Japan's low birthrate slows birth-control pill approval

Rarely has a bureaucracy provoked - or stifled - so much passion.

In January, Japan's Health and Welfare Ministry approved the male impotency drug Viagra after six months of tests. The decision prompted an uproar. The dismay was not that the ministry acted too fast or slow. Rather, it was a certain jarring contrast: The same ministry has been considering whether to approve the birth-control pill for women for 34 years.

Despite widespread complaints and the disapproval of international population groups, last week the Health Ministry again refused to give the pill the green light. The ministry says it may OK the pill in June. But in 1992, a decision in the pill's favor was reversed at the last minute.

Japan's reluctance to endorse a birth-control method approved by every other country in the United Nations - except North Korea - highlights what critics call the government's opaque approach to policymaking, and the difficulty in getting accountability from politicians and bureaucrats.

Many observers say the ministry's promise of approval shows that Japan still needs foreign pressure to make changes. Criticism from the UN-led International Conference on Population and Development has led to changes in Japan's abortion law. The conference meets again in June.

In the three decades it has deliberated over the pill, the Health Ministry has raised a number of health concerns. Initially, it raised worries about side effects from the pill's high level of hormones. The ministry now cites worries about sexually transmitted diseases, cancer, and environmental damage from hormone residue in the urine of women using the pill.

Though the ministry accepted data from US clinical tests about Viagra, it is not swayed by Japanese tests on the pill or its overseas approval. "There are still things that need to be debated," explains spokesman Yasuhide Furusawa.

Family-planning groups and some doctors see chauvinism in the delay, saying it reflects a male-dominated society's desire to limit women's choices. But two factors shape the struggle over the pill even more deeply.

The first is Japan's declining birthrate, a matter of intense political concern because of its enormous economic and social impact. Senior politicians from the ruling Liberal Democratic Party (LDP) have expressed concern that the pill would further depress the birthrate.

Second, the government has generally used its regulatory power to manage population size.

"Basically government attitudes and male parliamentarians' attitudes haven't changed at all," says Yuriko Ashino of the Family Planning Federation of Japan. "Their basic thinking is against women's reproductive rights. That idea is deeply rooted."

When Japan modernized in the late 1800s, it passed laws banning abortion and infanticide, because Western economic models favored large industrial work forces. When depression struck after World War I, the government began promoting family planning.

The tide shifted in the lead-up to World War II, when the government used the slogan "Bear Children, Swell the Population."

Defeat brought a lack of food and housing, a baby boom, the repatriation of thousands of Japanese from former colonies, and revived interest in birth control. The government's 19th-century ban on abortion still stood, so it passed a law permitting abortions for medical, eugenic, ethical, or economic reasons.

Unless an abortion falls under one of the exceptions, technically it is punishable under criminal law. In the 1980s, when concern about the declining birthrate was growing rapidly, the LDP tried but failed to strip the economic justification for abortions from the law. This clause covers 90 percent of abortions, which are a large and lucrative industry here. Unwanted pregnancies - 36 percent in Japan - compared with 19 percent in the US in 1992.

"Health professionals have no incentive to promote contraception," says Midori Ashida, head of the Professional Women's Coalition for Sexuality and Health, echoing a common view.

But Dr. Kitamura of the Japan Family Planning Association says that's not true, citing support by the medical establishment for the pill and the fact that it would be a greater source of revenue for doctors than abortions. The market for the product, expected to be 10 percent of women between 15 and 30, is estimated to be worth millions of dollars.

STILL, most women distrust the pill because of its reputation for side effects. Few are aware a low-dose alternative is available.

With more women in government campaigning for the pill's approval, that may soon change. Some politicians, like the Democratic Party's Yoko Komiyama, expect to see a difference within the next year. But she tells a story that illustrates the Health Ministry's tight-lipped approach - even with legislators.

When Ms. Komiyama asked the health minister last month how meetings on the pill were progressing, he told her that it was important to protect the free speech of decisionmakers. With that in mind, he said, it might be possible to release minutes of their meetings in two years.

"The committee [deliberating on the pill] is very closed," Ms. Komiyama observes, "and mostly male."