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No consent from spouse needed for abortion in broken marriages in Japan: ministry

The Central Government Building No. 5 that houses the Health, Labor and Welfare Ministry is seen in this file photo taken in Tokyo's Chiyoda Ward on Oct. 14, 2015. (Mainichi/Kimi Takeuchi)

TOKYO -- Japan's health ministry has spelled out new administration guidelines to the Maternal Health Act, which would allow women whose marriages have effectively collapsed due to domestic violence and other reasons to undergo abortions without their spouse's consent.

    There have been many cases in which women wanting abortions have been given the run around by multiple medical institutions or have been forced to give birth because they have been unable to provide their spouse's consent for an abortion. Because of this, support groups have been calling for a review in the administration of the law.

    The Maternal Health Act stipulates that when carrying out an abortion, doctors must obtain the consent of the pregnant woman and her spouse. Even if the woman is not married, many medical institutions seek consent from the man believed to have impregnated the woman out of fear of lawsuits and other problems they may face with the man involved.

    According to a 2017 survey conducted by the Cabinet Office, of 141 women who had been raped by men, 26.2% of the men were former spouses and 24.8% were former boyfriends. In response to the serious state of sexual domestic violence experienced by women, in February of this year the All Japan Women's Shelter Network, a nonprofit organization that assists domestic violence victims, submitted a request to the Japanese government seeking the elimination of the provision in the Maternal Health Act requiring the consent of the spouse for a woman to receive an abortion.

    In June 2020, Victim Support Forum, comprising attorneys, lodged a request with the Japan Medical Association (JMA) that the implementation of the Maternal Health Act be improved after an unmarried woman who became pregnant after being sexually violated was denied an abortion at multiple medical institutions.

    A Japanese abortion consent form is seen in this image. In the case of an unmarried woman, some medical institutions have a signature block for her partner or the man believed to have impregnated her. (Mainichi)

    In response to such moves, the JMA and the Japan Association of Obstetricians and Gynecologists (JAOG) have engaged in debate over the issue of consent. According to a source tied to those discussions, the JMA on March 4 asked the Ministry of Health, Labor and Welfare whether it was "correct to assume that consent of the person getting the abortion is sufficient in cases where the pregnant woman is the victim of domestic violence from her husband, or the marriage has otherwise effectively collapsed, and it is difficult to obtain the consent of the spouse." The health ministry is said to have responded in writing dated March 10 agreeing with the JMA's interpretation.

    The JAOG sent out a notice to obstetricians and gynecologists nationwide on March 14. As for determining whether a marriage has broken down or not, the association says that "it is ideal that based on the woman's statements, a doctor specified by the JAOG make the judgment, or a relative or a third party who knows the couple be asked to confirm the nature of the relationship." The association is also poised to request that the reason why the couple's marriage was judged as being broken be recorded in the women's charts.

    "There have been countless cases in which victims of domestic violence give birth unwillingly because they have been unable to obtain the consent to abortion from their husbands," says Chisato Kitanaka, an associate professor at Hiroshima University who heads the All Japan Women's Shelter Network. "If such husbands found out that their wives had gotten an abortion without their consent, there's a chance that their attacks would increase in intensity, which is one reason why the women themselves and their doctors hesitate to go through with abortion. It is significant that the government is taking a clear position on this issue."

    (Japanese original by Satoko Nakagawa, Lifestyle and Medical News Department)

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