How much do you know about SRHR?

　How would you respond if someone asked you what SRHR (Sexual and Reproductive Health and Rights) means? According to the SRHR Survey of a Hundred Million White Paper 2025^（1, implemented in April 2025 by SRHR for Japan, 24.7% of respondents answered "Familiar with SRHR" and 9.2% "Understand what they consist of." SRHR are spreading steadily within the Japanese context. On the other hand, the survey also found that while 56.5% of respondents called SRHR "Important," only 35.4% felt that they were "Respected in daily life," revealing the current wide disparity between awareness and actuality. Results indicated that the gap was particularly severe with regard to access to healthcare and information and to understanding of sexual consent. This article discusses the status and issues of contraception and abortion in Japan in particular, while providing an overview of SRHR and reflecting on the progress made so far.

　SRHR were first approached in the context of population control policy, as "reproductive health"; clarified as a human rights issue at the 1994 Cairo Conference, they are also reflected in the SDGs in fields including medical care, health, and gender. They have developed into a wider concept including sexual and bodily autonomy, no longer limited to reproduction alone. The Guttmacher-Lancet Commission, jointly established by the Guttmacher Institute (which conducts SRHR research) and the British medical journal Lancet, issued the following new definition of SRHR^（2 in 2018.

　Sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity. Therefore, a positive approach to sexuality and reproduction should recognize the part played by pleasurable sexual relationships, trust and communication in promoting self-esteem and overall well-being. All individuals have a right to make decisions governing their bodies and to access services that support that right.

　Achieving sexual and reproductive health (SRH) relies on realizing sexual and reproductive rights (SRR), which are based on the human rights of all individuals to:

• have their bodily integrity, privacy and personal autonomy respected
• freely define their own sexuality, including sexual orientation and gender identity and expression
• decide whether and when to be sexually active
• choose their sexual partners
• have safe and pleasurable sexual experiences
• decide whether, when and whom to marry
• decide whether, when and by what means to have a child or children, and how many children to have
• have access over their lifetimes to the information, resources, services and support necessary to achieve all the above, free from discrimination, coercion, exploitation and violence

　According to the new definition, SRHR have been reconfirmed to refer not simply to the state of being free of disease but to the realization of individual well-being in all aspects through sexuality. The package of services essential for SRHR is defined as including science-based comprehensive sexuality education (CSE) as well as information and care with regard to sexual functions and sexual satisfaction, prevention of sexual and gender-based violence, contraception, childbirth, abortion, infertility, prevention of sexually transmitted diseases, and prevention of reproductive cancers. In addition, the definition notes that people requiring support may include youth and the elderly, sex workers, refugees and immigrants, indigenous ethnic communities, sexual and gender minorities, people with disabilities, people with addictions, and those in disadvantaged situations; it states that everyone is entitled to access and to be able to pay the costs required.

　The World Association for Sexual Health (WAS) positions SRHR as a means of realizing gender equality and social justice, through its Declaration on Sexual Rights, Declaration on Sexual Pleasure (which defines pleasure as an essential element of SRHR), and Declaration on Sexual Justice (which calls for rectification of socially structural and institutional discrimination and inequality).

Issues in Japan

　While Japan, with its universal health insurance, has been globally recognized for the excellence of its perinatal care, it remains faced with numerous issues concerning SRHR. Among the issues coming to light are the inability to apply health insurance to contraception or abortion, scarcity of access and options for contraception, need for access to safe abortion, financial burdens of infertility treatment, lack of comprehensive sexual education, failings in criminal law and the legal system regarding sexual violence, insufficient support for victims, need to guarantee LGBTQ+ rights, period poverty, and more.

　For example, even now emergency contraception requires a doctor's diagnosis and a prescription, costing as much as six thousand to twenty thousand yen. Approximately 90 countries around the world provide emergency contraception at low prices or free of charge at pharmacies, without a prescription; the Japanese system lags far behind the international standard. The Project to Realize Emergency Contraception at Pharmacies, a citizens' organization, has gathered approximately 180,000 signatures to lobby the government; experimental sales at some pharmacies began in 2023, but as of August 2025 there is still no prospect of full implementation. Also, contraception in Japan is still largely based around the use of condoms, with limited options and availability for modern contraception methods permitting women's active choice (low-dose pills, IUS/intra-uterine contraceptive systems, contraceptive implants, etc.). The number of induced abortions performed in 2023 was some one hundred and thirty thousand, with the highest rates among women in their twenties in particular, and also including about ten thousand abortions for women in their teens. The oral abortion pill was first approved in April 2023, but the drug in question is usable only during the first nine weeks of pregnancy, a short period even by the international standard; it also costs some hundred thousand yen, comparable to surgery. According to a survey on the first six months of its availability^（3, it was used in just 1% of all abortions. Even now surgical methods such as vacuum aspiration or dilatation and curettage are the norm; the system requiring spousal consent for abortion also restricts the right to self-determination of the person receiving the abortion.

　In addition, the context includes the deeply rooted gender role awareness and gender norms of Japanese society, such as the taboo on women speaking out about sex or the tendency to assume that men will take the lead in sexual relations. In relationships involving economic dependence, these imbalanced power relations are even more prominent. Further, the scarcity of women and LGBTQ+ people in politics, where social system designs are determined, is also a factor in the lack of progress toward SRHR policy.

　Elsewhere, while the government has been passive regarding the promotion of comprehensive sexual education, it is working toward preconception care in the form of organizing "information provision and consultation systems required for life design." However, the focus of this initiative is on "enabling women's physical readiness for pregnancy," suggesting that it risks steering women in the direction of having children rather than respecting their own intentions and choices. Preconception care in the true sense must, in the future, be effective for people with various life courses in mind, including LGBTQ+ people, those who prefer not to marry or to have children, and so on. Similarly, while "life safety education," introduced as a measure against sexual violence, has been implemented throughout Japan, it does not touch on genuine content such as consent, sexual and bodily autonomy, or gender equality, only providing abstract guidance such as "keep an appropriate distance"; this issue likewise requires reexamination.

　To achieve SRHR, reform of these gender-related social norms is called for along with that of the structures of society itself, such as the systems and laws which create gender inequality. To realize SRHR for every single individual, we must focus on the complex and intersectional discrimination involving gender, sexual orientation, race, dis/ability, nationality, and so on, with every member of society taking action toward realizing SRHR.

【Author's note (added in May 2026)】

　In February 2026, Japan introduced non-prescription pharmacy access to emergency contraception. However, barriers remain, including the requirement to take the pill in front of a pharmacist, its high cost (around 7,500 JPY, approximately 50-55 USD), and regional disparities in access.

[Footnotes]

1）SRHR for Japan, SRHR Hundred-Million-Person Survey White Paper 2025
　 https://srhrforjapan.com/whitepaper/2025whitepaper_1.pdf
　 Accessed August 1, 2025

2）IPPF, Technical Brief: New Definition of Sexual and Reproductive Health and Rights
　 https://www.ippf.org/jp/resources/IPPF_technical_brief_SRHR_japanese
　 Accessed July 30, 2025

3）Ministry of Health, Labour and Welfare, Status Survey of Orally Induced Abortions and Study
　 on the Provision of Appropriate Information
　 FY2023 Report on Comprehensive and Shared Research (May 2024)
　 https://www.mhlw.go.jp/content/11121000/001308189.pdf
　 Accessed July 30, 2025