Country Profile – Japan

Brief history of the law :

Abortion in Japan is governed by two pieces of legislation. The first is the Criminal Code, which was first enacted in 1880 and in its present form dates from 1908. It prohibits the performance of all abortions; a woman who performs her own abortion is subject to up to one year’s imprisonment, and a person who performs an abortion on another is subject to up to two years’ imprisonment. Medical personnel are subject to harsher penalties. This prohibition against abortion reflects primarily the desire of the Japanese Government in the late nineteenth and first half of the twentieth century to increase the nation’s rate of population growth in order to support Japanese expansion.

The second piece of legislation governing abortion is the Eugenic Protection Law. This Law has its source in eugenics legislation that was enacted in 1940 and is patterned on similar National Socialist German legislation of the 1930s. In its original form, the Law had a two-fold purpose: 1) to increase the number of Japanese; and 2) to prevent the birth of genetically inferior offspring and promote a genetically healthy population. It permitted sterilization only for the prevention of hereditary diseases, and abortion only to save the life of the pregnant woman.

The current Eugenic Protection Law was approved in 1948 and, as amended in 1949 and 1952, was in effect with largely the same wording until 1996. The Law was a product of socio-economic conditions in Japan in the years immediately following the Second World War, when the country faced a serious imbalance between its rapidly growing population and war-shattered economy. The need to limit family size became increasingly apparent and there was a high incidence of illegally induced abortion. The Government responded by promoting family planning through the methods then available, which were mostly traditional, and by legalizing abortion.

In addition to authorizing sterilization on a variety of grounds, the Law allowed abortions to be performed in five situations: (1) when the pregnant woman or her spouse suffered from a hereditary disease or mental disease; (2) when a relative to the fourth degree of either spouse suffered from such a disease; (3) when either spouse suffered from leprosy; (4) when the health of the mother might be seriously affected from the physical or economic viewpoint; and (5) in the case of sexual crime. Appended to the Law was a list of medical conditions that justified the performance of an abortion under (1) and (2).

Under the Law, an abortion could be performed only in a medical facility by a physician designated by the local medical association. The consent of the woman and her spouse was required unless the spouse was unascertainable, unable to express his will or had died after conception of the feetus. If the woman who was to undergo the abortion was insane or mentally retarded, consent had to be given by the woman’s guardian.

Owing to the provision in the law of socio-economic grounds for abortion in (4) above, abortions became available. The time limit for the performance of abortions was not specifically set by the Law. Rather, the Law designated viability as the limit for all abortions. Subsequently, notices issued by the Ministry of Health and Welfare moved the point of viability from an initial eight months to 23 weeks. Although these notices, technically, do not have binding legal effect, they indicate the Government’s understanding of the Law and are almost universally followed.

There have been two recent changes to Japan’s abortion law, one minor and one major. The minor change was the issuance by the Minister of Health and Welfare in 1991 of a new notice lowering the Government’s understanding of the point of viability to 22 weeks. This change is apparently in accord with the Government’s view of progress in the development of the medical technology necessary to keep prematurely born children alive.

The major change involves a large-scale rewriting of the Eugenic Protection Law. Owing in part to the requests of organizations representing the disabled, as well as to modern scientific knowledge about inherited diseases, in 1996 the Government proposed and quickly enacted revisions to the law designed to remove its eugenic features. All references to the word “eugenic” have been removed from the Law, which is now known as the Maternal Protection Law. Also removed were the provisions of section 1 of the Law stating that its purpose was to prevent an increase in inferior descendants, and the parts of the Law that dealt with procedures for obtaining official approval for eugenic operations, the Eugenic Protection Committee, eugenic examinations and payment of expenses. The Law no longer authorizes the involuntary sterilization of mental patients and those with mental weaknesses. Most significantly, legislators dropped from the Law the eugenic indications for sterilization as well as abortion and the list of medical conditions appended to the Law that served as grounds for sterilization and abortion on eugenic grounds. Thus, abortions are now permitted only when the health of the mother may be affected from the physical or economic view and in cases of sexual offences.

Changes in the Law were supported by all political parties and were welcomed by advocates for the disabled, particularly after it became known that over 16,000 people with hereditary or mental disorders had been sterilized between 1949 and 1994 under the former version of the Law. However, some women’s groups were displeased that the legislative changes had not been more extensive and that they had not been consulted prior to enactment of the changes. Some hoped for the passage of wide-ranging reproductive health legislation, stressing the rights of women in this area.

With the liberalized law enacted in 1948, abortion became the primary mode of fertility control in Japan. Abortion played a significant role during the early years of the overall fertility decline, with contraception subsequently playing a greater role. According to health authorities, the number of induced abortions in Japan continued to increase after the 1948 law was enacted. A peak was reached in 1955, when more than 1,170,000 abortions were reported against about 1,731,000 officially registered live births. Thereafter, the number of induced abortions gradually decreased. As of 1983, slightly over 567,000 cases-about half of the number of abortions that were performed in 1955-were reported.

The vast majority of abortions in Japan have been performed under the maternal health protection indication, which is in effect a combination of medical and socio-economic reasons. Nearly 95% of abortions have occurred within the first trimester. In contrast to the general declining trend in the total incidence of abortion, the number of abortions obtained by women with low parity and by teenagers has been increasing since the late 1970s. As reported by one study in 1990, pregnancies among adolescents in Japan occur at a rate of about 22 per 1,000, and most of them end in abortion.

The high incidence of abortion in Japan is believed to be due in part to Government restrictions on contraceptive use. Oral contraception was illegal in Japan until 1999. Until then, it could be obtained from physicians for the control of irregular menstrual cycles and for other medical purposes but not for birth control. The intrauterine device was legalized in Japan only in 1974 after its effectiveness and safety had been proved abroad. The National Survey on Family Planning in Japan conducted in 1986 found that about 80 per cent of contraceptive users relied upon the condom. The survey results also demonstrated a relatively high rate of contraceptive failure; about 31 per cent of the women surveyed had undergone one or more abortions.

About 40% of them took place in women in their 20s and 30% among women in their 30’s. The ratio of abortions in the teenage population was around 10 to 1,000 females.

The Japanese laws on abortion cause difficulty especially for women suffering domestic violence, as the Maternal Protection Law requires a woman who wants to have an abortion to get the authorization of her male partner. DV offenders often use pregnancy as a tool of control over their wife and often rape their wife or do not want to use condom, specifically that the pregnant wife will not then escape from them. Women in shelters or during estrangement experience difficulty in obtaining the authorization of their partner and therefore in accessing abortion services.

Neither abortion, nor delivery is covered by health insurance coverage in Japan. It costs 1,000 US$ for abortion in the first trimester (Medical abortion is not approved in Japan, and D&C is considered the standard method for the first trimester) and 3,000 to 100,000 US$ for abortion in the second trimester. Poor women including DV survivors, migrant women and young women have difficulty in accessing to such expensive services.

Short summary of conditions within the law :

To save the life of the woman : Yes

To preserve physical health : Yes

To preserve mental health : No and substantially Yes; Doctors use the economic reason for women who wants to have an abortion for this reason.

Rape or incest : Yes

Foetal impairment : No and substantially Yes; Doctors use the economic reason for women who wants to have an abortion for this reason.

Economic or social reasons : Yes

Available on request : No

Additional requirements :

Induced abortions are allowed only within the first 22 weeks of gestation. All legal abortions must be performed within medical facilities at the discretion of a physician designated by a local medical association. The consent of the woman or her spouse is required.

Analysis of it being restrictive if at all

Policy :

(Government policy enabling for the law, enabling beyond the law in practice etc such as population control policy, pro- natalist policy, anti sex selection policy, two child family norm)

As a countermeasures to the falling birthrate, under the influence of the right wing administration, the reform for safe abortion, such as the abolition of the article of the Criminal Code which punishes a woman who performs her own abortion and the abolition of the Law for Protection of Mothers’ Bodies which requires spouse’s consent on abortion, become more difficult.

Practise :

Medical abortion is not approved in Japan. Only doctors can carry out operations of abortion.

(Providers trained, willing, enabling )

Reproductive Health Perspective Signatory to ICPD, CEDAW :

Signatory to ICPD, CEDAW: Yes/ No, any conditions

Japanese government signed ICPD and ratified CEDAW.

Abortion Statistics :

Total less than 300 thousand(276,352 cases in 2006 , 223,405 cases in 2009)
1st TM; 261,719 cases (94.7%) in 2006; 211,214cases (94.5%) in 2009
2nd TM; 14561 cases (5.3%) in 2006; 12,179 cases (5.5%) in 2009
Safe
Unsafe; There is no data about unsafe abortion.
Married women
Unmarried women
Adolescents ;the ratio of abortions in the teenage population was 10.5 out of 1000 Females in 2004 in Japan.
27,367cases out of 276,352(9.9%)
Septic abortions

Public sector :

Abortion services available according to law
1st Trimester
Cost ;about 1000us$
2nd Trimester

Most of public hospitals do not accept the woman who wants to have an abortion due to being busy with attending delivery.

Private sector :

Abortion services available
Cost ;about
1st Trimester 1000~2000us$
2nd Trimester 3000~10,000us$

Methods used :

D&C, EVA, MVA, MMA with Mife Miso, MMA with Miso alone, MMA with Methotrexate Miso
D&C is main method in the first trimester in Japan.
2nd Trimester with Ethacridine lactate , Misoprostol, D&E, Hyterotomy
It is said that the use of Prostaglandins is standard method in Japan.

Provider level allowed for surgical and medical abortion :

(Ob Gyn, MBBS,Nurses,Other)
Ob and Gyn

Abortion related morbidity mortality statistics :

No data.
But MMR in Japan is 6/100,000, so abortion related mortality is very rare.

Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment) :

N/A

Manufacture/ import of Mifepristone, Misoprostol :

Mifepristone is not approved.
Misoprostol is approved only for gastric ulceration or rheumatoid arthritis.

Facility and provider certification norms in brief :

The medical association certifies doctors who can carry out abortion-operation.

The certified doctors have to go along the norm made by the Health, Labour and Welfare Ministry.

Information available in national service delivery standards :

N/A

Informal / illegal providers if present who are they :

There are a few informal / illegal providers who carry out nonqualified abortion-operation. There are some import traders deal medical abortion, although they are illegal.

Population urban/ rural – Demography of the country, with an analysis of availability of abortion services ratio to population :

N/A

Role of government :

Supportive, enabling, creating barriers, provides adequate funding to run training and service delivery programmes

Rather restrictive because of low birthrateand under the influence of the right wing administration.

Role of religion/ religious leaders :

Enabling,supportive,neutral, restrictive Rather restrictive.

Local Ob Gyn societies :

Supportive, conscientious objectors
Some doctors are thinking abortion earnestly from the point of women, but many doctors are judging the abortion from the points of morals or profit.

Current status and potential of research :

N/A

Awareness amongst community members :

In Japan, most of women do not want to talk about abortion because of stigma.

Although most of feminists are interested in backlash issue and Prenatal diagnosis issue, few feminist are interested in safe abortion issue and Medical Abortion issue.

Role of member organization / individual :

N/A

Abortion Policy :

Grounds on which abortion is permitted :

To save the life of the woman : Yes

To preserve physical health : Yes

To preserve mental health : No and substantially Yes; Doctors use the economic reason for women who wants to have an abortion for this reason.

Rape or incest : Yes

Foetal impairment : No and substantially Yes; Doctors use the economic reason for women who wants to have an abortion for this reason.

Economic or social reasons : Yes

Available on request : No

Additional requirements :

Induced abortions are allowed only within the first 224 weeks of gestation. All legal abortions must be performed within medical facilities at the discretion of a physician designated by a local medical association. The consent of the woman and her spouse is required.

* While Japan’s abortion law allows abortions to be performed on the specific ground of health, It does not authorize abortions to be performed in the case of foetal impairment. However, since the law allows abortions to be performed for socio-economic reasons, mental health and foetal impairment grounds are presumably covered by this ground.

Reproductive Health Context :

Government view on fertility level : Too low

Government intervention concerning fertility level : No intervention

Government policy on contraceptive use : Indirect support provided

Percentage of currently married women using modern contraception (aged 15-49, 1994) : 53*

Total fertility rate (1995-2000) : 1.4

Age-specific fertility rate (per 1,000 women aged 15-19, 1995-2000) : 4

Government has expressed particular concern about : Morbidity and mortality resulting from induced abortion

No Complications of childbearing and childbirth : No / Yes

Maternal mortality ratio (per 100,000 live births, 1990) National
Developed countries : 18 / 27

Female life expectancy at birth (1995-2000) : 82.9

*Some women reported more than one methods; figure shown assumes that modern methods were not used in combination with other modern methods.

Background :

Abortion in Japan is governed by two pieces of legislation. The first is the Criminal Code, which was first enacted in 1880 and in its present form dates from 1908. It prohibits the performance of all abortions; a woman who performs her own abortion is subject to up to one year’s imprisonment, and a person who performs an abortion on another is subject to up to two years’ imprisonment. Medical personnel are subject to harsher penalties. This prohibition against abortion reflects primarily the desire of the Japanese Government in the late nineteenth and first half of the twentieth century to increase the nation’s rate of population growth in order to support Japanese expansion.

The second piece of legislation governing abortion is the Eugenic Protection Law. This Law has its source in eugenics legislation that was enacted in 1940 and is patterned on similar National Socialist German legislation of the 1930s. In its original form, the Law had a two-fold purpose: 1) to increase the number of Japanese; and 2) to prevent the birth of genetically inferior offspring and promote a genetically healthy population. It permitted sterilization only for the prevention of hereditary diseases, and abortion only to save the life of the pregnant woman.

The current Eugenic Protection Law was approved in 1948 and, as amended in 1949 and 1952, was in effect with largely the same wording until 1996. The Law was a product of socio-economic conditions in Japan in the years immediately following the Second World War, when the country faced a serious imbalance between its rapidly growing population and war-shattered economy. The need to limit family size became increasingly apparent and there was a high incidence of illegally induced abortion. The Government responded by promoting family planning through the methods then available, which were mostly traditional, and by legalizing abortion.

In addition to authorizing sterilization on a variety of grounds, the Law allowed abortions to be performed in five situations: (1) when the pregnant woman or her spouse suffered from a hereditary disease or mental disease; (2) when a relative to the fourth degree of either spouse suffered from such a disease; (3) when either spouse suffered from leprosy; (4) when the health of the mother might be seriously affected from the physical or economic viewpoint; and (5) in the case of sexual crime. Appended to the Law was a list of medical conditions that justified the performance of an abortion under (1) and (2).

Under the Law, an abortion could be performed only in a medical facility by a physician designated by the local medical association. The consent of the woman and her spouse was required unless the spouse was unascertainable, unable to express his will or had died after conception of the foetus. If the woman who was to undergo the abortion was insane or mentally retarded, consent had to be given by the woman’s guardian.

Owing to the provision in the law of socio-economic grounds for abortion in (4) above, abortions became available virtually on request since the pregnant woman needed only to find a physician who was willing to perform the operation. The time limit for the performance of abortions was not specifically set by the Law. Rather, the Law designated viability as the limit for all abortions. Subsequently, notices issued by the Ministry of Health and Welfare moved the point of viability from an initial eight months to 23 weeks. Although these notices, technically, do not have binding legal effect, they indicate the Government’s understanding of the Law and are almost universally followed.

There have been two recent changes to Japan’s abortion law, one minor and one major. The minor change was the issuance by the Minister of Health and Welfare in 1991 of a new notice lowering the Government’s understanding of the point of viability to 22 weeks. This change is apparently in accord with the Government’s view of progress in the development of the medical technology necessary to keep prematurely born children alive.

The major change involves a large-scale rewriting of the Eugenic Protection Law. Owing in part to the requests of organizations representing the disabled, as well as to modern scientific knowledge about inherited diseases, in 1996 the Government proposed and quickly enacted revisions to the law designed to remove its eugenic features. All references to the word “eugenic” have been removed from the Law, which is now known as the Maternal Protection Law. Also removed were the provisions of section 1 of the Law stating that its purpose was to prevent an increase in inferior descendants, and the parts of the Law that dealt with procedures for obtaining official approval for eugenic operations, the Eugenic Protection Committee, eugenic examinations and payment of expenses. The Law no longer authorizes the involuntary sterilization of mental patients and those with mental weaknesses. Most significantly, legislators dropped from the Law the eugenic indications for sterilization as well as abortion and the list of medical conditions appended to the Law that served as grounds for sterilization and abortion on eugenic grounds. Thus, abortions are now permitted only when the health of the mother may be affected from the physical or economic view and in cases of sexual offences.

Changes in the Law were supported by all political parties and were welcomed by advocates for the disabled, particularly after it became known that over 16,000 people with hereditary or mental disorders had been sterilized between 1949 and 1994 under the former version of the Law. However, some women’s groups were displeased that the legislative changes had not been more extensive and that they had not been consulted prior to enactment of the changes. Some hoped for the passage of wide-ranging reproductive health legislation, stressing the rights of women in this area.

With the liberalized law enacted in 1948, abortion became the primary mode of fertility control in Japan. Abortion played a significant role during the early years of the overall fertility decline, with contraception subsequently playing a greater role. According to health authorities, the number of induced abortions in Japan continued to increase after the 1948 law was enacted. A peak was reached in 1955, when more than 1,170,000 abortions were reported against about 1,731,000 officially registered live births. Thereafter, the number of induced abortions gradually decreased. As of 1983, slightly over 567,000 cases – about half of the number of abortions that were performed in 1955 – were reported.

The vast majority of abortions in Japan have been performed under the maternal health protection indication, which is in effect a combination of medical and socio-economic reasons. Nearly all abortions have occurred within the first trimester. In contrast to the general declining trend in the total incidence of abortion, the number of abortions obtained by women with low parity and by teenagers has been increasing since the late 1970s. As reported by one study in 1990, pregnancies among adolescents in Japan occur at a rate of about 22 per 1,000, and most of them end in abortion.

The high incidence of abortion in Japan is believed to be due in part to Government restrictions on contraceptive use. Oral contraception was illegal in Japan until 1999. Until then, it could be obtained from physicians for the control of irregular menstrual cycles and for other medical purposes but not for birth control. The intrauterine device was legalized in Japan only in 1974 after its effectiveness and safety had been proved abroad. The National Survey on Family Planning in Japan conducted in 1986 found that about 80 per cent of contraceptive users relied upon the condom. The survey results also demonstrated a relatively high rate of contraceptive failure; about 31 per cent of the women surveyed had undergone one or more abortions.