Access to medical abortion and abortion care in Japan

Objectives: On April 26, 2023, the Japanese Ministry of Health, Labour and Welfare approved the use of the medical abortion pill package (called the MEFEEGO Pack in Japan) on the condition that the patient undergoes either "hospitalization or outpatient observation at a facility with beds." The purpose of this study is to examine the immediate uptake of medical abortion and the current situation of peri-abortion care in Japan. Methods: The study design was an institution-level national survey. Questionnaires were sent to 3941 facilities to collect information on abortions and abortion consultations performed between May and October 2023. Results: Responses were received from 2096 facilities (53.2 % response rate). A total of 28,346 abortions were performed before the ninth week of pregnancy, of which the MEFEEGO Pack was used in 435 cases (1.5 %), with no serious complications. The proportion of facilities providing peri-abortion care services in all abortion cases was 10.9 % for mental health support, 3.3 % for counseling information, 50.6 % for support to prevent repeat abortions, and 73 % for contraceptive information. These services were more commonly provided in hospitals with a higher number of obstetrician-gynecologists and abortions, and where interprofessional collaboration was present. Physicians were the main providers of peri-abortion care, while midwives and nurses provided these services at only about 20 % of facilities. Conclusion: Greater interprofessional collaboration and increased involvement of midwives and nurses are necessary to prepare for a possible increase in the use of medical abortion in Japan.