Japanese laws make abortion an economic issue

In light of yesterday’s U.S. Supreme Court decision to allow individual states to outlaw abortion, we are here posting an article we wrote about Japanese abortion practices in 2012 in our money blog for The Japan Times. Though the article is still on the newspaper’s website, it seems to be behind the paywall and not necessarily in its original complete form. Of course, some of the information contained herein have changed in the past decade, especially with regard to contraception and non-surgical forms of pregnancy termination. We plan to write a new article about abortion in Japan in the coming weeks, but, essentially, the legal and financial matters mentioned below are still in place.

Contrary to what most people believe, abortion in Japan is not legal. The reason abortions are performed freely in Japan–officially about 210,000 in 2010, though there certainly were more–is due to amendments to the daitaizai (illegal abortion) law. These amendments, implemented shortly after World War II, allow for a pregnant woman to abort her child if the pregnancy threatens her life or health, or if the woman is financially unable to raise the child. It is assumed, for legal purposes, that the vast majority of women who undergo abortions do so for economic reasons. However, since there is no real provision for having women state her reasons when seeking an abortion, and no woman in Japan has been prosecuted for aborting a fetus since World War II, the procedure is considered effectively legal. It is also quite expensive. Unless the abortion is being carried out for health reasons, national insurance will not cover it. This situation has lead to a paradox: Most women in Japan who seek abortions ostensibly do so because of financial hardship, but are nevertheless forced to pay a great deal of money to have those abortions performed.

According to our own Internet survey of gynecology services and comments on various blogs and websites, the cost of an abortion up to the twelfth week of pregnancy ranges from ¥80,000 to ¥150,000, which is only the cost of the procedure and does not include consultation fees and medication. However, after the twelfth week of pregnancy, the cost increases considerably. Abortions performed between the twelfth and 22nd week of pregnancy cost between ¥300,000 and ¥500,000. Also, if the patient suffers from a chronic condition that could complicate the procedure, such as asthma, she is required to undergo the procedure at a general clinic, which tends to be more expensive than a women’s clinic or a gynecology office. Of course, if a physician concludes that the pregnancy threatens the woman’s life or health, insurance can be used for the abortion, and if the cost of the operation goes above a certain level, she can even receive a refund for any money she pays out of pocket. Even if the cost does not rise above that designated level, if she files an income tax return she can deduct the cost of her abortion on her return, including money she paid for sanitary napkins and even the taxi fare to the clinic. But this is only if the procedure was done for health reasons. Other costs that apply but usually aren’t mentioned have to do with the aborted fetus. If an abortion (or miscarriage) takes place after the eleventh week of pregnance, the attending physician has to fill out a death report that the mother files at the local city office. She then has to pay for cremation. There are also optional costs for mizuko kuyo, or memorial services for aborted babies, which start at about ¥40,000. 

The high cost of pregnancy termination figured into a recent survey carried out by the Asahi Shimbun, which sent questionnaires to 932 medical institutions that offer abortions, of which 343 responded. The two most common methods for surgical abortions are suction and D&C (dilation and curettage). The former method literally vacuums the fetus out of the uterus. With the latter method (soha-ho), the doctor cuts the fetus into pieces and scrapes the pieces out through the cervix. According to the Asahi article, suction is the preferred method in most developed countries, while in Japan most gynecologists use the D&C method. Of the survey respondents, 11 percent said they offer only suction, 35 percent D&C, and 48 percent both. In 2003 the World Health Organization released guidelines for “safe abortions” that recommended either suction or the so-called abortion pill (RU-486 or mifepristone). D&C was recommended during the early stages of pregnancy only when the other two methods were not available. The article also said that the American Centers for Disease Control has stated that D&C results in 2 to 3 times more serious side effects than the suction method and that used properly the abortion pill is perhaps the safest method. 

The abortion pill is available in most developed countries but not Japan, and the Asahi article implies that there is little chance of it being approved in the near future. Though the pill is expensive–in the U.S., it’s about $500–it is still cheaper than a surgical abortion. There is no indication in the article as to the relative costs of the two surgical methods, but the writer says the reason for the preference for D&C in Japan is that “most abortions are performed by older doctors who prefer to use the method they’re accustomed to.” One gynecologist quoted in the article says that “Japanese doctors” prefer D&C because “they are more skillfull with their hands.” The Japan Gynecological Academy reported only 21 “accidents” related to abortion procedures in 2010, but this figure is not reliable since most abortions are not covered by insurance and so reporting is not thorough.

We contacted the director of a women’s clinic in Tokyo to ask about the Asahi article. The director answered on the condition that we not use her name or the name of the clinic, and she took issue with almost everything the article stated. The WHO recommendations were misrepresented, she said, since they were mainly targeted at developing countries, many of which do not permit abortion. In these countries the suction method is preferable because it is easier. Doctors in those countries may not possess the skills necessary for a D&C, which the director says is a more efficient method of abortion when carried out properly. She also believes D&C is safer. As to whether one method is less expensive than another, she says they’re about the same in Japan, but in any case since they aren’t covered by insurance each institution sets its own price for abortion procedures. She offered no opinion on the abortion pill and whether the government would ever approve it, but she did imply that the risks were underappreciated. If the government ever did approve its use she believed it would be very expensive since pharmaceutical companies would be free to set a high price, citing the cost of so-called emergency contraception pills in Japan as evidence. The cheaper pills cost ¥5,000 for two, while the more expensive ones (less side effects) are ¥15,000 for two. She said gynecologists remain “astonished” at these prices. In the U.S., they cost between $10 and $70.

It should be noted that the number of abortions continues to drop every year (during the 1950s the number averaged a million a year) thanks to the introduction of the low dose birth control pill more than a decade ago, even though the health ministry reports that in 2009 only 3 percent of women used it as a contraception method. The cost of using the pill in Japan runs about ¥3,000 a month and also is not covered by insurance if used to prevent pregnancy.

The Value of a Family (from 1996)

The following article was written by Masako for the July-September 1996 issue of the English-language Japan Quarterly, which is no longer published. We are posting it here because we think it offers some useful background for the never-ending debate over whether Japanese married couples should be allowed to use separate surnames for legal functions. The article is about the family registration system, the koseki, and offers not only a brief history of the document, but a summary of its use in a practical sense. Since the article was published, certain changes have taken place in the Civil Code, and we have added updates to the story where they apply. These updates are provided in brackets. However, the article itself is here recreated exactly as it appeared in 1996, so that readers can get some sense of how much progress has been made. For the most part, not much; and as Masako implies throughout the piece, a lot of the process surrounding changes made in the koseki depends on the individual civil servant who carries it out at the counter. Consequently, some of the matters explained here that were contentious at the time have become less so due to a looser attitude on the part of front-line officials; but, in theory, the koseki hasn’t changed very much since 1996, and the surname issue, which is directly linked to the bureaucratic primacy of the koseki, is just as contentious now as it was when the article was written, if not more so. For a detailed and very readable discussion of the legal aspects of the koseki, we recommend the 2016 series that Colin P.A. Jones wrote for The Japan Times. We should also mention that Sato Bunmei, who talked to Masako at length for this article and was probably the most knowledgeable person at the time about the koseki, has since died.

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A place in the sun

About a year ago, many people in our part of Chiba Prefecture were still struggling with loss of electricity after two typhoons plowed through the peninsula in rapid succession. Our house was lucky and only lost power intermittently for short periods. Not far from where we live, however, there were some households who didn’t have power for more than a month, and the local authorities, not to mention the regional power providers, seemed at a loss as to what to do about it. Moreover, they didn’t seem sure of how to prevent such problems from recurring in the future, seeing how, with climate change and all, it was likely that these kinds of extreme weather events would happen again and perhaps more frequently.

Extended blackouts are, of course, a serious matter. In addition to loss of lighting function, it means your refrigerator won’t work and thus all your food contained inside will spoil; it means no air conditioning, which could be a big problem at the height of summer; it means no television, which provides emergency information in times when disasters like this strike; and it means no cell phones because no recharging capability. These are all problems that can occur to anyone in the path of a typhoon, but in the cases of the people mentioned above it could be even more serious. We live in an area where a lot of infrastructure is not available. Most of us get our water from wells, and so we need pumps that are run by electricity, so that means no water for bathing and toilets. We also aren’t hooked up to natural gas lines, so unless you get propane deliveries, it probably means you run your household on an all-electric system, so that means no cooking or hot baths/showers. 

At least one local municipality has taken preliminary action to be more prepared, and in doing so may spark a trend that should be promoted nationwide. In the city of Sosa, on the Pacific coast, a group of environmental activists has set up a “solar sharing” operation that started out with farmers who allowed the group to install solar panels on tall stanchions above their fields. The panels absorb sunlight, but are far enough from the ground to allow peripheral sunlight to reach most of the ground underneath them, so the fields still produce crops. The farmers still sell their wares, and the sharing group sells excess electricity from the solar setup to the local power company and puts the revenue back into the local government, which uses the money to promote solar energy on a household-by-household basis. According to an article in Harbor Business Online, Sosa seems to be the only local government carrying out such a program. What’s particularly interesting is that, besides the money made from selling the electricity, the program has no relationship with any major power companies, which makes sense. Electricity providers are very concerned about people generating their own power for their own use, since it means using less electricity from the grid, which they control. However, after last year’s typhoons, many residents of Chiba have realized they can’t count on the grid and its overlords to guarantee service in the event of an emergency. 

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We’re on Twitter!

We recently opened a Twitter account under the catforehead moniker. The Twitter handle is @catforehead1. We will use it to tweet links to English or Japanese articles and other items on the internet related to housing in Japan. Please follow us and tell your friends about it. Part of the reason for starting a Twitter account is to attract more attention to this site as we look for a publisher for our book. If anyone could help us in that department, please feel free to contact us through this blog or through the Twitter account. Thanks.

Addendum to March 2014 Home Truths column

DSCF2401Here is this month’s Home Truths column, which is about moving house. Yesterday, we read in the newspaper an item that would have been suitable for the column but it was too late to include it. The Japan Trucking Association has issued a press release warning consumers that from mid-March to early April, moving companies are expecting a huge amount of demand–one-third of demand for the full year, in fact–and urges anyone who is thinking of moving during that time to put off the move until later. In our experience, people usually move house because they have to, and have to move during a certain period of time due to specific circumstances, such as a new job, new school year, or the availability of a rental or purchased residence.  In any case, March 3 seems way too late to make such a warning, but, then again, anyone who is planning to move during the period described and  hasn’t made arrangements yet probably deserves whatever difficulties arise when they finally do try to make arrangements. But in the end, you can always rent a truck and do it yourself, which we’ve done many times.

UR Ogikubo

Unfinished courtyard

Japanese apartment complexes often have pretentious, unwieldy names that are meant to add a touch of cosmopolitanism to otherwise nondescript residences; something you might expect from an industry that managed to convince people to adopt the English word “mansion” for condominiums. Earlier this week when we went over to Ogikubo in Tokyo’s western Suginami Ward to inspect the new UR apartments that are starting to accept applications for tenants I couldn’t quite make out the name, which sounded French, and I neglected to write down the romaji iteration after we got there, though I do remember is started with a “C” and had an “X” and some consecutive combination of “E” and “I.” Maybe a “U,” too; but whatever it was I couldn’t pronounce it on sight. Having returned home I see it rendered in katakana as シャレール. So let’s just drop the whole thing and call them the Ogikubo UR apartments. Read More

Thanks for nothing

One of the Aso administration’s economic initiatives that was retained by the Democratic Party of Japan when it took over the government last year was an allowance for people who had lost their housing as a direct result of having lost their jobs, because, in most cases, the place they were living in was either owned or subsidized by their employers. The DPJ plan originally earmarked ¥70 billion for this allowance, with an additional ¥30 billion for it in the new supplemental budget. Read More

Older and smaller

Six of the ten elderly people who died in a fire in a Gunma Prefecture nursing care facility last March had been sent to the facility by the Sumida Ward welfare office. Since the fire, the press has talked a lot about this practice of sending poor old people out of cities, where they can’t afford public facilities, to rural areas where the land values and thus the facilities themselves are cheaper. The Tokyo government has carried out an investigation into how to solve this problem, and they’ve come up with an idea.

The Tokyo government wants to increase the number of single rooms in so-called “care houses” by 2,400. Care houses are privately run housing complexes where single seniors–meaning people over 60 years of age–live by themselves. The facilities have baths and serve meals. The Tokyo government has found that rent for these care houses is prohibitively expensive since land agency regulations state that each room of a care house must be at least 20 square meters. The Tokyo government estimates that a 20 square meter room costs about ¥180,000, which is beyond the means of the government itself if it is footing the bill for indigent seniors. So they have asked the land ministry to reduce the minimum standard to 7 square meters, which is the size of a 4.5-tatami room. This, the government estimates, would cost about ¥100,000. In other words, you pay about half for a room that is only one-third as big.

As of 2007 there were only 259 care houses in all of Japan comprising 86,000 resident seniors. Fifty were in Tokyo.