First Trimester Abortion in Japan
12 May 2022, British Society of Abortion Care Providers(BSACP)

By Sam Rowlands*1

There are signs that mifepristone may be coming to Japan – after it became available in China and France in 1988. Mifepristone is now approved for use in early medical abortion in 82 countries (https://gynuity.org/resources/list-of-mifepristone-approvals). Based on more than 30 years of clinical study, the safety, effectiveness and acceptability of mifepristone and misoprostol used for early medical abortion is beyond any doubt.1-3

Linepharma has applied for marketing approval for a combi-pack of mifepristone and misoprostol in Japan (https://exbulletin.com/world/1357452/). If approved, this would provide choice of a medical abortion for the more than 150,000 Japanese women who currently have surgical abortions each year. Acceptability and satisfaction with the abortion process is greatest when women can choose between methods and receive their preferred method.4

The Japan Association of Obstetrics & Gynaecology (JAOG) has stated that medical abortion should only be performed in a hospital setting, not in community health facilities (https://okumi.hatenadiary.com/entry/2022/05/05/124733). This is contrary to the World Health Organization (WHO) guideline recommendation 50 which encourages self-administration of abortion medicines outside of a healthcare facility and self-management of the abortion process.5

JAOG has also said that the fee for this service should be no different from that for a surgical abortion (about US$875). This seems to us unreasonable when the vast majority of women having a medical abortion do not need to occupy treatment room or operating theatre facilities.

Some doctors in Japan have said that use of vacuum aspiration is not practised much in Japan because of the risk of cross-infection from the aspiration system and that the instruments are more difficult to clean. The fact is that the cannula/syringe used in manual vacuum aspiration and the cannula/tubing used in electric vacuum aspiration are all sterile and single-use in high-resource countries.

A survey in Japan of all abortion providers’ practice during the year 2019 has shown that in hospitals only one-quarter of abortions are being done by vacuum aspiration alone; three-quarters are done by dilation and curettage (D&C) alone or by vacuum aspiration combined with curettage.6 In this study, complications were found to be higher in procedures using D&C than in those using electric vacuum aspiration. This use of D&C for surgical abortion in the first trimester is contrary to the WHO guideline recommendation 23 at paragraph 3.4.15 and is considered obsolete in modern practice.7

We welcome this move to approve mifepristone which potentially affects 25 million women of reproductive age in Japan. We call on the Japanese Ministry of Health, Labour & Welfare and the JAOG to pay attention to the extensive scientific evidence on the delivery of both medical and surgical abortion services. The introduction of early medical abortion should be done in such a way as to take into account the extensive worldwide experience and its proven safety track record. There should not be unnecessary restrictions to access such as excessive cost or overmedicalisation. Then the women of Japan will truly be able to benefit from the choices that now exist as a result of scientific progress.


日本産科婦人科学会(JAOG)は、薬による中絶は地域医療施設ではなく、病院でのみ行われるべきであると表明しています(https://okumi.hatenadiary.com/entry/2022 /05/05/124733)。これは、医療施設以外での中絶薬の自己投与と中絶プロセスの自己管理を奨励する世界保健機関(WHO)のガイドラインの勧告50に反するものです5。
(文 Sam Rowlands*)

1. de Costa C, Carrette M. Early medical abortion. In: Rowlands S, ed. Abortion Care. Cambridge: Cambridge University Press, 2014:62–70.
2. Aiken A, Lohr PA, Lord J, et al. Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG 2021;128(9):1464–1474. doi: 10.1111/1471-0528.16668.
3. Schummers L, Darling EK, Dunn S, et al. Abortion safety and use with normally prescribed mifepristone in Canada. NEJM 2022;386:57–67. doi: 10.1056/NEJMsa2109779.
4. Kapp N, Lohr PA. Modern methods to induce abortion: safety, efficacy and choice. Best Pract Res Clin Obstet Gynaecol 2020;63:37–44.
5. World Health Organization (WHO). Abortion Care Guideline. Geneva: World Health Organization; 2022. https://apps.who.int/iris/handle/10665/349316
6. Nakamura E, Kobayashi K, Sekizawa A, et al. Survey on spontaneous miscarriage and induced abortion safety at less than 12 weeks of gestation in Japan. J Obstet Gynaecol Res 2021;47(12):4158–4163.
7. Roblin P. Vacuum aspiration. In: Rowlands S, ed. Abortion Care. Cambridge: Cambridge University Press, 2014:71–79.

*1:Sam Rowlands医師は、“Abortion Care” Cambridge University Press; Illustrated edition (October 20, 2014)の編者で、強制不妊の問題を論じた‘Legalised non-consensual sterilisation - eugenics put into practice before 1945, and the aftermath. Part 1: USA, Japan, Canada and Mexico(同意のない強制不妊手術―1945年以前に実行された優生学とその後)’の共著者の一人として、日本の旧優生保護法の問題にも通じています。後者の論文は、日本の旧優生保護法被害者の控訴審の専門家意見書の資料として翻訳・提出されています。