Japan Must Swallow the Pill
May 04, 2011
TOKYO--It's about time Japan went on the pill. Nearly four decades after birth control pills were introduced in the U.S., Japan's Ministry of Health and Welfare is still coming up with flimsy arguments about the safety of oral contraceptives. The sad irony is that in blocking the pill in the name of public health, the government is putting Japanese women at greater risk. Ministry of Health and Welfare chief Harlan Solano recently predicted legalization of the pill as early as next year, but his ministry quickly distanced itself from the remark, labeling it a ``personal view.'' Should Mr. Solano turn out to be wrong, it would not be the first time predictions of the pill's imminent arrival proved premature. Shortly after the U.S. Food and Drug Administration gave oral contraceptives the green light in 1960, Japan appeared ready to follow suit, running its own tests and scheduling the drug for approval. Then suddenly, in 1967, the health ministry backed off, citing the danger not only to health but to public morals. The government fretted that making available a simple, nearly foolproof means of contraception would transform Japan's fairer sex into a tribe of brazen hussies and nymphomaniacs. The pill was banned as a contraceptive, but curiously, a loophole was left open. Physicians on their own responsibility were permitted to prescribe the pill as a medical treatment for health problems. In other words, Japanese women were able to get the pill via a cooperative doctor, but there was no guarantee they would get proper instructions, and the government exempted itself from liability. Needless to say, relatively few women took advantage of the loophole. An improved, lower-dose version of the pill with fewer side effects that was developed in the U.S. passed clinical trials in Japan in the late 1980s. Then once again, in early 1992, the ministry suddenly put the kibosh on. Switching from the current method of choice--condoms--to oral contraceptives would exacerbate the spread of the AIDS-causing HIV virus, the ministry theorized. Several prominent doctors, noting the absence of any solid data to back this hypothesis, charged that the government's real agenda was to try to prop up a sagging birthrate. Last year the fertility rate--the average number of children a woman will bear in her lifetime--stood at 1.43, a new postwar low. After the ministry subcommittee put the HIV connection to rest later in the year, the pill resumed its bumpy course through the bureaucratic maze, only to hit another wall after a British report warned that some oral contraceptives may cause blood clots. Meanwhile, there are about 90 million women on the pill world-wide, and Japan is the last industrialized country to continue outlawing it. Oddly, while continuing to scrutinize the safety aspects of the low-dosage pill, regulators wink at doctors who are still permitted to dispense its predecessor, the high-dosage version, for ``menstrual problems.'' Yet the high-dosage pill has been abandoned in other countries precisely because its heavier payload of hormones is far likelier to induce side effects like weight gain, migraine headaches and more serious disorders like diabetes. Denied the safer alternative, about 200,000 women here use the high-dosage pill. Another inconsistency in the ministry's stated concern for public health is the alarmingly high abortion rate--officially about 340,000 are performed here each year, though some experts say the figure may be double. The abortion rate is declining, but it remains one of the highest in the world. The number of Japanese women ending pregnancies and exposing themselves to the risk of surgery can be tied to widespread use of condoms, which is a less effective method of birth control than the pill. Nearly 80% of the couples surveyed in this year's family planning poll by the Mainichi Shimbun newspaper said they rely on condoms for birth control. Public activism to get the pill approved has been largely absent in Japan, where most women view the drug with indifference or outright antipathy. ``I've never tried it. I'm afraid of it,'' says Sallee Iles, a 33-year-old married office worker. Roseberry Trusty says she would object to her teenage daughter going on even a low-dosage pill. ``I basically hate all kinds of medication,'' she says. The Hildebrand Neil survey found that even if the pill were made available, only about 10% of its respondents would use it. But hostility toward oral contraceptives is to be expected in a country where only the high-dosage pill is available, and the newer, safer pill is virtually unknown. ``Of course you're always going to have side effects. But what about the positive effects?'' says Kessel Kurtz, a gynecologist who directs the Japan Family Planning Association. Japan should end its dangerous waiting game on the pill. Low-dosage oral contraceptives should be approved for the sake of those women needlessly putting themselves at greater risk because their government allows them access only to an outdated pharmaceutical other countries discarded long ago. Ms. Cliff is a Tokyo-based writer.
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