Katsunobu Kato, Minister of Health, Labor and Welfare
21, July, 2020
A Request for Improving Access to Emergency Contraceptive Pill in Light of theImpact of COVID-19

Citizen’s Initiative for Pharmaceutical Access To Emergency Contraception
Violence against women and children is rapidly increasing worldwide due toquarantine measures put in place to reduce spread of COVID-19, and it has beenreported that the number of people experiencing anxiety of unintended pregnancy isincreasing, especially among young people, in Japan. The emergency contraceptive pill(“morning after pill”, EC) is a medicine that prevents pregnancy after sexual intercourse
without contraception or sexual intercourse without proper contraception, including insituations of sexual violence. It should be taken as soon as possible, and within 72
hours of sexual intercourse. Contraception and family planning are essential to thehealth care of women and are important in any situation. Also, preventing unintended
pregnancies can lead to fewer deaths by child abuse. We are requesting the following toprotect the health of women and children amid ongoing uncertainties due to COVID-19:
1. To promote an environment where EC is used properly and safely
2. To improve, strengthen, and inform the system for providing face-to-face and online
medical care for emergency contraceptives
3. To resume the discussion regarding switching EC into OTC (over-the-counter)medicine immediately, reflecting the voice of the public
4. To make emergency contraceptives available without prescription at pharmacies,
with the involvement of a pharmacist

These requests are explored in more detail below.
1. To promote an environment where EC is used properly and safely
EC is a last resort and cannot prevent pregnancy perfectly. It is crucial to provide
appropriate aftercare when needed, support women’s choices by giving information
about daily contraception, sexually transmitted infection testing, or cervical cancer

screening, and nurture proper understanding of sex and sexuality through education.
Also, in Japan, because EC is expensive, there are problems such as financial barriers
to taking EC, or the buying and selling EC whose safety cannot be ensured throughSNS.
Emphasizing women's physical, mental, and social health, we demand apromoting an environment where EC is provided for affordable prices* in multiple means
to all women at risk of unintentional pregnancy and used properly and safely.
*Emergency contraceptives are designated by the WHO as an “Essential Medicine (essential forthe health of the majority of the population and should be offered at an affordable price toeveryone)”.

2. To improve, strengthen, and inform the system for providing face-to-face andonline medical care for emergency contraceptives
EC is a ‘prescription-needed medicine’, meaning that face-to-face consultation
with a doctor (regardless of the department) has been a requirement for women toreceive EC. Additionally, in July 2019, the `Guideline for the Proper Implementation ofTelemedicine' was revised to allow telemedicine for EC with certain requirements being
met. From April 2020, a special and time-limited treatment has been implemented due
to COVID-19, and it is now possible to have a consultation with a doctor for obtaining
EC by phone or video call, even when the original requirements are not met. Currently,
the Ministry of Health, Labor, and Welfare provides online training for medical doctors
on prescribing EC through telemedicine. On the other hand, training for pharmacists hasbeen available only offline, so that they have been postponed in many regions. Also, thelist of trained medical doctors and pharmacists has not been published or madeavailable for the public.
We urgently request to improve and strengthen the system for providing EC,
including establishment of an environment where pharmacists nationwide can take partin training, and disseminate information from people in medical care to the generalpublic.

3. To resume the discussion regarding switching EC into OTC (Over-the-counter)medicine immediately, reflecting the voice of the public.

Although the majority of the public comments supported accessibility to EC at apharmacy, it was denied at the Evaluation and Review Conference on Conversion ofMedicine from Medical Use to Guidance/General Use in 2017. Despite this, the Ministerof Health and Welfare stated that “We cannot avoid discussing OTC again” in 2018.
On 18th May 2020, the Council for Regulatory Reform Promotion of the Cabinet Officepublished “Opinions for Expanding OTC Drug (Switch OTC) Options (draft)” andannounced: “medicines that have been converted to OTC in many other countries suchas emergency contraceptives are not approved in Japan".
The WHO (World Health Organization) is advising all over the world to “Ensureaccess to emergency post-coital contraception, including consideration of over thecounter provision" during the COVID-19 pandemic.
We demand to resume the discussion regarding switching EC into OTC(Over-the-counter) medicine immediately. In addition, to reflect voices from the public,
the committee members should include not only specialists like pharmacists or medical
doctors but also representatives of civil groups and women who understand thebackground and situations of women who are in need of EC, and act to represent thisgroup.

4. To make emergency contraceptives available without a prescription atpharmacies with the involvement of a pharmacist
EC has been established as a safe drug without serious side effects, meaningthat it does not need to be under strict medical control. Therefore, in 19 countries, EC isdirectly available at pharmacies, and 76 countries let people buy EC at pharmacies withconsultation and explanations by pharmacists. On the other hand, in Japan, it isnecessary to have a doctor's medical consultation and a prescription throughface-to-face consultation or telemedicine, and it costs about from 6,000 yen to 20,000
yen (60-200USD). We hear statements like: "I gave up taking EC because ofpsychological barriers to medical consultation and cost.", " the procedure took too longand I could not take EC within 72 hours of sexual intercourse; I got pregnant,", "I could
not use telemedicine because it requires credit card payment and I didn't have a card."
To ensure that all women at risk of unintended pregnancy can access EC,
besides strengthening the provision of medical consultation, we demand to create anenvironment where women can get EC properly and with a sense of security atpharmacies: without a prescription and with the involvement of a pharmacist.

*1) BPC: Behind The Pharmacy Counter *2) OTC: Over The Counter
For G7 (7 major countries) excluding Japan, EC can be purchased at pharmacies through BPC
in Germany, the United Kingdom, Italy and OTC in the US, Canada and France. It costs from
8-40 USD.

[Supporting organizations (in alphabetical order)]<General Incorporated Association>
Chabudai Gaeshi Jyoshi Action
Japan Family Planning Association (JFPA)
JLIPA
Kanagawaken Women’s Pharmaceutical Association
Little Women Project

Professional Women's Coalition for Sexuality and HealthSpring<Public Interest incorporated foundation>
Japanese Organization for International Cooperation in Family Planning (JOICFP)<Approved Nonprofit Organization>
Empowerment Kanagawa
Florence
Katariba
Masorebonita
Single Mothers Forum<Nonprofit Organization>
All Japan Women's Shelter Network
BOND ProjectChild First Japan
Lighthouse: Center for Human Trafficking Victims
National Network for Domestic Violence prevention
Piccolare
PilconSexual Assault Relief Center Tokyo (SARC Tokyo)
Shiawasenamida

Solidarity Network with Migrants Japan, Women’s ProjectWomen’s Clinic Network<Others>#Nandenaino Project[Inquiries]

Citizen’s

Initiativefor

PharmaceuticalAccessTo

Emergency

Contraception(CIPATEC)
E-mail address: info@kinkyuhinin.jp[Reference Material]
WHO `Contraception/Family planning and COID-19''https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answ
ers- hub/qa-detail/contraception-family-planning-and-covid-19?fbclid=IwAR1poiAktBdEi-I6YZ
HQ2j3dYnlu4nlCpfoh967Cmn5_ziFXPjWxs3XsGGIWHO ``Emergency Contraception''
https://www.who.int.en/en/news-room/fact-sheets/detail/International
Conception ://www.cecinfo.org/
Regulatory Reform Promotion Council “Opinion (draft) for expanding OTC drug (switchOTC) options”https://www8.cao.go.jp/kisei-kaikaku/kisei/
publication/opinion/200518honkaigi01.pdf