Global Policy Forum

By Suvendrini Kakuchi *

After spending thousands of dollars on painful fertility treatments over the past two decades, Keiko and her husband, both in their early 40s, called it quits last October. "While it is still tough being childless, I have to acknowledge that not running after doctors has given me some relief. I am now going through the hardest part, which is accepting my infertility," says the English teacher, who requests that only her first name be used.

Keiko, as with Japan's growing number of infertile patients, longs for a baby not only to fulfill her own desire but also to meet high social pressure to produce an offspring. "I desperately wanted to have a child as my husband works all the time. Moreover, my mother-in-law kept asking me when she could see her grandchild and I felt so bad for not doing my duty," she says. According to the latest government statistics, the nation's birth rate--currently 1.3 babies per woman--is down from postwar highs of between 1.4 and 1.7 in the 1960s. Some activists say the inability to bear children takes a heavy toll on many women.

Childless, Feeling Guilty

"Childless women in Japan grapple with extreme loneliness and guilt," says Junko Kurihara, spokesperson for the Tokyo-based Friends of Finrrage, a support group dealing with infertility. "We have programs to help them regain their confidence." But for infertile women the struggle to overcome a sense of inadequacy is uphill in a country where women find immense social esteem in bearing children. Instead, many women, like Keiko, are turning in droves to fertility treatments. Data compiled by the Japan Society of Obstetrics and Gynecology in 1999 indicate that 1 in 10 couples--or close to 300,000 patients--are currently undergoing fertility treatments in Japan.

The trend, according to health authorities here, is consistent with other industrialized countries where lifestyle choices--such as late marriages--have produced higher infertility rates. In Japan, however, the struggle to overcome fertility through technological interventions is outstanding. For instance, Japan, with a population of 20 million, has 474 medical institutions (including privately-owned clinics) that offer fertility treatments, compared with 350 in the United States, with a population of 280 million. Government statistics also reveal that every year, about 12,000 babies--1 in every 100--are conceived through the aid of fertility technology. Doctors predict the ratio to rise to 1 in 50 in a few years.

The country is also seeing its share of fertility-treatment landmarks. A Japanese woman in her 60s last year underwent extensive treatments to become the country's oldest woman to give birth. About 50 couples have resorted to surrogacy and circumnavigated Japanese law against the practice by working with surrogate mothers from overseas. Meanwhile, a doctor recently began operating the nation's first egg bank for healthy women who want to delay their pregnancies.

Government Effort to Boost Fertility

To redress the falling birth rate, which could decline more steeply with any further economic decline, the Ministry of Health, Labour and Welfare set up an infertility department in September to boost fertility treatment. While full details about it are not yet public, the program is expected to allow women to use their health insurance for fertility treatments.

Tomoko Kashiwage, an official at the new infertility treatment center, says the average cost for a couple undergoing fertility treatments is almost $50,000 over four years, a price too high for most couples. "A new subsidy plan will be launched in April 2004 to pave the way for more couples to undergo treatment," she says.

While activists welcome insurance coverage as a means of easing the financial burden, they caution that the boom in infertility treatments increases societal pressures on women having difficulty conceiving. These activists want fertility treatments to offer a range of options to women, including the choice that Keiko recently made, to give up fertility treatments. Medical programs, they say, must emphasize the safety risks of fertility treatments and help women feel comfortable about choosing, possibly, not to have a child at all.

"What is urgently needed is not more invasive and psychologically damaging medical treatment, but a concrete debate and legislation to raise consciousness and protect the reproductive rights of women," says Yuko Ashino, director of Japan Family Planning Services in Tokyo, a leading provider of reproductive-health services.

Trying to Deepen Public Awareness

Against the current backdrop, Friends of Finrrage--which stands for Feminist International Network of Resistance to Reproductive and Genetic Engineering--now has 400 members and is working urgently to promote a deeper understanding of the issue in Japan. This year the Tokyo branch of Friends of Finrrage conducted six workshops on women's reproductive rights, which included sessions on the social pressures borne by women without children, such as feelings of being unwomanly or derelict in upholding a social duty to procreate. In the seminars, participants revealed callous treatments by male doctors who blamed them for being infertile or called them old when they sought help for being unable to conceive.

Friends of Finrrage is also spearheading a movement against conservative male politicians who often make disparaging remarks against childless women. In July, the group demanded but did not get an apology from a former prime minister, Yoshinori Mori, who joked during a public debate on declining birth rates, saying "women who do not have children are a drag on the economy." Women reacted with outrage. "His comments show clearly that nothing has changed," said Keiko Yamauchi, an opposition politician. "Male politicians continue to view women as only worthwhile to support men."

In addition, Friends of Finrrage's monthly newsletters have become a useful source of independent research material on reproduction technology and treatments, a breakthrough in Japan where infertility is treated as a disease needing special treatment. Kurihara also reports their seminars are now drawing more husbands, something of a landmark in public concern for women's reproductive health. "Traditionally men see reproduction as a woman's business, leaving important sexual and fertility issues to their female partners," says Kurihara. "With more men participating, we see a change in old attitudes."

Surveys by Friends of Finrrage also indicate adoption is not a popular option. Children available for adoption number around 38,000, but only 2 percent of couples seeking fertility treatments saw the practice as a viable alternative to treatment. "The focus on fertility technology has actually worked against adoption because couples believe doctors can help produce a child. There is now more pressure on women," says Kurihara.

About the Author: Suvendrini Kakuchi, a Sri Lankan national, is a freelance writer in Japan who contributes to both English and Japanese publications.

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