by Kumi Tsukahara, PhD — RHR Literacy Lab, Japan
Japan’s long-awaited approval of the abortion pill in April 2023 was celebrated as a progressive step. But nearly two years later, it has become clear that the change was largely symbolic. Actual access to medication abortion remains deeply restricted due to persistent institutional, legal, and cultural barriers.
Under the Maternal Body Protection Law (MBPL)—which dates back to 1948—doctors in Japan hold discretionary power over abortion access. This framework, grounded in paternalistic assumptions, continues to subject women to gatekeeping. Even in 2025, abortion care is shaped by stigma, lack of privacy, and logistical obstacles that are unique in the global context.
The abortion pill was introduced under highly restrictive conditions: it costs between ¥100,000–150,000 (without insurance coverage), requires in-clinic administration “in the presence” of a doctor, and remains subject to the MBPL’s spousal consent requirement. Rather than promoting autonomy, the system reflects deep institutional distrust toward women. Unsurprisingly, in April 2025, the Japan Association of Obstetricians and Gynecologists reported that only 1.2% of all abortions performed in the country were via medication—evidence of ongoing resistance from the medical establishment.
Another major obstacle is that only MBPL-designated doctors, who qualify based on their experience with surgical abortions, are allowed to prescribe abortion pills. This requirement has no bearing on the safety or delivery of medication abortion, and stands in stark contrast to WHO guidelines, which support provision by a wide range of health workers and even self-management. Japan’s refusal to separate surgical and medical abortion protocols creates needless limitations.
My research has also documented cases in which unmarried women are still required to obtain male partner consent—a practice not grounded in law but often enforced by conservative clinics. This reflects a broader societal norm in Japan that continues to privilege male authority in reproductive decision-making.
The need for reproductive autonomy has never been greater. Modern women experience approximately 450–500 menstrual cycles in a lifetime—compared to around 50 in pre-modern times. Increased ovulation, along with the normalization of non-reproductive sex, naturally leads to more unintended pregnancies. Meanwhile, pregnancy and childbirth still pose significant health risks, making access to safe abortion essential.
Some commentators in Japan have suggested that easier abortion access may be contributing to the country’s declining fertility rate. This claim is both incorrect and dangerous. Fertility is shaped by the lack of state support for parenting—not by women’s access to abortion. Restricting reproductive rights won’t increase birthrates; it will only deepen inequality and suffering. What Japan needs is affordable childcare, secure employment, gender equality, and comprehensive sex education—not more control over women’s bodies.
Japan has a long history of shelving progressive policy recommendations in favor of reactionary “birthrate countermeasures.” In the 2000s, under Prime Minister Shinzo Abe, these measures were often accompanied by gender backlash and sex education bashing. These political choices have created the reproductive healthcare landscape we see today.
My forthcoming book, to be published by Shueisha in September 2025, examines how systematic neglect of reproductive rights in Japan is not just a matter of gender justice—it is a central factor in the country’s demographic and social crisis. Without reproductive justice, there can be no sustainable future.
For now, the book will be available only in Japanese. ST