Tokyo
THREE decades after the rest of the industrialised world, Japan has begun its final deliberations on whether to introduce the contraceptive pill. A panel of experts at the Ministry of Health and Welfare will consider whether legalising the Pill-which is currently banned in Japan as a contraceptive-could encourage the spread of HIV. The panel is the last hurdle to be overcome before the Pill is approved.
The experts will make their recommendations in May, and government officials are expected to approve the Pill in June. Health workers hope women will be able to obtain it as early as July.
Japanese women denied access to modern family planning methods have sought other ways to limit their families. About one-third of a million have an abortion each year. Another 200 000 have persuaded their doctors to prescribe one form of the Pill, not officially as a contraceptive but as a treatment for 鈥渕enstrual irregularity鈥�-the only legal use of these drugs in Japan. But this form of the Pill is rarely used in the West because it contains a higher dose of synthetic oestrogen than most modern, lower-dose Pills, and so carries a higher risk of side effects such as blood clotting.
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In the past, officials have argued that the Pill鈥檚 safety could not be guaranteed. Only in 1987 did the health ministry begin clinical trials on 5000 women, which concluded that side effects were minimal.
The latest official explanation for Japan鈥檚 delay is that oral contraceptives might encourage people to abandon condoms and so could lead to higher rates of HIV infection. At present, HIV is rare in Japan.
The health ministry鈥檚 Pharmaceutical Affairs Council began its deliberations on legalising the Pill in 1990. Two years later it shelved the issue on the grounds that the Pill would 鈥渞educe the use of condoms and lead to a quicker spread of AIDS鈥�.
That argument quickly fell apart. In 1992 the Geneva-based International Committee for Research in Reproduction published a study which concluded that 鈥渢here is no evidence to indicate that use of oral contraceptives contributes to the more rapid spread of HIV infections and AIDS in the world鈥�. Japan鈥檚 own Society of Obstetricians and Gynaecologists supported this view. But the question has had to wait until now to return to the ministry鈥檚 expert panel.
Many observers think the real reasons behind the delay include the government鈥檚 fears of a shrinking population (see Figure). Women in Japan now have on average only 1.4 children each, one of the lowest rates in the world. 鈥淭he process is very secretive,鈥� says Kunio Kitamura, director of the Japan Family Clinic in Tokyo. 鈥淚 think the government may be afraid of the low birth rate.鈥�
Women鈥檚 groups are less enthusiastic about the Pill than health professionals. In a study last year, more than 70 per cent of women expressed concern about side effects. But Kitamura thinks the Pill鈥檚 popularity will increase once manufacturers are allowed to publish information about newer, low-dose formulations.FIG-mg20740401.GIF