For some people, becoming pregnant in Japan is great news. It can be the start of an exciting new chapter of your Japan life, and a source of great happiness. However, for some women, carrying an unplanned pregnancy to term feels like an impossible prospect, whether due to financial constraints, social pressure, health or personal reasons. If this happens to you, you have options.
Depending on your home country, attitudes and regulations regarding abortion may be more or less lenient than you are used to. In Japan, abortion is legal if it’s related to preserving physical health, in the case of rape or incest, or for economic or social reasons. It is also not uncommon. Though slightly questionable due to underreporting, according to the Ministry of Health, in 2016 there were 168,015 abortions in Japan.
If, for any reason, you need to go through this frightening situation, here is some basic information on what to know before you do it — and how to be prepared for it.
What to know in advance
If you suspect that you might be pregnant and are considering termination, act quickly as it becomes more difficult (and expensive) to abort the further you are into your pregnancy. Medical abortion (‘the abortion pill’) is not available in Japan. The only option is a surgical abortion, which can be performed in many ob-gyn clinics in Tokyo. Abortion is legal until the third trimester, after which it can only be performed if the life of the mother is threatened.
Something that might be shocking to women from western countries is that Japan requires the consent of the father for an abortion to be performed. The only exception to this is if you can document that the father is missing, deceased, or that the pregnancy is a result of rape. In reality, however, the clinic will not verify who the actual father is, so if you are not comfortable with involving that father, you can ask (or bring along) a male friend to sign the consent form instead.
When booking your abortion appointment with the clinic, the staff will instruct you where to obtain the consent form and what to bring on the day of your appointment. Typically, the form can be downloaded from the hospital’s website, as in the case of Tateyama Ladies’ Clinic which we mention later in the article.
Abortion is not covered by the Japanese national health insurance so you will have to pay for the procedure yourself. First trimester abortions (up to 12 weeks under the Japanese system) cost around ¥100,000. Second-trimester abortions can cost ¥200,000 or more due to the greater complexity of the process and the additional hospital services involved.
The actual procedure
First trimester abortions are typically completed in half a day. The exact details of the procedure will vary by clinic and your individual situation, but the following is what you can expect on the day of the surgery.
On arriving for your appointment you will first be taken into a separate room where a nurse will confirm your documents (specifically, the signed consent form by the father), will ask you a few things related to your general health and allergies, will collect the payment for the procedure and will have you get changed and ready to meet the doctor.
Once inside the doctor’s room, you will be placed on an IV, given medication and may wait an hour or two for your cervix to soften. You will be placed under anesthetic — whether it’s local or general will depend on the circumstances. After the procedure, you will be allowed to rest for a while in a separate room at the clinic to recover your strength. You may experience bleeding afterward and some clinics require you to bring your own sanitary towels so be sure to ask. The clinic will provide you with medication to take in the coming days to aid healing and prevent infection and will typically ask you to visit them again within a week to see if you’re healing well and there are no complications.
Following the surgery, you will not be able to drive and even if you intend to use public transport, it is probably a good idea to ask a trusted partner or a friend to pick you up and make sure you get home safe.
Second-trimester abortions are more complex and costly, typically requiring a hospital stay of a few days and the provision of a death certificate of the fetus (as well as placement of the fetus in a cemetery, if you wish).
The following are Tokyo based ob-gyn clinics that also offer abortion. Please note that, while all of these options have English language support to some degree, not all medical or administrative staff will speak English and so it would be wise to call ahead to discuss your language options.
- Toho Women’s Clinic, Kiba
- Ikenoue Obstetrics and Gynecology, Setagaya
- Oak Clinic, Ginza
- Kioicho Ladies Clinic, Nagatacho
- Tateyama Ladies’ Clinic, Minato-ku (Aoyama Itchome)
If an English speaking ob-gyn is unavailable to you, you could opt for medical translation. Japan Health Info can provide this service for you if you are up to 10 weeks pregnant, and they may also be able to assist you with finding the healthcare provider.
Aftercare and psychological support
Although your ob-gyn will provide you with medication to ease the physical after effects, psychological support in most cases is minimal. Most women who voluntarily opt for an abortion feel relief after it is all over, but it is also normal to experience a wide range of emotions. You may find it helpful to talk about your feelings with your partner or a trusted friend or family member. If the psychological aftereffects are interfering with your daily activities, reach out to one of the many excellent English language mental health resources in Tokyo such as TELL Japan.
Foreigners considering an abortion in Japan may take comfort from the testimonials of women who have been in the same situation. Two women who have had abortions in Japan agreed to share their experiences with Savvy Tokyo anonymously. Both women were satisfied with their quality of care and have now recovered physically and emotionally from the experience.
The first woman undertook abortion as an outpatient procedure and went home the same day.
“The procedure itself was quick, and I was put under enough anesthesia to not feel pain, but I was conscious the entire time. My friend came and picked me up because I wasn’t allowed to drive afterwards. I was given three days’ worth of medicine to stop the blood flow and shrink my uterus, but after three days I had to return to work and wasn’t allowed to use tampons (due to risk of infection) which meant running to the bathroom between every class to change my pad due to all the bleeding. The procedure was expensive but very clean and professional and made the emotional experience of having an abortion a little bit easier. I did have to see the final ultrasound and was asked “Are you sure?,” but there was no shaming and despite the circumstances, it was a relatively OK experience.”
The second woman chose to terminate her pregnancy based on the grounds of not being ready to start a family and because she was concerned that a medical condition she had could impact the health of the fetus. She undertook the procedure under general anesthetic.
“At no point during the visit to the clinic, hospital, or any of my doctor’s visits was I told not to choose to terminate. The doctors and other medical professionals that I encountered seemed very supportive and understanding. My partner also expressed to me that he was willing to go along with whatever decision I chose. The procedure was about ¥180,000 and was not covered by insurance. Financially it is a burden, but the hospital allowed me to make installment payments.
I don’t regret my decision because I am still being treated for my medical condition and I can’t imagine what it would be like to also be pregnant and have these issues. I come from a very liberal family and my mother is a medical professional so I grew up understanding the importance of doing what is right for your own health. This whole situation was actually a very big surprise for me and never imagined I would have to make a decision of this nature. Even though I feel okay about my experience, I still feel sad about it sometimes, but I just try to keep in mind that I needed to think of what was the best decision for myself at that moment and when the right time comes I’ll be ready.”
Abortion can be a taboo topic that can bring up a lot of complex feelings. If you are going through this, remember any and all of your emotional reactions are valid, including a lack of feeling. Dealing with an unwanted pregnancy when living in a foreign country can be a scary prospect, but there are safe, legal options with language support available to you, and a lot of stories with happy endings.