The spread of the birth control pill in the West more than three decades ago is widely regarded as a milestone in the liberation of women and a turning point in social history.
So when is the pill coming to Japan? One of these years, the government says.
Japan is one of a tiny number of countries — perhaps the only other is North Korea — where the pill is still banned for contraceptive purposes. But these days there are signs that the pill may be legalized in the next few years, perhaps even next spring, and the next question is whether women will use it.
For now, the answer many Japanese women offer is: not me!
“I don’t think I’ll use it,” said Sayuri Ogawa, 36, a gynecological nurse. “There are many other contraceptive measures. I don’t mind if other people use it, but I myself don’t dare.”
Japanese women tend not to see the pill as an icon of feminism or of sexual liberation, but rather as an untrustworthy chemical concoction that affects the natural rhythm of their bodies.
In Japan the condom is the most widely used form of birth control — the choice for contraception three-quarters of the time, according to surveys — followed by withdrawal. When condoms fail, for they are one of the least reliable forms of contraception, many women turn to abortion, which is easily available here.
“Japanese women have reached a certain stage, mentally, so that whether or not the pill is approved we are already making our own decision as to whether to have a baby,” said Chiemi Amano, 44, who runs an export-import company with her husband. “The approval of the pill would not be a new advancement for women.”
Women obviously have a say in the making of babies, and indeed, even without the pill, many are not having them. Based on current birth rates, the average Japanese woman is expected to have just 1.4 babies, and this is one reason the government has not been pushing the pill: It worries that effective contraception would lower the birth rate even more.
Another concern is AIDS and the fear that use of the pill rather than condoms would allow the disease to spread. But tests showed no higher incidence of AIDS among those who use the pill.
So the Ministry of Health and Welfare may recommend approval next spring, and American pharmaceutical companies like the idea of millions of Japanese women taking their product every morning.
But even if the ministry lifts the ban, there will be another battle to win over the Ogawas of Japan. While millions of women around the world take the pill for granted, in Japan the pill conjures up painful memories, awkward feelings and a general sense of aversion.
Some remember Japan’s thalidomide babies, who were born two to three decades ago with shortened arms after their mothers took sedatives to alleviate morning sickness. Some have heard about side effects that may occur with high-dosage pills, which were once used in Japan.
Others say not enough research has been done about the potentially serious side effects, like cardiovascular disease, weakened immunity, cervical cancer and thrombosis, a serious blood-clotting affliction.
“Since this is a male-dominated system, the side effects tend to be neglected,” said Reiko Takeda, a gynecologist and hormone specialist who endorses condoms over pills. “We should not be like that. Women should study about the side effects more seriously.
“If someone has to have sex every day, like 30 times a month, in that case, a pill would be necessary. As one of the choices, it is necessary. But we should avoid it as much as possible.”
A stronger form of the pill is currently available in Japan for medical purposes, and some women are using it as a substitute for the low-dose contraceptive pill normally taken by American women.
When Amano, who has two older children, once had a gynecological problem, her doctor prescribed the pill. She took it, but vomited and felt so sick that she stopped taking it after about three days.
“I have the image that it could be a dangerous thing because of the side effects, but I’m interested in using it,” Amano said. “But I may not have the courage to take it.”
Some women worry that taking the pill would send a signal of promiscuity.
Indeed, for many women, the pill could upset the delicate dynamics in the relationship between Japanese men and women.
Even married women tend not to discuss contraceptives openly with their husbands, and traditional Japanese men often are used to having women follow their lead, especially in sex.
Yumiko Kurita, a 43-year-old married woman who spent a year in the United States, said she was awed by the independence of American women, who made their own decisions about whether to take the pill.
“I thought they were basically different from us, they were so independent in their lives, while we just followed our men,” Kurita said. “But even now, if I look back, I have to say, I couldn’t do that.”
Kurita says she is a traditional Japanese wife, and when her husband stumbles in the door at 2 or 3 in the morning, she is up waiting to welcome him home.
Since her husband is a doctor, she is never wanting for medical advice. But when she has questions about contraceptives, she asks her gynecologist, not her husband. In fact, she says, contraception is not so essential, anyway.
“Considering how busy my husband is, there’s no danger — I don’t have to talk with him about contraceptives,” she said. “He’s so busy that we go for two, three months without a relationship, sometimes even six months.”
Other women quietly worry that if they took the pill, they would scare away their men.
“There is a feeling among men that it is intolerable that women take the lead, and, if women did, it would hurt their pride — it is the Samurai principle that men should take the lead,” said Dr. Ikuko Ikeshita, who promotes the pill. “The husband of one of my patients started not wanting to have sex with his wife when she started to take pills.”
Doctors say some women do not even consider whether to use contraceptives, leaving the matter totally in the hands of their partner, who is not always so careful. For Ikeshita and others, that means that abortions end up becoming a dangerous form of birth control.
“Between married couples, wives often have difficulty asking their husbands to wear condoms,” said Nobuko Sema, an advertising manager who formed a small informal group to support the pill. Sema, who is divorced, added half-jokingly: “I told my husband very clearly my views, and that may have been the cause of our divorce.”
Japan has among the best health statistics, with the lowest infant mortality rate in the world and better health care coverage than the United States. But only 56 percent of women of childbearing age use any form of contraception, including condoms, and education about sex and human reproduction is sparse or virtually nonexistent in schools.
The Education Ministry ardently defends its reluctance to have sex taught in the classroom. “Some people say the United States gives more sex education to kids,” said Kazunari Asunuma, an official in charge of sex education. “But then, who has more teenage pregnancy?”
Kazuyo Kariya, a 25-year-old gynecological nurse, has been explaining the merits of the pill to all her friends.
“My first choice would be the condom, and then the pill,” she said. “Even if the pill is a low-dose pill, it doesn’t mean it is totally free of side effects. And a condom is successful at least 90 percent of the time.”
Her second reason for not taking the pill may also echo a common attitude.
“I have no intention of taking the pill,” Kariya said. “I am single. I have no steady partner, so I have no opportunities for sex.”
