Women’s Health

1.　Maternal Mortality Rate

• Each year, there are more than 300,000 maternal deaths worldwide, which translates to about 800 deaths per day. This can be attributed to factors such as young pregnancy and childbirth (pregnancy and childbirth before the age of 20), lack of family planning, underdeveloped medical environment and health services, and delays in infectious disease control [1]. According to a 2000 report, 95% of maternal deaths occur in Africa and Asia, 4% in Latin America and the Caribbean, and the remaining 1% in high-income countries. In particular, it has been shown that 1 in 16 women living in sub-Saharan African countries are likely to die from pregnancy and childbirth [2].

2.　Gender-based Violence

• Gender-based violence refers to any act that harms another person against their will based on social gender differences. In the Democratic Republic of Congo, which has been called “the worst place in the world for women,” two in three women have been victims of sexual violence since 1996 [3]. In 2014, the Islamic State captured more than 7,000 women and children, and more than 3,000 are still unaccounted for due to forced marriage, sexual violence, and human trafficking [3].
• Victims of violence are more likely to experience forced or unexpected pregnancies, unsafe abortions, fistulas (obstetric fistulas)^[i], and the development of sexually transmitted infections, including HIV, as well as death, depending on the severity of the violence [4].

3.　Reproductive Health^[ii]

• At the end of 2018, there were 37.9 million HIV-positive people worldwide, 1.7 million new HIV infections per year, and 770,000 deaths from AIDS per year [5]. In sub-Saharan Africa, the number of positive females aged 15–24 years is reported to be twice that of males. Furthermore, when restricted to adolescents aged 15–19 years, four out of five new infections are among women [5]. It has also been reported that in African countries such as Rwanda, Tanzania, and South Africa, women who have experienced physical or sexual violence by an intimate partner are more likely to be infected with HIV [6].
• There are more than one million sexually transmitted infections (STIs) per day worldwide [7,8]. Among them, Chlamydia trachomatis, and gonorrhea can cause serious complications in women, including pelvic inflammatory disease, and infertility [9].
• The main contraceptive method used globally is oral contraceptives, followed by female sterilization, and intrauterine devices (IUDs) [10]. Among them, many women in European countries take oral contraceptives as their primary method of birth control [10,11]. The rates of oral contraceptive use in each country are shown in the next section.

[i] A complication that occurs during childbirth, it is a condition in which the vagina and the surrounding bladder and rectum are pierced. It causes incontinence of urine and or feces and can lead to discrimination.

[ii] People should be able to have a safe and fulfilling sex life, have the ability to reproduce, and have the freedom to decide whether or not to have children, when to have them, and how many to have.

1.　Cervical Cancer

• Cervical cancer generally develops through cervical intraepithelial neoplasia (CIN) caused by sexually transmitted human papillomavirus (HPV) infection [12]. Vaccines are designed to prevent the development of cervical cancer by preventing infection with the causative agent, HPV. The vaccination rate in Japan was over 70% at one point, but after multiple adverse events were reported in 2013, the vaccination rate dropped to less than 1%. Cervical cancer affects about 10,000 women and kills about 2,900 per year in Japan, and the incidence rate among young people is similar to that of low- and middle-income countries [13]. The number of deaths from cervical cancer is expected to increase in the future due to vaccine hesitancy. In Japan, as of April 2021, the HPV vaccine is available for girls from the 6th grade of elementary school to the 1st grade of high school^[iii] and the public bears the expense. In addition, the Ministry of Health, Labor and Welfare (MHLW) has prepared a leaflet explaining the effects of HPV vaccination, the vaccination schedule, and the risks of the HPV vaccine [14].

2.　Modern women and oral contraceptive use rates (including low-dose pills)

• According to the United Nations Population Division statistics for 2019, the oral contraceptive (including low-dose pills) use rate in Japan is 2.9%. The oral contraceptive use rate in Western countries is 25.6% in Norway, 26.1% in the UK, 33.1% in France, 28.5% in Canada, and 13.7% in the US, while in East Asia the rate is 2.4% in China, 6.2% in Hong Kong, and 3.3% in South Korea. In Southeast Asia, the oral contraceptive use rate is 8.4% in Myanmar, 10.5% in Vietnam, 19.6% in Thailand, 8.8% in Malaysia, and 13.7% in Cambodia [11,15]. These figures show that the oral contraceptive use rate in Japan is very low, not only among Western countries, but also among Asian countries.
• Modern women have more menstrual periods in their lifetime due to fewer births than women in the past, leading to dysmenorrhea and endometriosis [16].
• In Japan, 18.2% of all couples and 28.2% of childless couples have undergone (or are currently undergoing) infertility testing and treatment. This represents 1 in 5.5 couples overall [17].

3.　Sexual violence and sex crimes

• According to a survey by the Cabinet Office, one in thirteen women said that they had experienced forced sexual intercourse, meaning that as many as four million women have been victimized. On the other hand, there were 1,307 recognized cases of victimization in one year, and 492 cases were prosecuted, which is only 37% of the total number of recognized cases [18]. It is estimated that 20–50% of victims of sexual violence experience Post Traumatic Stress Disorder (PTSD). Depression, panic disorder, social fear, and other psychiatric disorders are common among victims of sexual violence, whether or not they are associated with PTSD [19].

[iii] From the first day of the year in which the child becomes 12 years old to the end of the year in which the child becomes 16 years old.

• 1979: The United Nations General Assembly adopted the Convention on the Elimination of All Forms of Discrimination against Women, which calls for the adoption of appropriate measures to eliminate discrimination in political and public life, and in economic and social activities.
• 1994: International Conference on Population and Development in Cairo adopts the Cairo Declaration on Population and Development.
• 1995: The Beijing Declaration and the Platform for Action was adopted at the World Conference on Women, setting forth the goals of gender equality, development and peace, as well as the agenda for women’s empowerment.
• 2000: The United Nations Special Session of the General Assembly convenes the “Women 2000 Conference” to reaffirm the content of the 1995 Platform for Action, which includes items such as women and health and violence against women.
• 2015: The Millennium Development Goals (MDGs) are established, setting out eight goals to be achieved by 2015. Goals 3 and 5 set targets for promoting gender equality, improving the status of women, and improving maternal health.
• 2030: The Sustainable Development Goals (SDGs) are established, setting out 17 goals to be achieved by 2030. Goal 3 (Health and Well-being for All) and Goal 5 (Achieve Gender Equality) continue to set targets from the MDGs to improve maternal health and promote gender equality.

• 1947: The Labor Standards Law prohibits discrimination against women in wages.
• 1985: The Equal Employment Opportunity Law aims to ensure equal opportunity and treatment for men and women in employment, and to promote measures to ensure the health of female workers during pregnancy and after childbirth.
• 1997: As a related law to the revision of the Equal Employment Opportunity Law, the Labor Standards Law was partially revised, and the provisions protecting women that restricted women from working overtime, late at night, and on holidays were abolished.
• 1999: The Basic Law for a Gender-equal Society was enacted, aiming to realize a society in which both men and women can play an active role in all fields according to their ambitions, based on the five pillars of respect for human rights, consideration of systems and practices in society, joint participation in the formulation and decision-making of policies, balancing family life and other activities, and international cooperation.
• 2016: The Act on Promotion of Women’s Participation and Advancement in the Workplace obliges companies to create a working environment in which women who want to work can do so.