Will the ‘morning-after pill’ make gynecologists obsolete?
In February, the health ministry approved the “emergency contraception” drug NorLevo, which was developed in France and is being distributed in Japan by the pharmaceutical company Sosei. It went on sale this week. Often called “the morning-after pill,” the drug was first marketed in 1999 and since then has been approved for sale in 50 countries. Sosei first applied for approval in 2001. The reason it took so long has something to do with Japan’s sclerotic drug testing system, but probably more to do with bureaucratic queasiness over the idea of women being able to prevent pregnancies unilaterally. After all, it took more than three decades to get the low-dosage birth control pill approved, and less than a year for Viagra to receive the go-ahead.
NorLevo should not be confused with the so-called abortion pill, RU486. Emergency contraception is supposed to be taken within 72 hours following intercourse to prevent conception, with a second pill taken 12 hours after the first one. The effectiveness is said to be more than 80 percent. It will be available by prescription (in some countries, like Canada, it can be bought over the counter), but users cannot use national health insurance to pay for it. The internet import price is anywhere between ¥2,500 and ¥6,600 for one dosage, meaning two pills. So far the domestic price hasn’t been made public, but it is probably in that range.
It’s expensive, but still much cheaper than an abortion, the vast majority of which are performed on married women. Young, unmarried women tend to have the baby and marry the father. The average cost of an abortion is around ¥100,000. The procedure is basically illegal in Japan but there’s a loophole that allows gynecologists to perform them on women who have “economic issues.” In 2009, about 220,000 were done, or one-fifth the number of live births that year. Because of the unavailability of the low-dosage birth control pill until recently and the paucity of sex education classes in public schools, abortion was for many years considered a form of birth control. So despite its high price, NorLevo could very likely cut the number of abortions significantly in the future, which is a good thing for women’s reproductive rights but not necessarily good news for the obstetrics-gynecology profession.
For a while now ob-gyns have had to contend with falling incomes due to the declining birthrate. Abortions became a larger part of their livelihoods. When abortion becomes less of an option for women, gynecologists will have less to do. Fewer medical students, thinking it not a lucrative field, will choose gynecology and obstetrics as a course of study.
In the past, emergency contraception in Japan was carried out with the mid-dose birth control pill, which was approved many years ago ostensibly to treat menstrual disorders though mostly they were used as de facto birth control pills. Taken right after intercourse, the mid-dose pill will prevent pregnancy, though its effectiveness is not as high as NorLevo’s and the side effects are more noticeable. The police also distributed the mid-dose pill to rape victims free of charge, though, obviously, that meant the victim had to come to the police and file a rape report. Such victims may have preferred going to a doctor, who would have kept the incident confidential. But then they’d have to pay for the full treatment.