Japan May Soon Have 'Pill'

Decades-old oral contraceptives near official approval

FOR all its high-tech trendiness, Japan has not followed Western nations in accepting one modern discovery: oral contraceptives, otherwise known as "the pill."But after missing out on the social revolution that the pill has wrought in other countries since the 1960s, Japanese women may soon be offered the drug by their doctors. The Japanese Ministry of Health and Welfare is expected to approve the pill sometime next year, some 30 years after its introduction in the West. Yet when the pill is released, it may be met with little enthusiasm from Japanese women. "It's not natural to constantly raise one's body temperature," says a 21-year-old woman at a gynecological clinic. "Even if the pill is made accessible, I doubt I would use it." While nearly 30 percent of women would welcome the additional choice in birth-control methods, only about 10 percent say they would use the pill, and more than half say they would not, according to a poll last year by the Japan Family Planning Federation. "It is physically hard for women to keep taking pills every day. It's like losing your natural rhythm," says Miyoko Kohno, a Hiroshima gynecologist. "I doubt if many women, especially teenagers, would actually take the pill." Even some feminists are skeptical of the pill's use, fearing that it would lead to a lopsided burden on women in a relationship. "There is a concern that it would allow men to be irresponsible, pushing the physical burden of birth control solely on to women," says Yuriko Ashino of the family-planning federation. Japan's interest in oral contraceptives dates back to the 1950s, when a group of doctors began research on the topic with government support. For reasons still shrouded in mystery, the process of approval of the pill was suddenly stopped in 1965. The official reason was concern over its side effects. "Since 1965, there had been an unspoken rule that oral contraceptives are not to be allowed in Japan. The ministry didn't allow any import of such drugs, even for industrial research purposes," says a pharmaceutical company scientist, who asked not to be identified. One widespread theory is that the wife of then Prime Minister Eisaku Sato, together with some new religious groups, strongly opposed the measure on moral grounds. Another theory, highlighted by Dutch journalist Karel van Wolferen in his 1989 book, "The Enigma of Japanese Power," speculates that the Japan Medical Association opposed the pill because it would reduce the lucrative abortion business of many doctors. Dr. Kohno disputes this argument by saying that legalization of the pill would not reduce the number of abortions in Japan. "Most women, especially teenagers, are not comfortable with the idea of taking drugs every day," she says. So why, after more than two decades, is the pill again nearing approval? The reason, says Dr. Kunio Kitamura, director of Japan Family Planning Association, is the development of low-dosage pills abroad in the early 1980s. Other experts assume that the Japan Obstetric and Gynecological Society also has reassessed the pill's impact. Although many abortions are likely to be unreported, Japan probably has a lower number of abortions in proportion to its population than the United States because of cultural restraints, says Kitamura. By far, the most common contraceptive in Japan is the condom, used by 73 percent of couples practicing birth control, according to a family-planning federation poll. With such widespread use of condoms and also the rhythm method, many women will likely see the pill as a distant option. "In Japan, the pill is just another word for side-effects," says Dr. Kitamura. Adds Tokyo gynecologist Dr. Shizuko Sasaki, "At a time when women are becoming health conscious, I don't think they would welcome the pill." Still, pharmaceutical companies are eagerly awaiting the pill's debut in Japan. Even if 10 percent of eligible women use it, the firms see enormous profits. The one possible hitch to final approval of the pill is that the government has recently become worried about Japan's declining birthrate, 1.53 percent, one of the lowest among industrialized nations.