Japan approves abortion pill

Justin McCurry氏による投稿 2023年5月23日

The Lancet World Reportの記事を見つけました。なんと、私のコメントが載っているじゃないですか!? 確かに取材は受けたけど、記者からこの雑誌に載せたとは聞いていませんでした。しかも日本の中絶事情が間違ってる……急いで連絡を取ります!

Article info

Experts say that tight restrictions mean that the drug's approval will probably limit widespread access. Justin McCurry reports from Tokyo.

Japan has approved for the first time the use of an abortion pill, but sexual health campaigners say the long-awaited move is unlikely to widely improve the reproductive rights of the country's women.

The Health and Welfare Ministry approved the treatment, manufactured by Linepharma International, at the end of April, well over a year after the company had submitted its application. Mefeego is a two-stage treatment that begins with mifepristone, which suppresses the hormone needed to sustain pregnancy and, 36–48 h later, misoprostol, which constricts the uterus. The treatment must be taken orally within 9 weeks of the onset of pregnancy and, if taken as directed, is 93·3% effective according to clinical trials.

Japanese health authorities have come under mounting pressure to introduce abortion pills available in many other countries—eg, in France for more than three decades—from women's rights campaigners who feared a repeat of the 40-year push to approve oral contraceptives, finally approved in 1999. Previously, only surgical abortions were available in Japan, in the first 22 weeks of pregnancy.
Although Mefeego has potential side-effects, including mild abdominal pain and vomiting, WHO includes the medication on its list of essential and safe abortion drugs. The Mefeego pack is available in around 80 countries, according to Linepharma, although it is not clear when prescriptions will begin in Japan.

Restrictions on the pill's use mean it is unlikely to signal a breakthrough in access to abortion in Japan. Women undergoing the treatment must remain in hospital until the termination has been confirmed by a doctor, and the pill—like surgical abortions—will not be covered by health insurance. Surgical abortions in Japan cost between ¥100 000 and ¥200 000 (£587–1174), with late-stage terminations sometimes costing more. Although no price has been set for Mefeego, the pill pack is expected to cost around the same as a surgical abortion. Additionally, women seeking to take the drug must have the written approval of their spouse, a requirement that campaigners say effectively deprives them of their full reproductive rights.

The need for third-party consent generated a public debate in 2021, when a 21-year-old woman was arrested after the body of her newborn baby was found in a park. She received a suspended sentence after telling the court she had been unable to end her pregnancy because she could not gain the written consent—demanded by her doctors—from her partner. The Health Ministry has since advised the Japan Medical Association that exceptions can be made when the spouse is unknown or unable to make a decision on the proposed termination, as well as for unmarried women and those who become pregnant as a result of rape.

But the high price and strict conditions applied to the abortion pill could deter many women in Japan, where there were 126 174 abortions in the year ending March, 2022, according to the Health Ministry. Most of those terminations used vacuum aspiration, but the curettage method, which requires the removal of tissue from the uterus, was used in 24% of cases, despite warnings from WHO that it has become “outdated” as it could result in complications.
Linepharma applied for Mefeego approval in December, 2021, and a decision had been expected earlier this year. But it was held up by 12 000 submissions by the public, about a third of which reportedly objected to the pill's approval. The unusually large number of submissions reflects the controversy over the availability of abortion in Japan since it became legal in 1948. Action for Safer Abortion Japan has urged the Health Ministry to keep hospital stays to an absolute minimum, adding that decisions on subsequent visits should be left up to the woman. The campaign group also said Mefeego should be covered by national health insurance or its use subsidised by the Government, and that spousal consent should not be required.

Kumi Tsukahara, Director of the Reproductive Health Rights Literacy Institute, said she welcomed the pill's approval, but said the cost and restrictions were “totally unfair”. “Providing abortion pills in this way…will create barriers to access for those who need this medicine”, Tsukahara told The Lancet. “They are violating [a woman's] right to access methods and information for safe abortions as written into treaties and human rights covenants.”
Tsukahara said she feared that many women will give up on using the treatment when they learn they could have to make multiple visits to the clinic and be kept there “at the most physically and mentally distressing time”. She added: “I fear that the high fees and inaccessibility mean that the abortion pill will not be widely used, even after decades. And if the number of people using them doesn't increase, pharmaceutical companies offering inexpensive generics may give up on entering the Japanese market.”