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東京大学公共政策大学院 | GraSPP / Graduate School of Public Policy | The university of Tokyo

Why is birth control pill usage so low in Japan? A quantitative study that illuminates the political interests of medical stakeholders

By Momoko Nakayama    Yuhei Shimada   

A unique study that quantitatively analyzes differences in attitudes towards expanded access of low-dose oral contraceptives (OCs) amongst medical stakeholders in Japan. Our research conducted across 24 prefectures in Japan reveals a stark contrast in perceptions towards increased accessibility of OCs between different stakeholders – a high number (91.7%) of pharmaceutical associations were in support of increased accessibility of OCs, while the support was low (52.9%) for doctor associations. These findings quantitatively illuminate economic/political interests of doctor associations as a new factor hindering OC accessibility, suggesting that policy makers will need to overcome the opposition of doctor associations in order to improve OC access in Japan.

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0.9% – this figure illustrates the percentage of women in Japan who use low-dose oral contraceptives (OC) as a form of contraception. Compared to the US or Canada where OC usage is 11.1% and 43.7%, respectively, the 0.9% figure in Japan is strikingly low.

Historically, Japan’s intransigence towards OC usage has been prominent, as Japan was the last industrialized nation to legalize OCs in 1999. However, nearly a quarter of a century later, this societal resistance remains unchanged, which prompted us to ask – what is preventing OC usage expansion, and who is behind the opposing force?

Existing research attributes social-cultural concerns for the deterioration of sexual morality, authoritative concern for adverse health effects, as well as economic and political interests of medical stakeholders as factors that hinder OC usage in Japan. Nevertheless, given that these factors have never been measured quantitatively in the past, we embarked on a study to quantify different medical stakeholder’s attitudes toward OC accessibility expansion to illuminate possible economic/political interests.

Through our survey targeting medical stakeholders from 24 different prefectures in Japan divided up into 10 categories, we found that amongst medical stakeholders, pharmaceutical associations were most supportive of increased OC accessibility, while doctor associations had relatively negative attitudes towards increased accessibility of OCs.

The opposition coming from doctor associations may be explained by their economic interests, as physicians and gynecologists currently benefit economically as designated prescribers of OCs. Thus, an increase in accessibility of OCs (through channels such as over-the-counter purchases, etc.) entails the loss of their status as designated prescribers, which can lead to their economic loss.

Our findings quantitatively identify both the opposing and supportive forces amongst medical stakeholders, which might provide a direction for policymakers in their movement to expand the recognition of sexual and reproductive health and rights in Japan.


For further details on the study, please view our research letter that was published in the Journal of Obstetrics and Gynecology Canada.
*Free access is provided through the link below until August 22, 2023