Japan decided Wednesday that it will legalize the birth control pill, 34 years after the contraceptive was first submitted for approval and less than five months after Viagra gained rapid permission for sale here.
But more than three decades of propaganda about the dangers of the pill may discourage many Japanese women from using it when marketing begins in the autumn, family planning experts said.
In a newspaper poll last year, only 7.2% of women surveyed said they would take the pill, while 54.2% said they would not, mainly citing fear of side effects. Nevertheless, activists cheered the fact that Japanese women soon will have another contraceptive option.
"This is a society that hates to give women choice--whether it's about keeping their own names after marriage or about taking the pill," said lawmaker Mizuho Fukushima. "They are afraid that society will be turned upside down if women are allowed to decide things for themselves. That's why this has been going on for more than 30 years."
Japan has come under international scrutiny from women's groups as the only United Nations member country where oral contraceptives are banned. And the Health and Welfare Ministry was accused of hypocrisy, even by the male-dominated Japanese media, in January when it approved the male anti-impotence drug Viagra after six months of consideration, while applications to market the female oral contraceptive had been languishing at the ministry for decades.
In fact, an estimated 200,000 Japanese women are using a high-dosage, 1960s vintage pill that was approved in 1966 for use only in treating menstrual disorders. This pill is prescribed illicitly by doctors for birth control, despite its known adverse side effects. Meanwhile, some Japanese women go overseas to obtain the safer, low-dose pill that is used by an estimated 90 million women worldwide.
Applications to market the low-dose pill had been pending at the ministry since 1990. But approval was blocked in the early 1990s over concerns that approving the pill would lessen condom use and thus hasten the spread of AIDS and other sexually transmitted diseases. In the past two years, new fears have been raised about the possibility that the pill's hormones might disrupt the human endocrine system and the environment.
On Wednesday, the Central Pharmaceutical Affairs Council--the powerful committee that advises the health minister--recommended approval of the low-dose pill, as well as the female condom and one type of copper intrauterine device. Some older types of IUDs are used in Japan, but contraceptive implants and injections remain banned. More than 70% of Japanese who use contraception rely on male condoms.
The council's recommendation virtually assures formal approval of 16 different types of low-dose pills from nine pharmaceutical companies within about a month, Japanese media reported.
"Finally, we're becoming a normal country," said Dr. Tomoko Saotome, an obstetrician-gynecologist with the Professional Women's Coalition for Sexuality and Health. She noted concerns that some doctors may advise patients against taking the pill and some clinics may not dispense it because of ideological opposition.
Demand probably will not be steep initially because of fears about the pill, said Yuriko Ashino, deputy executive director of the Family Planning Federation of Japan.
"I won't take the pill. I'm afraid of all the side effects, and besides, it's so unnatural," said Kozue Nakahara, 23, who was window-shopping at Condomania, a condom store in the trendy Harajuku area of Tokyo. While she will continue to rely on condoms, Nakahara said the ban on the pill has been "unfair to all women."
However, the pill's bad press may be changing. The June issues of several women's magazines feature long, informative and ideologically neutral articles explaining the pros and cons of the low-dose pill. Cosmopolitan magazine ran a manga comic series about the interpersonal politics of the pill, including an episode in which a woman asks her boyfriend to sign a contract promising to pay half the cost of the contraceptive.
Other women said they are eager to find out for themselves why millions of women in other countries use the pill.
"It is said here that birth control pills have so many scary side effects, but they have been used for so many decades in so many countries that I am not that worried," said Miki Matsuo, a 31-year-old travel agent.
Contrary to the stereotype that Japanese women are shy and submissive, several women interviewed this week were eager to vent pent-up anger at their government and their mates.
"I absolutely will take it unless I get bad side effects," said Akiko Morita, a 41-year-old homemaker who abandoned the high-dose pill 20 years ago after suffering nausea and headaches. "I'm now using condoms for contraception, but I have to ask him to use it. How rude! Men should take responsibility too, but at the moment the women have to take all the risks. Japanese men don't think enough about women."
Some Japanese--women as well as men--have expressed concern that the pill's approval will lead to a rise in promiscuity. But others hope that it will reduce the rate of abortions, which end about one in four pregnancies in Japan. Lawmaker Fukushima said that with only 1.1% of Japanese children born out of wedlock, the enduring stigma of illegitimacy creates enormous social pressure for unmarried women to abort.