JAPAN – One clinic began prescribing abortion pills and now others seem to be starting

by Kumi Tsukahara

The Mefeego Pack, produced by Linepharma, a combi-pack of one mifepristone and four misoprostol tablets, was launched on 16 May 2023 in Japan, and a clinic run by Dr Miho Uchida, of the Japan Women’s Foundation, began offering “oral abortion pills” for the first time in Japan on 25 May 2023.

As far as we could confirm, on 27 May, 11 hospitals or clinics had joined the providers listed on the website of the pharmaceutical company, Linepharma KK, as institutions authorised to provide this medication. Over the weekend of 27-28 May, at the time of our first review, we discovered that the ten clinics that had followed the lead of Dr Uchida’s clinic had disappeared from the list, we didn’t know why. However, on the Monday morning, 29 May, one of the ten clinics was back on the list and two others then newly appeared, totalling four clinics offering abortion pills (as of this writing – 1 June).

Because medical abortion will be provided outside the health insurance system and not covered by any public funds, women must pay the equivalent of the most expensive surgical abortion in Japan. At Dr Uchida’s clinic, the total fee for a medical abortion is the same as for a surgical abortion, set at 99,000 yen (USD 710.46)

In Japan, written consent of the spouse is legally necessary as a pre-condition for obtaining any method of abortion. In addition, a patient cannot take abortion pills very early in pregnancy, because the doctor can only prescribe their use after they have confirmed the pregnancy is in the uterus by transvaginal ultrasound, which means usually after the 6th week. However, according to Dr Christian Fiala of Austria, who spoke at the #Action for Safe Abortion Japan online event on 28 May, using abortion pills very early is effective when an ultrasound test is unavailable. If nothing happens, he said, then an ectopic pregnancy should be suspected and the patient sent to a higher-level medical facility. Thus, very early medical abortion can serve as a form of screening for ectopic pregnancy.

Japanese abortion patients are required to take both types of the medications in front of a physician. After taking the misoprostol, they are required to remain in the hospital until the pregnancy is expelled, or for up to eight hours. Many obstetrics and gynecology facilities in Japan are not dedicated only to abortion services; they often also house pregnant women, mothers with newborn babies, women having infertility treatment, and gynecology patients, all in the same wards, which can be uncomfortable for abortion patients.

Moreover, the doctors say that in 90% of cases, the abortion is complete within 8 hours after taking the misoprostol, but what about the remaining 10%? The Ministry of Health, Labor, and Welfare and the Japanese Association of Obstetricians and Gynecologists (JAOG) state that this in-hospital waiting rule is “temporary” and will be lifted once safety is sufficiently confirmed, but the criteria that will define safety are unclear.

JAOG also states that patients who come to the hospital and take mifepristone on the first day at any time, and misoprostol two days later at 9 am should remain in the hospital until the pregnancy is expelled, and that if the expulsion is not complete by 5 pm, surgery will be performed the next day or later. However, whether the patient will be hospitalized for this for a fee or sent home at their own risk is not explained clearly. Some may have to pay an additional fee for hospitalization, back-up surgery and/or multiple hospital visits out of pocket.

“The approval of abortion pills in Japan means that women now have more options,” says Dr Uchida. ”From now on, Japanese women no longer have to risk their lives to use foreign abortion pills on their own. Now a qualified doctor can fully explain the options and risks of abortion and make the best choice for her. This is a step forward in Japan from the perspective of ‘reproductive rights’.”

But it is likely to take a little longer for Japan to achieve reproductive rights which guarantee that women themselves can make the best choices for themselves.

Note: This is an updated version, as of 1 June 2023, of this report, which was published at: Hatena Blog: Abortion in Japan ; PHOTO by Philip Fong/AFP in Le Monde, 30 April 2023: International Women’s Day rally, Tokyo, 8 March 2023