregnancies using the medication alone within twenty-four hours as initially expected. Among the remaining eight women, however, for some women parts of the fetus remained within the woman’s body, thus necessitating surgery, while other women failed to expel the fetus within the projected timeframe. […] Approximately 60% of the women (71 women in total) reported abdominal pain and vomiting. Of the 45 women judged to have experienced side-effects, some experienced serious side-effects, including one woman who broke out in a fever.
If this information seems to belie Dr. Osuga’s claim in the Mainichi article that “There are hardly any side effects, and it’s extremely safe,” this may be because he appears much more circumspect when quoted by other outlets. NHK provided a fuller, more nuanced quote:
University of Tokyo professor Osuga Yutaka, who participated in the clinical trials, said, “Generally speaking, the medicine is extremely safe and there are almost no side effects. However, because [the medicine] contracts the womb, many women experience abdominal pain and lower abdominal pain. This pain can be lessened to some degree by taking an analgesic with [the oral abortifacients]. Also, there will definitely be a certain amount of bleeding, because the fetal sac (the fetus and the placenta) are expelled. In a few cases there was even more bleeding detected than this. If there is bleeding it can lead to anemia and also cause other diseases, so I want women to consult with their physicians. […] If abused, administering this medication can possibly be considered a crime. Therefore it is best to take the medication under the direction of a physician. Distribution is controlled because each dose is marked with a number. So, I expect that methods of use will include, for example, taking the medicine in the presence of a physician.”
As in the United States, news in Japan on the subject of abortion is very often skewed in favor of the pro-choice side. NHK is legally mandated to provide balanced coverage, but many other outlets aren’t as conscientious.
Getting the Facts Out, Making the Risks Known
In this environment, as in the US, bypassing the biased media and appealing directly to politicians can be an effective strategy. On May 30, I had a Zoom call with my friend Ikeda Masa’aki to discuss the abortifacient debate. Mr. Ikeda is the organizer of the Tokyo March for Life and a leader of the pro-life movement in Japan. He shared with me the notes for a statement made in mid-May by Hirata Kunio at the Giin Kaikan office complex, used by members of the Japanese parliament (Diet).
Dr. Hirata, who is vice president of the Embryo Fund (Embryo Kikin), a pro-life organization supporting at-risk mothers, informed the Diet members and others in attendance that 26 women had died in the United States as of June 30, 2021, due to complications from abortifacients approved by the Food and Drug Administration (FDA) in September of 2000. This is not likely to be reported by pro-choice-leaning newspapers in Japan.
Dr. Hirata also pointed out that while the first dose (mifepristone) of the two-dose set would be taken in the presence of a physician, the second dose (misoprostol) is taken several days later by the woman alone. Many women change their minds between the first and second doses, Dr. Hirata said, and provided a link to an American organization that helps women in such a situation. Also, Dr. Hirata reminded politicians that only physicians are qualified to perform abortions, so when a woman administers misoprostol, she effectively performs an abortion without the proper qualification, which may make it a violation of Japanese law.
Further, Dr. Hirata explained, there was a great need to provide complete and accurate information about the possible side-effects of abortifacients. He mentioned the so-called emergency contraceptives marketed under the names Yaz and Lunabell, and encouraged everyone to learn the facts about injuries and deaths associated with these pharmaceuticals. Physicians, Dr. Hirata continued, should make the risks known and obtain written consent from patients to avoid liability and demands for compensation.
Dr. Hirata also raised questions about the clinical testing of abortifacients in Japan. The trials involved women staying in the hospital after taking the second dose of the two-dose set. However, he said, in actual practice women will take this second dose at home, without any physician present. Therefore, there are serious doubts as to whether the clinical trials were adequately performed, as they manifestly did not mirror real-world conditions.
Japanese Pro-Lifers Sound the Alarm, Encounter Opposition
Because of these risks, and most of all because abortifacients kill unborn babies, pro-lifers in Japan have been raising the alarm and speaking out. My friend Vincent Kato, a Tokyo March for Life veteran and an active prolifer, has been circulating a petition that calls on the government to deny approval for the abortifacients.
Japanese citizens are encouraged to sign the petition and show support for “a society, families, and schools that warmly welcome babies in the womb and their mothers!” Thanks to the hard work of Vincent and a dedicated (and growing) group of prolifers, even the Archbishop of Tokyo—not normally given to taking a stand for life—signed the petition. Cardinal Thomas Maeda, much friendlier to life, signed as well. So did Dr. Hirata.
These pro-life efforts are meeting opposition from the usual quarters. In a Diet cabinet committee meeting in June 2021, for example, Japan Communist Party parliamentarian Tamura Tomoko advocated for the speedy approval of oral abortifacients. Also, Socialist Party Diet member Fukushima Mizuho recently issued a statement in opposition to a document released May 17, 2022, by the Ministry of Health, Labour and Welfare, which stated that (as with surgical abortions in Japan) women seeking to procure chemical abortions would need the approval of their spouses.
A Yahoo! News Japan report quoted Fukushima:
The conditions placed on abortion, namely the high cost of surgical abortions and the need to obtain the agreement of the male [i.e., the father of the child], interfere with measures taken against unwanted pregnancies. […] Oral abortifacients are effective at preventing painful incidents where newborn babies are abandoned
Mr. Ikeda told me during our Zoom call that many feminists are in favor of chemical abortion because they see it as a quicker and more humane alternative to the standard abortion practice in Japan, namely dilation and curettage at the hands of an ob-gyn.
What Do Ob-Gyns Say?
However, Mr. Ikeda continued, oral abortifacients may have an effect on Japanese society quite different from what the feminist activists expect. Because, he said, while “abortions bring in money”—around $750 in US dollars and sometimes more—“ob-gyns don’t like performing abortions . . . ob-gyns often see abortions as running directly counter to their calling, which is caring for children in the womb and delivering them safely into the world.”
Mr. Ikeda is hopeful that oral abortifacients will help accentuate the reality of abortion—the harms, the risks, the taking of innocent human life—and that this will, in turn, lead to greater sobriety concerning such a painful, deadly, and final procedure.
The above-cited NHK article includes the following comments by Dr. Kinoshita Katsuyuki, president of the Japan Association of Obstetricians and Gynecologists:
If oral abortifacients are proven safe following the completion of clinical trials, then it is probably inevitable that they [will] be introduced [in Japan]. However, I am concerned that some people may mistakenly believe that abortions will be easy, that abortions can be as simple as just taking medicine. I believe there will be women who take the medication and begin bleeding during the night, causing them to worry. There must be a system in place to handle such eventualities right away.
NHK also cites Dr. Kinoshita as advising that, for the time being, prescriptions for oral abortifacients be written only by physicians qualified to perform abortions and working for medical facilities capable of admitting patients. “The physician does not just write a prescription,” Dr. Kinoshita added. “The physician will have to perform after-care, such as by operating on the woman if the [child and placenta] fail to be eliminated [from the body].”
Therefore, Dr. Kinoshita tells NHK, prescriptions for oral abortifacients should cost around 100,000 yen (around 760 US dollars at today’s rate), roughly the equivalent of what a surgical abortion currently costs in Japan.
The Fight Is Far from Over
However, opposition to Dr. Kinoshita’s professional opinion is increasing. The same NHK article mentions “seven citizens’ groups” that have been gathering signatures on petitions in support of making oral abortifacients available at a cheap price. On December 14, 2021, NHK reports, those groups submitted more than 40,000 signatures to the Ministry of Health, Labour and Welfare. The petition points out that the World Health Organization (WHO) lists oral abortifacients as “essential drugs,” and stresses that abortifacients are already in use in many countries around the world.
One of these citizens’ groups is “Safe Abortion Japan Project,” headed by ob-gyn Dr. Enmi Sakiko. Dr. Enmi says she “hopes to see the swift realization of safe abortion by medicinal means, carried out under international guidelines.”
The leftwing Foreign Correspondents’ Club of Japan is also pushing pro-abortion rhetoric, featuring “International Safe Abortion Day Japan Project” member Kajiya Kazane and other advocates in emotional pleas to end the Japanese law that allows fathers to have a say in whether their children are killed in the womb.
Miss Kajiya has been touted by many in the media here as a voice for “women’s rights.” On May 25, for example, Kajiya appeared on the popular Abema Times television program; an article touting that appearance came out at Yahoo! Japan the following day.
Mr. Ikeda sees the discussion over oral abortifacients as perhaps a tactic by pro-abortion forces to muddle debate and distract from the real issue. “It is no coincidence that oral abortion pills are being discussed in Japan at a time when Roe v. Wade is a hot topic,” he tells me. “The goal of the pro-abortion forces is to create the impression that there is a conflict over abortion in Japan, just as there is in the United States.” In reality though, the real question, he says, is not about methods, but about human life. That is where the battle must be joined.