Birth Control Pill Hard to Swallow for Some Japanese
When Japanese health officials approved the use of low-dose birth control pills in June 1999, they legalized a form of birth control that had been available to millions of women in other countries for years. Their procrastination provoked some women's health advocates to ask, "What took so long?"
The resistance reflects a general disregard for women and their health needs, say Michael Reich, chair, Department of Population and International Health; Iain Aitken, lecturer, Department of Maternal and Child Health Care; and Aya Goto, a former MPH student at HSPH who now lives in Japan. They published a paper on oral contraceptives and women's health in Japan in the December 8, 1999 issue of Journal of the American Medical Association. Reich and Aitken followed up with a related seminar at HSPH last week.
High-dose oral contraceptives were approved in the US in 1960. Japan's Ministry of Health and Welfare planned to follow suit in 1965, but cries that such a pill would lead to sexual immorality, coupled with protests from condom makers and abortionists, stifled the debate. High-dose refers to the levels of hormones in the pill. Higher levels may increase chances for cardiovascular problems and stroke.
Japanese doctors were allowed to prescribe high-dose pills for therapeutic--not contraceptive--reasons as early as 1971, but 14 more years passed before Japanese researchers engaged vigorously in studies of low-dose contraceptive pills. The studies concluded that the pills were effective, but the studies were shelved, say the HSPH researchers. They cite press reports that the Ministry of Health and Welfare feared that the pill would lead to decreased use of condoms, resulting in increases of sexually transmitted diseases.
After more debates that included concern about the polluting effects of hormone-tainted urine to the environment, Japanese officials issued their approval last year. The same ministry of officials approved Viagra, the pill that helps prevent erectile dysfunction, in six months.
Although available to them, Japanese women have not rushed for pill prescriptions, in part because "a lot of residual fears about side effects remain," said Aitken. He added that the Japanese society as a whole do not use pharmaceuticals extensively.
The lack of enthusiasm may also result from the requirement that women who use oral contraceptives must visit their gynecologists every three months--service for which they pay from their own wallets. Unlike abortions, which were legalized in Japan in 1948, the pill and related doctor's visits are not covered by health insurance policies.
Reich, Aitken, and Goto applaud the Japanese government for approving
the pill, but urge officials to increase their emphasis on women's health
issues. Only then, the reseachers say, can the benefits of oral contraceptives
be realized by the women who use them.
