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We’re living through a global emergency. Why is emergency contraception still so inaccessible?

10th July 2020

Written by Kazuko Fukuda, SheDecides 25x25 Young Leader Japan.

The emergency contraceptive pill (also known as the morning-after pill, or EC) can prevent pregnancy when one has sex without sufficient protection, or after being sexually assaulted. It is more effective when one can take it sooner and therefore, it’s available at pharmacies in more than 90 countries to ensure quick access. 

However, in Japan emergency contraception is a prescription-needed medicine, and to get it you have to see a doctor. 

In Japan, clinics are sometimes too far away and stigma makes it difficult for women to access emergency contraception. In addition to that, the only nationally approved emergency contraception, NorLevo, costs about 100 USD per dose. For most young people this is far too expensive, and there is no insurance to cover it.

It is true that survivors of sexual assault can get financial support for getting EC, but that is only when they make an official report and only 3.7% of victims actually go to the police. This is largely because of a culture of victim blaming. Under the Japanese sexual offense's law, the definition of 'rape' is so narrow that many women hesitate to report it. If you’re interested to learn more, check out this video about Shiori Ito, who’s experience has come to symbolise Japan’s #MeToo Movement. 

Also, in Japan, less than 5% of women are on modern contraception. The most commonly used contraception is merely condoms or withdrawal, which are less effective than modern contraception. This risk is exacerbated by the fact that in Japan, people are often not properly taught how to use a condom. In fact, the most common reason for asking for emergency contraction is failure or breakage of the condom. 

Better access has been denied by authority

 In Japan, emergency contraception was approved in 2011. In 2017, Japan's Ministry of Health, Labor and Welfare discussed making emergency contraception available at pharmacies without prescription. Although 320 out of 348 public comments showed positive response to that, the motion was denied due to opposition from groups such as the Japan Society of Obstetrics and Gynecology (JSOG). The investigative commission concluded “pharmacists would not be able to explain usage” or “haphazard use would increase.”

In 2019, Japan's Ministry of Health, Labor and Welfare decided to let patients use telemedicine to get a prescription for EC under certain conditions. It is still not clearly regulated and active, but they will set some rules like ① Only patients with difficulty of seeing a doctor due to geographical difficulty or victim of sexual assault can use telemedicine (to avoid haphazard use), ② Patients have to take the medicine in front of pharmacist (to avoid reselling or using it recklessly), ③ Patients must have a have a check up with a gynecologist after three weeks (because it's assumed women themselves have no ability to see whether they get pregnant or not). 

COVID-19 and EC in Japan 

With all of this in mind, I'm worried about accessibility to emergency contraception during the COVID-19 pandemic. 

From 11 to 20 May, my SRHR project #nandenaino worked with NPO Pilcon to conduct a survey about anxiety linked to unintended pregnancies and access to emergency contraception in Japan during COVID-19. We managed to collect answers from 1545 people.

In the results, 116 women out of 1292 felt anxiety about unintended pregnancy during the COVID-19 pandemic in Japan. The most common cause for concern (shared by one third of these 116 participants) is ‘failure of male - condom’. Of these 116 participants, 10.3% of them said they could not refill oral contraception. Also, 13 of them said they were sexually assaulted.

Of the 116 women, only 20 (17.2%) of them could obtain emergency contraception. Although the government now allows telemedicine in general (including emergency contraception) due to COVID-19, this fact was only known by 33% in this survey (523/1545) and only 5 of them used telemedicine, while 14 of them visited clinic. 

The biggest reason women had given up obtaining oral contraception was the cost (21 participants, 53.3%). Meanwhile only 14 participants said they had done so out of fear of getting COVID-19 (14 participants, 36.8%). 

During the ongoing pandemic, access to emergency contraception has not been protected. 94.1% of all participants (1454/1545) agreed that emergency contraception should be available over the counter at pharmacies. 

Let’s make a change

 NPO Pilcon and the #Nandenaino project have been working on an online petition to demand availability of emergency contraception at pharmacies since 2019. We have already collected more than 65,000 signatures and we are trying to reach 100,000 signatures. It is available in English, so it would be great if you can stand up and speak out with us. 

Also, on 17 May 2020, Asuka Someya (president of NPO Pilcon), Sakiko Emmi (Gynecologist), and I held an event at the National Diet and launched the ‘Citizen’s Initiative for Pharmaceutical Access To Emergency Contraception’. The petition I mentioned will be connected to this new project and now we are preparing to submit signatures with a letter to the Minister of Health, Labour and Welfare. We are calling for comments from organizations and activists supporting us to post them on our website (you can see examples here). We believe external pressure is extremely important for this issue, so please contact us if you find some interests. 

Even as an international reader, the consequences of this lack of access could have an effect on you too. Before COVID-19, Japan welcomed 30 million people as tourists and the government is actively trying to bring in more workers and students from overseas too. In 2021, Japan will hold the olympic games. I have already seen many of my friends from foreign countries face difficulties finding emergency contraception in Japan. I am concerned what will happen when we have even more people from countries where emergency contraception is widely available. Please stand up for your friends, family, lover, or even yourself. 

In 2018, WHO recommended that “all women and girls at risk of an unintended pregnancy have a right to access emergency contraception and these methods should be routinely included within all national family planning programmes.” I believe the day will come when everyone in Japan can enjoy one of their basic human rights - access to emergency contraception. So that she can decide over her body, life, and future.