Her Body, Not Her Choice: Do Women in Japan Need Consent From Their Partner to Get an Abortion?
Image credit: Mak / Unsplash
Japan was among the first countries to pass a law that made abortion legally possible—yet today, women still need their partner's permission to end a pregnancy. Exorbitant costs, limited access and persistent stigma create a system critics argue is more about control than healthcare.
Despite being possible in Japan, abortion is technically a crime (we know it seems counterintuitive). Articles 212 through 216 of the Japanese Penal Code prohibit abortion. However, exceptions to the law exist. The Maternal Body Protection Law from 1948 made it possible for women to receive abortion treatment up to 22 weeks of pregnancy under the following four conditions: A woman must prove health risks, economic hardship, rape or present written spousal consent from her husband to obtain an abortion.
The term spousal consent implies that women are required to obtain permission from their husbands to receive abortion treatment. However, the need for consent from a male still applies to all women. Often, it's the case that women in unmarried relationships or single women are required to present a consent form from the father, whether that be a casual hook-up or boyfriend.
Kumi Tsukahara is an independent researcher of reproductive health and rights in Japan. According to her, it's with concerning frequency that unmarried women need to provide proof of consent for abortion.
'Although not legally required in such cases, the prevailing interpretation of the Maternal Body Protection Law and the conservative nature of medical institutions result in excessive compliance with the rules. The practice varies from clinic to clinic, but it is alarmingly common,' the expert says.
Only around ten countries or regions, including Japan, require women to obtain their spouse's consent for an abortion. These countries include Indonesia, Turkey, Taiwan, Morocco, Kuwait, Syria, Equatorial Guinea, the United Arab Emirates, Yemen and Saudi Arabia.
If you need an abortion in Japan or want practical guidance on how the process works for foreigners, Japan Truly offers a helpful guide on abortions in Japan . Image credit: Jakub Velička / Unsplash
Hiromi Kusano is also familiar with the practice of consent being required on the part of unmarried women. She states that this often forces women to lie. She is the Senior Advocate Officer at the Japan-based international NGO, Japanese Organization for International Cooperation in Family Planning (JOICFP), which promotes sexual and reproductive health and rights in Japan and beyond.
'The reason why this happens [asking consent from unmarried women's partners] is that the abortion doctors are afraid they might get sued by the male partner of the pregnant person. So, they typically ask the pregnant person to present permission from the partner. And that causes many, many, many problems for Japanese women,' Kusano explains.
If a woman is afraid of asking her partner or unable to obtain permission, she has to ask a friend or other male acquaintances to sign as the father for her to receive abortion treatment.
Tsukahara says the issue of consent reflects a broader cultural trend in Japan: the prioritization of male authority in reproductive decisions. Women's legal and ethical rights to control their own bodies are often undermined.
Kusano says that the Maternal Body Protection Law protects men. It surprises her that many men are not happy about the thought of eradicating spousal consent. 'They seem to think they have the right to decide whether or not a woman should have an abortion. They think of the baby as their possession.'
Kusano argues that spousal consent and the Penal Code restrictions on abortion are outdated and should be abolished. 'Not only because it undermines women's bodily autonomy. But also because it completely ignores women's rights as human rights,' Kusano says.
Asuka Someya is a sexual health campaigner who founded the NGO Pilcon. They work to raise awareness of sexual health for junior and senior high school students and parents in Japan.
Her motivation to fight for sexual and reproductive health rights comes from what happened to her when she was 20. As a college student, she became unexpectedly pregnant with her boyfriend after their contraception failed. Shocked and upset, she found herself unsure of what to do.
'Abortions are very expensive. And if I went through with the pregnancy, I would've had to give up on my education, future jobs and dreams. So, I decided to have an abortion, but I felt very guilty,' Someya says.
In Japan, health insurance doesn't cover abortion. The procedure is expensive, typically costing between ¥100,000 and ¥200,000—this equates to between $700 and $1,400. Image credit: Ryoji Iwata / Unsplash
In April 2023, Japan approved medical abortion with the use of the two-step abortion pill (the MeFeego Pack) for pregnancies of up to nine weeks. Previously, women in Japan could only access surgical abortions. In contrast, medical abortion, using pills instead of surgery, was legalized in France in 1990, followed by Britain in 1991 and the United States in 2000.
Medical abortion is generally safer than surgical abortion because it's non-invasive and doesn't require anesthesia. Surgical procedures carry higher risks of infection, injury and complications. While both methods are safe when properly managed, medical abortion is preferred in early pregnancy for its lower risk and simpler recovery.
Although medical abortion is an improvement in abortion options, Tsukahara says: 'The approval of the abortion pill was a symbolic step forward, but its impact on actual access has been minimal.'
To undergo a medical abortion, the pregnant woman must be hospitalized at an approved clinic for two days. Japanese law mandates that a designated doctor must oversee the procedure. The medical abortion involves taking two types of pills, 36 to 48 hours apart. As a result, authorities consider it safer to monitor the woman in a medical setting.
Several countries allow medical abortions at home between seven and ten weeks of pregnancy. These include the United States, France, New Zealand, Canada, Denmark and the UK.
As of February 2025, only five percent of abortion clinics in Japan offer medical abortions. This is because few clinics offer inpatient facilities. There is also a lack of designated abortion doctors. Tsukahara notes that, according to the latest data from May 2024, only 11 of Japan's 47 prefectures have designated doctors authorized to provide abortion pills.
Tsukahara argues that the requirement for supervised use of the abortion pill not only humiliates women but also reflects a deep-rooted medical distrust of women themselves. She believes these factors significantly limit the pill's practical usefulness and further marginalize women's reproductive autonomy.
Spousal consent is still required for medical abortions. Adding to that, the cost of hospitalization and medical care isn't cheap. In fact, the total expense of a medical abortion can easily equal or exceed the price of a surgical abortion.
'Approving abortion pills was a legal shift, not a systemic reform,' Tsukahara states.
Emergency contraception, or the morning-after pill, is currently available to purchase for ¥7,000 to ¥9,000 ($49 to $62) over the counter through a pilot study, spanning a mere 340 of Japan's pharmacies, says Someya. The trial period runs from November 2023 to March 2026. Japan's health ministry launched the pilot study to test whether emergency contraceptive pills can be safely and effectively sold without a prescription.
According to the Japan Pharmaceutical Association's website, women must present identification and take the medication in the presence of a pharmacist.
'It's to prevent illegal use or inappropriate use. The government is concerned that people would resell the pills,' Someya explains. She finds it degrading that women have to go through these extra procedures, despite the fact that the World Health Organization (WHO) considers emergency contraception suitable for general over-the-counter sale.
Keep in mind that if you don't speak Japanese, you can't buy emergency contraception over the counter presently. The sale of emergency contraception in pharmacies is part of the special government-approved pilot study, meaning that all communication has to be conducted in Japanese. It doesn't matter if your partner or someone accompanying you speaks Japanese. Under current rules, you cannot purchase emergency contraception over the counter unless you can speak and understand Japanese.
Those who don't speak Japanese or cannot visit one of the 340 pharmacies in the pilot program can only access emergency contraception through a mandatory doctor's visit, which costs around ¥15,000 (approximately $105). This makes it one of the most expensive morning-after pills globally, according to Someya. Image credit: Kouji Tsuru / Unsplash
Kusano argues that the stigma surrounding abortion and contraception in Japan keeps the discussion minimal. Most women find it shameful to go through an abortion because it's so stigmatized. As a result, the topic struggles to gain public support.
Still, some changes for medical abortion may be on the horizon. In July 2024, the health ministry said they are considering expanding the availability of the abortion pill to allow clinics without inpatient facilities to use it. Under the ministry's new proposal, patients who live within 16 kilometers of a designated clinic and can return within a week for a follow-up could leave the clinic immediately after receiving the abortion pills. The spousal consent is not subject to change.
Critics question whether it's wise to further ease access to abortion, especially as Japan's birth rate continues to decline. Analysts project it will fall to just 1.38 by the end of 2025, well below the replacement rate of 2.1. But is forcing pregnancies by maintaining current abortion laws really an appropriate approach to fix the population rate?
'Restricting abortion does not increase birth rates,' says Tsukahara. 'It increases suffering and inequality. Reproductive health care, including access to abortion, should be seen as part of a comprehensive approach to women's health. Not simply as a factor influencing fertility rates.'
To change societal views and conditions on abortion in Japan, Someya believes the first step is knowledge and information. 'We need to empower more women to speak out about the inadequate conditions surrounding abortion. It's our decision, our lives and our bodies.' Learning about a more progressive view towards abortion rights had a big impact. It gave her confidence in her decision to choose what was best for her.
Are you interested in reading further about sexual and reproductive health rights in Japan? If so, head to our article uncovering The Controversy of Japan's 'Baby Hatch'–where women anonymously can hand in their baby. Or, read what sex ed teacher June Low deems wrong about sex education in Japan .
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A former director of the Ministry of Foreign Affairs' Global Health Policy Division, in 2019 he was briefly director of medical and scientific affairs at Philip Morris Japan.
