In Japan, women who seek sterilisation procedures like tubal ligation or hysterectomies must meet conditions that are among the most onerous in the world. They must already have children and prove that pregnancy would endanger their health, and they are required to obtain the consent of their spouses. That makes such surgeries difficult to obtain for many women, and all but impossible for single, childless women.
Now, five Japanese women are suing the country’s government, arguing that a decades-old law known as the Maternal Protection Act violates their constitutional right to equality and self-determination and should be overturned.
During a hearing at Tokyo District Court last week, Michiko Kameishi, a lawyer for the plaintiffs, described the law as “excessive paternalism” and said it “assumed that we think of a woman’s body as a body that is destined to become a mother.”
Kameishi told a three-judge panel of two men and one woman that the conditions for voluntary sterilisation were relics of a different era and that the plaintiffs wanted to take “an essential step in living the life they have chosen.”
Japan lags other developed countries on reproductive rights beyond sterilisation. Neither the birth control pill nor intrauterine devices are covered by national health insurance, and women who seek abortions are required to gain the consent of their partners. The most common form of birth control in Japan is the condom, according to a survey by the Japan Family Planning Association. Fewer than 5 per cent of women use birth control pills as a primary method for preventing pregnancy.
Experts say that the plaintiffs in the sterilization case, who are also seeking damages of 1 million yen (about $6,400) per person with interest, face considerable hurdles. They are pushing for the right to be sterilized at the same time that the government is trying to increase Japan’s birthrate, which has fallen to record lows.
“For women who can give birth to stop having children, it is seen as a step backward in society,” said Yoko Matsubara, a professor of bioethics. “So it may be difficult to get support” for the suit.
Although women have made some progress in the workplace in Japan, cultural expectations for their family duties are much as they have always been. The lifestyle of not getting married or having children is still rejected in society.
In Japan, sterilisation is a particularly sensitive issue because of the government’s history of forcing the procedures on people with psychiatric conditions or intellectual and physical disabilities.
Sterilizations were performed for decades under a 1948 measure known as the Eugenics Protection Law. It was revised and renamed as the Maternal Protection Act in 1996 to remove the eugenics clause, but lawmakers retained stringent requirements for women who wanted abortions or sterilizations. Despite pressure from advocacy groups and women’s rights activists, the law has remained unchanged since the 1996 revision.
In principle, the law also affects men who seek vasectomies. They must have their spouses’ consent, as well as prove that they are already fathers and that their partners would be medically jeopardized by pregnancy.
In practice, however, experts say that far more clinics in Japan offer vasectomies than sterilization procedures for women.
The entrenched rule of Japan’s right-leaning Liberal Democratic Party, along with the country’s deep-rooted traditional family values, has prevented progress in reproductive rights, said a member of the Women’s Network for Reproductive Freedom.
In Japan, the medical profession “is still very patriarchal in its thinking,” said Lisa Ikemoto, a professor of law. Doctors “operate as a cartel to maintain certain social norms.”
Women themselves are often hesitant to buck societal expectations because of heavy pressure to conform.
“Many people feel that trying to change the status quo is selfish,” Ms. Tatsuta, the model and plaintiff, said shortly before the hearing last week. But when it comes to fighting for the right to make choices about one’s own body, she said, “I want everyone to be angry.”
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