“I wanted to take it, but I couldn’t do it over the weekend”, most medical offices being closed, she told AFP. Unable to get an appointment within 72 hours of having sex, when this emergency contraception is most effective, “I had to leave it to chance and I got pregnant”.

The morning after pill cannot be bought without the approval of a doctor in Japan, it costs up to 140 euros because it is not covered by health insurance and it is the only medicine that must be taken before a pharmacist to avoid the black market.

A government panel of experts was formed in October 2021 to study the possibility of making this emergency contraceptive available over the counter in Japan, as it is in North America, in most countries of the European Union and in some other Asian countries.

But gynecologists have expressed reservations, including that it could promote the spread of sexually transmitted diseases by encouraging casual and unprotected sex.

Megumi Ota decided to terminate her pregnancy after her partner, who had refused to use condoms, reacted coldly to the news.

“I felt helpless,” says the 43-year-old woman, who was 36 at the time and now runs a support group for victims of sexual trauma.

– “Paternalistic tendency” –

Japan has high-quality medical care, but it was ranked 120th out of 156 countries in the World Economic Forum’s 2021 Gender Equality Report.

“In the Japanese system, there is a perception that women could abuse” their reproductive rights, indignant Asuka Someya, a 36-year-old defender of these rights.

“There is a strong paternalistic tendency in the medical world. They (doctors, editor’s note) want to keep women under their control”.

The debate in Japan comes as the US Supreme Court is set to overturn a 1973 ruling guaranteeing access to abortion across the country.

An estimated 610,000 unplanned pregnancies occur each year in Japan, according to a 2019 survey by German pharmaceutical group Bayer and the University of Tokyo.

Abortion – legal in Japan since 1948 – is possible up to 22 weeks, but the consent of the spouse is required, with rare exceptions, and the surgical procedure is for the moment the only option authorized in the archipelago.

A British pharmaceutical company, Linepharma, applied last year in Japan for authorization of its abortion pill for use in early pregnancy, but discussions are continuing.

Termination of pregnancy is not reimbursed by health insurance and the operation can cost between 100,000 and 200,000 yen (between 700 and 1,400 euros), late abortions sometimes being even more expensive.

Asuka Someya, who had an abortion when she was a student, says she was “terrified” when she was told that the operation could leave her sterile. “But I thought then it would be my fault.”

– “It needs to change” –

The male condom is by far the preferred contraceptive method in Japan, and alternatives are not widely promoted.

The contraceptive pill was approved in 1999 in the country after decades of deliberation. It is taken by only 2.9% of women of childbearing age, compared to around a third in France and almost 20% in Thailand, according to a report by the United Nations in 2019.

Gynecologist Sakiko Enmi, who is campaigning for better access to the morning after pill, asks the Japanese government to stop dragging its feet: “That has to change”.

Levonorgestrel, a drug used in emergency contraception to delay or prevent ovulation, has been legal in Japan for more than ten years. But “it does not reach those who really need it because of its low accessibility and its price”, regrets Ms. Enmi.

Women can now visit a doctor online to get a prescription, but they still have to take the morning after pill in front of a pharmacist.

A government panel rejected making it available over-the-counter in 2017 and many doctors remain opposed to it.

Last October, a survey by the Japanese Association of Obstetricians and Gynecologists (JAOG) revealed that 92% of professionals questioned said they had concerns on the subject, in particular on the misuse of this emergency pill.