As I explained in the previous post, I had the opportunity to interview employees of Bare Hope adoption agency here in Japan, and they shared with me a great deal of information regarding Japanese adoption and its closely related issue, Japanese abortion. My previous post was on adoption, and this post will focus on abortion. Again, if there are any flaws or misinformation in my post, the fault is mine.
In Japan, abortion has been legal since 1949, earlier than any other industrialized country. Because of this, Japan was once a site of medical tourism specifically in the area of abortion. The birth control pill was only finally legalized in Japan in 1999 (partly due to pressure from abortion doctors not to legalize it and thereby potentially reduce their incomes), but most Japanese prefer to use condoms due to the side effects and cost of the pill. In recent years, Japan has conducted about 300,000 abortions per year; however, in the most recent year for which I could find data, 2012, there were approximately 200,000 reported abortions. It is legally permitted up to the 24th week of pregnancy*.
The interviewees explained to me that in reality, there are a great many abortions not reported for various reasons. The primary reason they discussed was abortions conducted after the legal limit. Because it is not only illegal to perform an abortion after 24 weeks, but also to purchase an abortion after 24 weeks, all involved (the doctor performing it, the hospital hosting it, and the couple seeking it) are legally at risk. Therefore, should something go wrong, the woman wouldn’t dream of suing the doctor or hospital, even in cases of ridiculously blatant malpractice, because she would have to confess to committing a crime in order to do so. In other words, unethical physicians whose entire income is from abortions may frequently conduct illegal abortions because it translates to money with extremely little risk of reprisal because neither the hospital nor the woman and her family would report him for seriously damaging or even almost or actually killing her.
There’s also a significant economic impact. Prior to entering nursing school, I was required to watch an older (I think 1990s) PBS documentary on medical systems around the world. Though it attempted to portray the various systems with equal weight and without bias, it was very obviously, even from the beginning before any information had been shared, biased in favor of socialized medicine. Interestingly, it discussed Japan in a positive light, even though Japan’s system isn’t technically socialized medicine. In Japan, the government sets price controls on medical services rendered so that people can better afford their care; insurance companies also exist in Japan and, thanks to price controls, their premiums tend to be lower than those in America, to the truth of which I can now personally attest. However, these government price controls are so strict that a great many doctors go out of business because they simply cannot afford to work with such little pay, especially when they have business overhead and student loans to pay for. The end result is not enough doctors in Japan to care for the population (though, to be fair, the population is shrinking and growing older, so these physician-to-patient dynamics may change for better or for worse).
Where this relates to abortion is in the cost of maternity care. The Bare Hope interviewees told me that abortion costs much more than live birth**, so most hospitals cannot afford their overhead without abortion. In other words, they will very definitely go out of business if they do not perform abortions. Furthermore, illegal abortions cost significantly more than legal abortions—again, with no risk of getting sued by the family should something go wrong or should the doctor and/or hospital engage in ethically questionable financial practices such as hidden fees—and so the ultimate effect of illegal abortions is to result in obscene financial gains for the doctor and hospital and potentially a great number of women harmed and even killed or nearly killed with no legal recourse for the woman or her family.
In the U.S., the majority of abortions occurring after 24 weeks gestation are for convenience, according to the late Dr. George Tiller’s own figures, with less than 10% due to disabilities or medical conditions incompatible with life. I’ve read that those Japanese babies illegally aborted after 24 weeks are primarily disabled and majority capable of surviving outside the womb, but it’s impossible to know for certain since reporting of illegal abortions is obviously nil. The #1 reason for legal abortion is that the parents are not married. Many of the parents seeking an abortion for disability—specifically, Down Syndrome—come first to Bare Hope saying that they will give birth and place the baby for adoption rather than aborting if the adoption agency can ensure the child will be adopted. Obviously, Bare Hope can’t make such a promise, and so many babies who would otherwise be born alive and potentially placed with a loving family are instead aborted. For this reason (and for other reasons discussed in the last post), Bare Hope is seeking a partnership with a U.S. adoption agency that specializes in placing Down Syndrome babies. If you have any information on this, please let me or Bare Hope know!
*At this stage, the child has a beating heart, brain waves, fingerprints, all vital organs in place, and a personality, and is capable of feeling pain. There is at least a 50% chance of surviving outside the womb if born at this stage. Abortion at this stage is more dangerous to the mother than live birth.
**I honestly don’t know how much of that is due to price controls and how much is due to the 5-day postpartum stay in Japan as compared to the typical 24-hour stay for vaginal births in the U.S.