Empowering Japanese Women: Increased Agency through Health

By Hiromi Murakami

Woman on her way to work, Akishima-shi, Tokyo. Source: iMorpheus’s flickr photostream, used under a creative commons license.

Woman on her way to work, Akishima-shi, Tokyo. Source: iMorpheus’s flickr photostream, used under a creative commons license.

As its aging population continues to grow and the birthrate continues to fall, Japan is facing a demographic crisis and rapidly shrinking workforce. Despite this reality, Japanese women, a highly-qualified resource, continue to be underutilized. The Abe administration has made the empowerment of women a core element of its economic growth agenda. Yet, fundamental issues that affect women’s health and ultimately impede efforts to empower women have been poorly addressed. While promoting measures for increasing capacity for childcare and setting ambitious numerical targets for female management, the administration’s agendas surprisingly lack emphasis on strengthening “agency,” which helps women to make their own decisions and control their own lives. Supporting women’s agency, particularly in reproductive health, would not only minimize socio-economic burdens but also promote women’s further contributions to the economy.

Despite being one of the world’s most-developed nations, Japan is strikingly backward in some indices that symbolize the lower level of agency for women. For example, according to 2013 UN data, the rate of use of oral contraceptives (OC) in Japan among women who are married or in a union is 1 percent, a figure that compares unfavorably to the African continent’s average of 8.1 percent, Southeast Asia’s 16.5 percent, and Australia’s 30 percent. Japan’s legal system continues to have major components that support traditional, male-oriented social norms. It was only in 2013 that the Supreme Court ruled it unconstitutional that the century-old civil code provision stipulating inheritance share for a child born outside wedlock i.e. “an illegitimate child” should be half that of a legitimate child’s share. Despite the Supreme Court’s ruling, the government refused in May 2014 to change a provision of the current family registration law that requires specification whether newborn babies are legitimate or not. Conservative LDP politicians argued that change will “destroy the traditional family system,” while such discriminatory birth registration continues to cause life-long discrimination against “illegitimate children” and their mothers.

Furthermore, in the face of concerning rising trends of intimate partner violence (IPV), Japan lags behind. Japan only has 243 IPV specific shelters nationwide compared to 1905 shelters in current U.S. programs, even though the U.S. population is merely 2.5 times larger than Japanese population. Likewise, the Act on the Prevention of Spousal Violence and the Protection of Victims — requiring local and prefectural governments to establish strategies to address IPV — only passed in 2001. Despite such efforts, the number of stalking and domestic violence victims, the majority of which are women, is rising substantially.

The 2014 World Bank report, Voice and Agency,also emphasized that limited reproductive health options are critically affecting women’s agency and empowerment. In Japan, a low-dose OC was finally approved in 1999, after 35 years of debate and delay, providing women with access to a long overdue option for self-administered contraception. This stands in stark contrast to Viagra which was immediately approved by the Japanese health authorities within 6 months in 1999 and is widely distributed.

Today, birth control pills are still not practically accessible for the majority of women in Japan. According to a poll, 64 percent of males surveyed said that they had never heard of the “after-pill,” and more than 60 percent of women did not know how exactly the low-dose OC functions. A study cited that major reason amongst Japanese women for never taking OC was difficulty obtaining a doctor’s prescription. Accessible OC may able to reduce the recent relatively rising trend of Japan’s legal induced abortions for women in their 30s and 40s, and the loss of productivity, income and health burden associated with the procedure. Sufficient health education and accessible OC may help prevent teens getting into the potentially vicious socio-economic cycle of poverty and child abuse.

On the other hand, for Japanese women who desire to have children, their choices are also relatively limited. Japan suffers from a shortage of obstetricians and gynecologists, especially in rural areas. Costly fertility treatment is available, but commercial egg bank, surrogacy, or child adoption systems are simply not available as choices unless women go overseas. This partly relates to delayed Japanese legal discussion in defining the biological parent and legal parent. Japanese women not only are given limited tools to manage their own health but also have quite limited choices for having children, meanwhile the country suffers with one of the lowest birth rates in the world.

Therefore, it is important for the Abe administration to take action in improving fundamentals for women’s health environment. Without addressing strengthening agency and revising laws that currently lock-in traditional gender roles for society, Japanese women empowerment policies are insufficient. Here are some concrete policy steps:

  1. Strengthen “agency” by improving the health environment for Japanese women. In particular, policies should address encouraging Japanese women to have annual health check-ups as they are significantly low when compared internationally. Increase access to health education by introducing nurse practitioners for easier access to health consultation and by providing contraceptive education and reproductive health choices for all age groups of Japanese women.
  2. Active discussion is needed on determination of biological and legal parents and various guidelines impeding Japanese women’s ability to manage their health. Transitioning from predominantly male occupied policy-making bodies to female-lead conferences will be critical. Encourage society to have positive views for women to take various choices without penalty or criticism.

For successful women’s empowerment policies, the Abe administration must practically separate discussions of preserving traditional values and gender roles from improving the agency of Japanese women. If Japan’s women have the ability to access broader health options this would not only reduce the burden on their health, but also help support a healthy, productive female workforce, permitting the contributions to the various economic activities that Japan needs.

Dr. Hiromi Murakami is an Adjunct Fellow with Global Health Policy Center at CSIS.


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