Family Planning in Japanese Society: Traditional Birth Control in a Modern Urban Culture

By Samuel Coleman

The book description for the previously published "Family Planning in Japanese Society: Traditional Birth Control in a Modern Urban Culture" is not yet available.

• Language: English
• Publisher: Princeton University Press
• Release date: Mar 9, 2021
• ISBN: 9781400843992

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Family Planning in

Japanese Society

Family Planning in

Japanese Society

Traditional Birth Control in a

Modern Urban Culture

Samuel Coleman

With a new foreword by Patricia G. Steinhoff

PRINCETON UNIVERSITY PRESS

PRINCETON, NEW JERSEY

Copyright © 1983 by Princeton University Press

Published by Princeton University Press,

41 William Street, Princeton, New Jersey 08540

In the United Kingdom: Princeton University Press, Oxford

Foreword to the 1991 edition

© 1991 by Princeton University Press

All Rights Reserved

Library of Congress Cataloging-in-Publication Data

Coleman, Samuel.

Family planning in Japanese society: traditional birth control in a

modern urban culture / Samuel Coleman; with a new foreword by

Patricia G. Steinhoff.

p. cm.

Originally published: Princeton, N.J.:

Princeton University Press, © 1983.

Includes bibliographical references and index.

ISBN 0-691-03133-9—ISBN 0-691-02.865-6 (pbk.)

eISBN 978-1-400-84399-2

1. Birth control—Japan. 2. Contraception—Japan. 3. Marriage—

Japan. I. Title.

[HQ766.5.J3C65 1992]

304.6'66'0952—dc20 91-35976

R0

To My Parents

who have given me so much

Table of Contents

LIST OF TABLES  ix

LIST OF FIGURES  x

FOREWORD TO THE 1991 EDITION by Patricia G. Steinhoff  xi

ACKNOWLEDGMENTS  xxi

1. Introduction: How the Japanese Limit Fertility  3

The Widespread Use of Induced Abortion  3

A Dearth of Modern Methods of Contraception  7

Implications of the Japanese Pattern  10

The Study  13

2. Resources for Terminating Pregnancies  18

The Legacy of the Early Postwar Experience  18

How the Law Works  20

Finding an Abortionist  25

Safety and Cost  27

3. Resources for Contraception  30

Early Experiences in Family Planning  30

Modern Contraception and the Law  34

Obstetrician-Gynecologists and the Pill Ban  36

Contraception Versus Abortion in the Obstetrician-Gynecologist’s Practice  38

Doctors’ Attitudes Toward Contraception  41

The Activities of Family Planning Workers  44

Organizational Limitations  47

Condom Sales in the Commercial Sector  50

Birth Control Education in the Popular Media  54

4. Abortion, the Necessary Evil 57

Religious Sentiment and Symbolism  57

Religious Symbols in Secular Contexts  65

Fetus versus Infant  66

Polls and Surveys of Attitudes  68

The Determinants of a Morally Acceptable Abortion  72

Women’s Emotional Responses to the Abortion Experience  76

Men’s Attitudes Toward Abortion  80

Abortion Avoidance  82

5. Making Do: Method Adoption and Performance  87

Users’ Attitudes Toward Condoms  87

The Unfamiliar Modern Methods  89

Indications of the Unavailability of Modern Methods  93

Personal Information Channels  95

Cooperation and Control  100

Adopting the First Method  109

Rhythm, the Great Escape from Condoms  in

Patterns of Unwanted Conceptions  115

The Switch to Modern Contraception  118

6. Conjugal Roles and Women's Status  126

Conjugal Role Organization and Contraception  126

Role Segregation in Japanese Contraceptive Adoption and Use  129

The Japanese Conjugal Division of Labor  130

Leisure  135

Emotional Interaction and Communication  136

Class and Conjugal Role Relationships  139

Women’s Status as a Factor in Family Planning  141

The Important Factor of Education  147

Women’s Status in Japan  149

Women’s Status in Their Marriages  152

A Hypothetical Adaptation  154

7. Sexuality  156

Women’s Sexuality and Initiative in Contraception  156

Women’s Status and Sexuality  163

Male Sexuality and Initiative in Contraception  167

Male Preferences in Female Sexuality  171

Risshinben—The Heart of Sexuality  173

The Dubious Status of Marital Sexuality  174

The Sexuality of the Service Providers  179

8. Four Couples  184

Affluent Blue Collars: The Imaizumi Couple  184

Youthful Middle Class: The Ishida Couple  188

Older Middle Class: The Miyamoto Couple  193

Anomalies: The Kondo Couple  198

9. What Would Bring About a Change?  204

Deus Ex Machina  205

Change from the Top Down  206

Change from Service Providers  210

Change from the Bottom Up  213

The Necessary Social Trends  215

APPENDIX A. Selection and Characteristics of the Questionnaire and Interview Samples  223

APPENDIX B. Translated Questionnaire Form  229

APPENDIX C. Selected Nationwide Japanese Surveys on Family Planning and Related Areas  237

REFERENCES IN ENGLISH  241

REFERENCES IN JAPANESE  251

INDEX  263

List of Tables

1-1. Distribution of Reported Abortions by Age, Japan and United States, 1976

1-2. Percentage Distribution of Contraceptive Methods in Use Among Currently Contracepting Japanese Wives, Tokyo Area Clinic and Hospital Sample, 1975-1976

4-1. Response to Mainichi Survey Question on Attitude Regarding Induced Abortion, 1975

5-1. Distribution of Responses to a Question Regarding Priority of Contraceptive Method Features, in Percentages, Tokyo Area Clinic and Hospital Sample, 1975-1976

5-2. Method Control Preferences Among Currently Contracepting Wives by Type of Method Actually Used, in Percentages, Tokyo Area Clinic and Hospital Sample, 1975-1976

5-3. Mean Monthly Coital Frequency Among Currently Contracepting Wives by Age and Type of Contraceptive Method, Tokyo Area Clinic and Hospital Sample, 1975-1976

6-1. Educational Attainment Levels Among Women in Two Age Groups in Japan and the United States, in Percentages, 1970

7-1. Mean Monthly Coital Frequency Among Wives by Age and Education, Tokyo Area Clinic and Hospital Sample, 1975-1976

List of Figures

1. Distribution of Contraceptive Methods Among Currently Contracepting Married Women in Japan and Seven Other Industrialized Countries, in Percentages, 1974-1978

2. An Advertisement for Condoms in the Japan Family Planning Association’s Monthly Publication, The Family Planning (Kazoku Keikaku)

3. A Magazine Advertisement for Condoms

4. A Supermarket Circular Advertising Two Dozen Condoms (Arrow) Sale Priced at 450 ($1.61)

5. Poster for a Mizuko Requiem at Seigen Temple in Tokyo

6. Panels from I’m a Gynecologist

7. Cartoon Depictions of Fetuses

8. Type of Method Used Among Currently Contracepting Wives by Length of Marriage, Tokyo Area Clinic and Hospital Sample, 1975-1976

9. Comparison of Birth Rates per 1,000 Female Population in Five-Year Age Groups

Foreword to 1991 Edition

The other day I received a letter from a complete stranger who said he had heard an astounding bit of information about Japanese society, which he . found almost impossible to believe: that the average Japanese woman has seven abortions; birth control, other than condoms, is illegal; Japanese couples have been known to visit shrines where they bring or visit little dolls that represent their aborted children; and there is no organized family planning."

Well, yes and no. Each of the assertions contains a grain of truth, but is partly wrong. The number of abortions is closer to two than seven, and it is only birth control pills and certain IUDs that have been kept off the market. But even if each factual error were corrected the writer would remain incredulous, because what is missing is the social context within which such bits of information begin to make sense.

Fortunately the letter writer continued, I would be grateful if you could direct me to any sociological or anthropological studies that address these issues. That part was simple. I immediately sent him to this book, which will correct all the factual errors and explain why Japanese family planning presents such an unusual pattern.

Since its first publication in 1983, Family Planning in Japanese Society has been the definitive work in English, and it surpasses anything that I know of on the subject in Japanese as well. I don’t think you could find such a book among Japanese research publications on the subject, because it asks questions that Americans ask, and answers them in ways that Americans comprehend. Yet it certainly could not have been produced by an American social scientist who did not know Japan, even with an army of Japanese collaborators and graduate student assistants.

Samuel Coleman’s study bears the special analytic stamp of the outside-insider who speaks Japanese and knows Japan well, but is sufficiently removed from Japanese culture to question the obvious and to be undeterred by social and political taboos. From that special perspective comes research that is both social-scientific analysis and cultural translation, with explanations that follow the logic of contemporary social science, but also convey the internal logic of everyday life in another culture.

Coleman is one of a very small number of social scientists, mostly U.S. trained, who have the requisite talent and special skills to do this. Some of these scholars are native speakers of Japanese, but others, like Coleman, have had to do it the hard way and learn Japanese along with their other academic subjects. His work reflects the methodological and analytical sophistication of contemporary American graduate education, plus the language skills, multidisciplinary breadth, and cultural understanding of a dedicated Japanese area specialist.

The research question seems deceptively simple. Why doesn’t family planning in Japan work the way it is supposed to? More specifically, how has Japan managed to lower its birth rate effectively without using the same array of modern contraceptives that other industrialized countries rely on? And why doesn’t such a highly developed country use the same forms of birth control as its western peers?

The answers cannot be found by adding another variable to a family planning survey, or by applying more sophisticated mathematical models to the data analysis. Coleman uses survey data well, but to find the real answers he had to go far beyond it. In order to comprehend birth control utilization in Japan, he had to investigate the social structure, economics, and politics of both the medical profession and other providers of family planning services. To understand Japanese birth control choices, he had to examine the dynamics of middle-class family life. He did not flinch at exploring aspects of sexuality that most Japanese do not talk about with their sexual partners, let alone with strangers. To grasp the cultural reinforcement for the preferred family planning choices, he looked at women’s magazines and studied popular religious beliefs and practices.

Most of all, he listened carefully when people told him about their lives and their emotions. As a foreign man studying the intimate details of Japanese sexual behavior, Coleman had the good sense to design part of the study around interviews with married couples, and the sensitivity to have a Japanese woman interview the wives while he talked to the husbands. The resulting differences in perspective are eye-opening.

It is all here, each piece carefully fitting into the puzzle until the whole picture becomes clear. When you have finished this book you will not only have the facts right concerning family planning practices in Japan, you will also understand the price this set of family planning arrangements exacts and who pays it. In addition, you will have new insight into how some key aspects of Japanese society work, including families, sexual relationships, interpersonal relations, medical care, and interest group politics.

Since the research for this book was conducted during the mid-1970s, it is fair to ask whether the picture it paints is still true today. Overall, I think the answer is yes. Japanese society is changing, but Coleman has explored his topic so deeply and so well that it offers an excellent guide to the changes. To put this book into perspective for the 1990s, we need only look briefly at what is happening in three critical, interrelated areas: the availability of modern contraceptive methods; the status of women; and the use of abortion.

AVAILABILITY OF CONTRACEPTIVE METHODS

Just as this edition is going to press, a low-estrogen birth control pill is coming onto the market in Japan. Thus in the 1990s the birth control pill will be generally available in Japan for the first time. The big question is how this will affect the prevailing pattern of family planning that Coleman has described.

The national family planning surveys show little change in the contraceptive preferences of married women since the 1970s, and remarkably little interest in switching to the pill if it were available. One current prediction is that only ten percent of women now using other methods will switch to the pill. Coleman’s study shows us why that situation has prevailed for so long, and provides exactly the background needed to observe what will happen as the pill becomes more readily available. He has also provided an excellent roadmap for studying how the pill has finally reached the market.

It will be a while before pill usage can be measured reliably, but readers of Coleman will be checking the women’s magazines for signs of change and also following how the medical associations respond. One clue will be whether these opinion leaders present the new low-dose pill as a safe alternative, or continue to emphasize the side effects and health dangers that have helped to dampen interest in the pill in the past. 1 think there will be a larger shift to the pill than the family planning surveys suggest, and that leads to the issue of changes in the status of women.

THE STATUS OF WOMEN

Coleman’s study focuses almost exclusively on married women, the traditional sample for family planning studies, and his findings reflect the overwhelming standardization of marriage and family planning practices in postwar Japan. Most of the women in his survey and interview samples were sexually inexperienced at marriage, but were quite well educated and had worked for several years before marrying. They often continued to work until their first pregnancy, and then dropped out of the labor force to become full-time housewives and mothers raising the modal two children. If they later returned to work it was only on a very limited part-time basis, when childcare and household responsibilities permitted.

In the 1990s, the majority of married women with children are back in the labor force. They are there for the money to maintain a comfortable middle-class lifestyle, to pay for the extras for their children, and for the mental stimulation and personal satisfactions of working outside the home. They are also there because Japanese employers now want and need them desperately. Japan’s postwar success in lowering fertility has produced a chronic labor shortage, and married women are a critical part of the solution.

The total fertility rate, an estimate of the number of children a woman will have in her lifetime, now stands at 1.57. This is so far below replacement level that in 1990 alarmed conservative politicians proposed an increase in family allowances to try to induce women to stay home and have more children. The idea drew an immediate negative response both from women’s groups and from employers, who suggested that a more realistic approach was to provide better support systems so that women could have children and remain in the labor force.

In most societies, increased participation of women in the labor force leads to better use of birth control and a lower birthrate, as women gain more power in the household and greater personal autonomy. In Japan the birthrate was already very low before married women began returning to the labor force but, as Coleman explains, that low birthrate was achieved through the combined use of condoms, rhythm, and abortion, rather than through the use of more reliable methods of contraception. Japanese couples are very effective users of poor family planning methods.

Coleman has traced the intricate family dynamics that have made this family-planning arrangement work, and he predicted in the early 1980s that a shift to improved contraception was likely to come about only through changes in married women’s status in the household, as a result of greater and more satisfying outside employment. That is precisely what has been happening over the past decade, but until now better birth control alternatives have not been readily available. The question of how much difference the introduction of the pill will make has focused on these married women, yet it seems unlikely that family dynamics have changed radically within the kinds of households that Coleman studied in the 1970s, even if more of the wives have returned to work.

Large-scale social changes often creep up unnoticed because a certain dominant pattern of behavior is still followed by the mainstream of the society, while alternative ways of behaving appear around the fringes and gradually become more common. If researchers keep looking only at a mainstream that is defined by that dominant pattern of behavior, they will not notice the change until it has revolutionized the society. In this case, focusing too heavily on the behavior of married couples who are reached through the standard sampling frames used for family planning surveys obscures the major changes that have taken place among young, single Japanese women over the past decade.

In the 1990s, these young women are better educated, more economically independent, more career oriented, and more sexually sophisticated than their counterparts were just a decade ago. The average age of marriage is creeping upward, and the percentage of women in their thirties who remain unmarried is also rising. Although there is little hard data yet, it seems apparent that premarital sexual activity has increased, and with it the demand for contraceptives and abortion among young, single women. Even more important for the long term, the proportion of young women who expect to combine a career and marriage is increasing. These women do not anticipate simply a return to the labor force as low-paid part-timers when their children enter school. Instead, they hope to maintain a professional career with some brief interruptions for childbearing. That is still a very difficult lifestyle to maintain in Japan, but more and more couples are trying to make it work.

Such couples have different family dynamics from the traditional Japanese postwar pattern because they strike a very different bargain from the very beginning of their marriages. Coleman has laid the groundwork for future studies of these new families in two ways. First, by laying out the internal dynamics of more traditional Japanese marriages, he shows us where to look for change. Second, in his description of Anomalies: The Kondo Couple in chapter eight Coleman has given us a glimpse of a very different lifestyle. In 1990 the Kondos are still unusual in Japan, but much less so than in the 1970s, and more and more young single women aspire to a similar marital relationship.

I think the demand for the pill will come from these new sophisticates, who will begin using it long before they marry. They may not turn up in significant numbers in traditional family planning surveys for another decade, but by then it will be time to reopen the whole question of family planning in Japan, including the role of induced abortion.

USE OF ABORTION

Because of the high failure rates of condoms and rhythm, the preferred contraceptive method, induced abortion remains an essential component of Japanese family planning practices. This phenomenon has been of great interest to Americans because of the continuing domestic debate over abortion. Coleman’s Family Planning in Japan remains one of the best sources for understanding all aspects of how and why abortion is used in Japan.

A book as comprehensive as this, however, often becomes a resource for purposes its author never intended. In this instance, evidence and arguments that Coleman developed in the course of analyzing family planning among married couples in Japan may easily be misunderstood when read from the perspective of the highly polarized abortion debate in the United States. Without in any way undermining Coleman’s basic argument about the relationship between high utilization of abortion and the institutional factors that limit access to modern contraceptive methods in Japan, I think some of his points about Japanese use of abortion need further clarification and context.

After explaining why the prevailing pattern of birth control use leads to a high demand for induced abortion, and outlining the economic interests that encourage the continuation of this situation rather than a shift to better methods of contraception, Coleman argues against the hypothesis that Japan’s high rate of abortion reflects a more positive or casual attitude toward abortion than prevails in western societies. To make the point that abortion is not a comfortable solution for Japanese women, he presents evidence suggesting that many of them experience sadness and guilt over their abortions. This is true, but taken out of context it could leave readers with the erroneous impression that Japanese have a more negative attitude toward abortion than people in other industrialized societies, or that women in general are more traumatized by abortion than is in fact the case.

The focus of Coleman’s research, and of virtually all social research on abortion in Japan, is on married women who use abortion for the purposes of spacing births or limiting family size. There are no reliable statistics on abortions obtained by unmarried women, although the number is generally thought to be increasing. It is probably safe to assume that the majority of all abortions in Japan in 1990 were performed on married women.

By contrast, in the United States and most other industrialized countries where it is available, induced abortion is most often used by young, single women to delay the birth of the first child. The U.S. research shows that women who have previously given birth are more likely to experience negative emotions such as sadness and guilt following an abortion, whereas women who terminate a first pregnancy by abortion rarely experience either short-term or long-term psychological difficulties after the procedure. Thus the evidence Coleman has presented probably reflects the specific social circumstances in which most abortions take place in Japan, rather than a generalized social or cultural response that varies by country, or a phenomenon that most women experience.

In the same vein, Coleman points out that Japanese married women undergo abortions with little social support from family members or the larger society. This too is certainly true, but requires some context. The way family members handle an abortion crisis follows the standard Japanese procedure for handling any kind of conflict or crisis in a small group. The problem is pushed back onto the individual, who is expected to deal with it privately in a way that will best support the larger interests of the group, while others try to ignore the situation and pretend the unpleasant problem does not exist.

There are virtually no rewards in Japanese society for acting on an abstract moral principle at the expense of important social relationships, but there is considerable indirect reward for someone who makes a personal sacrifice for the collective welfare without complaint. Hence, while there appears to be little social support for a woman who undergoes an abortion, there would be no support at all for her refusal to do so if giving birth would cause hardship or embarrassment to other family members. The negative tenor of public opinion about abortion is tempered by the general understanding that it is indeed a necessary evil, as the title of chapter four of this book conveys.

As part of the same overall argument that abortion is not a positive alternative in Japan, Coleman also points to the existence of religious opposition to abortion, and describes the Buddhist practice of commemorating aborted fetuses with mizuko statues, which he views as evidence of social disapproval and abortion guilt. There are indeed some fundamentalist new religions in Japan that strongly oppose abortion in ways that resemble their counterparts in the United States. However, the mainstream Buddhist attitudes and the practices related to mizuko stem from a rather different approach. They can best be understood within the context of the special psychological circumstances of marital abortion and the limited support Japanese women receive from other family members when they resort to abortion.

An important new study by Buddhist scholar William La-Fleur (forthcoming in 1992 from Princeton University Press) explores the Buddhist theology and practices related to abortion in greater detail. LaFleur argues that the Buddhist approach to abortion is very different from the situation in the contemporary United States, where religious groups that oppose abortion strongly condemn and reject women who undergo the procedure, and encourage them to feel heavy guilt. By contrast, Japanese Buddhism, while regarding the act of abortion as morally wrong, acknowledges the social exigencies that cause women to resort to it. Buddhism reaches out to the women with compassion, offering them a way to relieve their sadness and guilt through the use of mizuko statues.

While granting that there has been some commercial exploitation of the mizuko practices, LaFleur emphasizes the positive role that Buddhist clergy and institutions have played by addressing sympathetically the human dilemma of abortion. This explanation of Buddhist practices and attitudes is fully consistent with Coleman’s main point about abortion, that it is heavily used in Japan not out of the user’s preference, but because powerful economic and political interests have favored the use of abortion over the introduction of modern contraceptive methods such as the pill.

The political and economic relationship between abortion and the availability of contraceptive alternatives is what makes the introduction of the low-dose pill in 1991 such a critical event, and correspondingly, makes the publication of a new paperback edition of this book so timely.

Patricia G. Steinhoff

University of Hawaii

Acknowledgments

I could not have conducted the research for this book had it not been for the assistance that Japanese and American colleagues and friends so willingly gave me. In Japan, medical specialists, paramedicals, and counselors in social work and family planning offered not only their time for interviews and discussions, but administered my questionnaires to their clients, provided me