With the declining birth rate and out-of-date laws governing women’s health care in Japan, things may get a little more complicated than you’re used to at home, but nothing’s impossible.
Japan has some questionable priorities when it comes to women’s choices regarding their own bodies, and there are some harsh realities that might have you decide to plan ahead. Firstly, these things are not covered by health insurance, so keep that in mind if you’re a resident, as stuff is pricey. Secondly, individual doctors and pharmacists are able to make decisions regarding your access to services based on your personal situation, and there is nothing you can do about it. If you can, try to go to specialist clinics in larger areas, as they are more likely to be forward-thinking and accepting of requests. For example, a friend had the price of her contraception increased to beyond her means as her local doctor told her she should “go home and get married, because she is too old to be living this way”—and there’s just no come back. Japan is modern in someways, but be prepared for views that differ to what you may be used to, and no rights to fight back. Warnings aside though, you can still get your hands on those hormones, and if you’re sticking to Tokyo it’s much easier.
Finding a gynecologist
There are plenty of ob/gyn clinics, but narrowing them down to ones that speak English and ones that accept health insurance can make it more pricey, but hey ho, you’d probably guessed that by now. There are also some horror stories about lack of privacy, forced requirements for physical examinations, etc., so remember that if you’re not comfortable, just get up and leave. There is no need to feel pressured just because you’re in another country, there are clinics that treat you normally. Finally, in terms of doctors, it can be common here for doctors to dismiss your symptoms and just say there is nothing wrong, you’re not in pain, go home. This happens to men too, but a lot more to women, especially when it it involves ‘women’s problems’ and male doctors (hello 1930s throwback culture). Don’t take it, trust yourself to know your body and seek a second opinion elsewhere if you know something is wrong.
If you prefer a female doctor, this again limits things, but there are places available. Here are some options for reliable English-speaking, women’s healthcare providers in Tokyo.
- K Ladies Clinic in Shinjuku. They only take walk-ins and you can get birth control, emergency contraceptives and pap smears here—although arrive early to avoid queues. (male doctor only)
- Primary Care Tokyo has Joe Kurosu, a Standford-trained GP with training in women’s healthcare. They offer birth control, Plan B and pap smears as well as STD testing. (male doctor only)
- Toho Clinic: A female, English-speaking doctor – the offer birth control, Plan B, IUDs and early-term abortion as well as IVF treatment
- Ikuaikai Ladies Clinic: A female, English-speaking doctor – you can get the pill and Plan B here as well as pregnancy tests, pap smears and breast exams
- Parkside Hiroo Ladies Clinic: English-speaking doctors, at least one female – you can receive birth control pills and emergency contraception (17,300 yen!) as well as the HPV vaccine course
So, straight up, injectable contraceptives like Depo-Provera, contraceptive implants and extended-cycle oral contraceptives are generally not available, and IUDs are available but not popular—leaving The Pill as the most accessible option. Many friends with implants have been met with horror by doctors who asked why they had gone to such measures, “didn’t they know pills were available now?!” So yeah, it can be difficult to get implants and coils here, or to have them removed, but not impossible.
Pill access is much more limited than you may be used to, with only a few brands available. Some clinics refuse to prescribe it for contraceptive purposes either as they don’t agree with it, or because it is not considered ‘reliable’. So if they begin questioning you about the purpose, you may find it easier if you say you need it to ease heavy periods and stomach cramps. If you would like the pill to ease symptoms of endometriosis, it is possible to get in covered on health insurance, but easing painful periods is not enough (sorry).
The main thing to be aware of is that pills here are only available in low-dosages so you may find they differ to your usual brand. In some cases clinics will only give you 1-3 months worth at a time, and you may have to pay an appointment fee every time to renew the prescription. One clinic that avoids this and has an English-speaking doctor is Primary Care in Shimokitazawa (five minutes from Shibuya)—after your initial appointment you can collect a repeat prescription from reception without charge. The average cost is around 2,000-3,500 yen a month, so depending on where you’re used to, this could be pricey as hell or amazing. There are some places that will post it to you without the need for consultation, this site is able to arrange this for you.
The main brands available are: Marvelon, Favoir and Ortho-21 (Monophasic 21 active), Triquilar, Ange, Ortho 777 , Labellefille and Marvelon (Multiphasic 21/28 active).
Bringing it in:
Since it is expensive, limited and a hassle to acquire here, it may suit you better to bring some pills with you instead. You are allowed to bring a month’s quantity at a time without any paperwork and up to a year’s worth with a Yakken-Shoumei (a type of import certificate). You can either bring pills in your luggage or have them posted to you (always with the necessary paperwork if more than a month’s supply)—you can read up on the details here.
IUS, IUD and implants
If you would like to get an IUS implant fitted or removed, you can visit the Toho Clinic who offer Mirena (This is pretty much the only place I found that wasn’t eye-wateringly expensive). A fitting costs 60,000 yen with a 10-year warranty, ring removal costs 6,000 yen and if you have had it inserted at another clinic and need it removing, it costs 15,000. Mirena is an IUS, therefore it is made of plastic and releases progesterone and not copper like an IUD (although in terms of insertion and removal it is the same). The only approved IUDs are Multiload and NovaT.
For regular arm implants like Nexplanon, getting them fitted here is nigh-on impossible—and getting them removed is also difficult. 99% of places will shrink back in horror and say they can’t remove it because they don’t know what it is, and technically a course is required in removal to prevent liability for issues. Some women clinics will remove them for you, but most won’t list it as a service, so you may have to call around and ask for suggestions. This hospital in Tokyo has been known to remove them, but the procedure is done by a dermatologist rather than a specialist. If you are having issues with an implant and have not yet arrived in Japan but plan to stay here, it would be sensible to consider having it removed prior to arriving.
Yeah, it’s happened to everyone, and sometimes it’s just bad luck. If you’re not up for the 2.4-kids dream just yet, you might want to get your hands on the morning after pill, and since it’s a ticking time-bomb you need to be fast. These are only available with a prescription and are also not covered by Japanese health insurance. Prices vary depending on which clinic you go to, but can be anywhere between 3,000-20,ooo yen a pop, depending on which type you are given. Only two are approved here (and only approved in 2011), Planovar (combination) and Norlevo (progesterone only), with the former being cheaper.
Since not all clinics are certified to provide the pills, you will need to check ahead (not a great moment to be wasting time at the wrong place). This website has a full list of all clinics across Japan that offer Plan B, and although it is in Japanese, using the Google Translate extension on Chrome is enough to search locations, etc. (it is run by the Japan Family Planning Association). Alternatively, the previously mentioned K Ladies Clinic in Shinjuku prescribes it and is walk-in only, so ideal for emergencies. Primary Care Tokyo also offers Planovar on site as well as prescriptions for Norlevo, and a limited supply of Ella (which is not yet approved in Japan but is elsewhere).
If you can, depending on the accessibility in your home country, it may be worth bringing a reserve pack with you—just to avoid a lot of stress and money if anything goes wrong.
Easily accessible, pregnancy tests here follow the same general rules, and will show up the blue lines or the word pregnant—although sometimes in kanji, so you might want to double check with a dictionary to be sure. You can find them in pharmacies and drug stores and they will be folded in a brown paper bag to hide your shame for you. It is worth knowing that you can get false negatives on pregnancy tests, but it’s almost impossible to get a false positive, So, if you’re still not trusting the sticks, you may want to arrange for a doctor’s pregnancy test. These will be available at any ob/gyn clinic, or you can try the list of family planning facilities mentioned above.
Abortions (early and late term)
If you have a not-so-happy surprise then you have some options, but they are going to cost you. Abortion is technically legal in Japan, but comes with a number of requirements which can make it difficult to get and is expensive. The stipulated requirements are that you have serious financial or social reasons that make you unable to continue with the pregnancy (and obviously medical reasons are included). You are also required to provide a signed letter from yourself and your partner giving consent. The letter is not required if the pregnancy is the result of a sexual crime or if the partner cannot be located due to being missing or dead. The abortion pill commonly used to terminate early-stage pregnancy is not available in Japan, and early-stage terminations are therefore treated as out-patient treatments. After 12 weeks, it becomes an in-patient procedure and it becomes significantly more difficult to find somewhere willing to take on the procedure (even over 10 weeks, many clinics will refuse to help). Procedures are not covered by Japanese health insurance and can cost anywhere between 100,000 yen and 200,000 yen and more for the early-stage termination, and between 350,000 yen and 500,000 yen after that, along with possible additional hospital charges.
Further reading: Making Sex Safe Again: Of Condoms and STI Testing in Tokyo