Nepalese women in Japan face challenges in accessing sexual and reproductive health services

Despite a substantial Nepalese community in Japan many Nepalese women face significant challenges in accessing essential sexual and reproductive health services (SRHSs) due to language barriers and differences in healthcare laws and services between Nepal and Japan. In Nepal, women have free access to a wide range of contraceptive and abortion services, while Japan places more restrictions on certain contraceptives and does not provide free abortion services. These limited options make women more reliant on their male partner to use contraceptives for birth control. These challenges in accessing contraceptives, especially female-oriented contraceptives, lead them to acquire contraceptives from Nepal, increasing the risk of inappropriate use, unintended pregnancies, and other serious health complications.

A recent study by a team of researchers led by Professor Masako Tanaka from the Faculty of Global Studies, Sophia University, Japan, sheds light on the challenges faced by Nepalese migrants in accessing SRHSs in Japan. The research team included Dr. Rachana Manandhar Shrestha from the Institute of Asian, African, and Middle Eastern Studies at Sophia University and the Department of Community and Global Health at The University of Tokyo, Japan; Dr. Richa Shah from the Health Action and Research, Nepal; Dr. Divya Bhandari from the Department of Global Health and Population at Harvard University, USA; and Dr. Bijay Gyawali from the Amoha Center for Mental Health and Well-Being, Nepal. This study published in Volume 12, Issue 13 of the journal Healthcare on 2 July 2024, examines the use of different contraceptives and access available to Nepalese men and women both in Nepal and after migrating to Japan.

Sharing the motivation behind this study, Prof. Tanaka shares, "Being a certified social worker and domestic violence counsellor, I have observed several unintended pregnancy cases among migrant women. I also lived outside of Japan for 2 decades. So, I was familiar with contraceptive options abroad. Therefore, I could understand the difficulties of migrant women in Japan."

The research team investigated the challenges affecting access to contraceptives and the reasons behind them, by using a mixed-methods approach with both qualitative and quantitative data. They conducted an online questionnaire survey with 186 participants (80 women and 106 men), to understand the general trends in contraceptive use and access to reproductive health services between June 2020 to January 2021. To gain deeper insights, they conducted virtual focus-group discussions (FGDs) with 24 participants comprising of 10 men and 14 women. These discussions brought to light personal experiences, cultural barriers, and several specific issues that were not captured by the survey.

In the FGDs, participants discussed their general access to sexual and reproductive health information and services in Nepal and Japan, sharing their contraceptive needs, usage, support from their partners or spouses, and the challenges faced in accessing SRHSs in Japan. The responses from the discussions were analyzed using 4A framework (availability, accessibility, acceptability, and affordability).

The study found that condoms were the most used contraceptive method both in Nepal and Japan. However, traditional contraceptive methods such as the rhythm method and withdrawal were prevalent in Japan.

Many participants also brought contraceptives with them to Japan, including condoms, oral contraceptives, and emergency contraceptives. The most common reasons were the ease of obtaining contraceptives, minimal cost, free access, and the absence of a language barrier in Nepal. In contrast, participants highlighted the language barrier, higher cost, not knowing how to obtain them, concerns about side effects, lack of insurance coverage, and cultural and social stigma as challenges in accessing contraceptive and abortion services in Japan. Additionally, the researchers pointed out that the lack of options and the high costs of contraception and abortion are common issues faced not only by migrant women but also Japanese women.

Furthermore, this study also highlighted the importance of incorporating SRH education into pre-departure training in Nepal and organizing post-arrival training in Japan. Elaborating on this, Prof. Tanaka adds, "Training programs will be developed and implemented on sexual and reproductive health services, including contraception available in Japan for migrants before and after their arrival. Nonprofits and migrant groups will provide outreach and support to meet the needs of migrants, and health care workers will be trained to overcome cultural and language barriers."

"I hope that policies will be implemented that embody the spirit of universal health coverage, ensuring that contraceptive services are accessible, affordable, and available in destination countries, so that migrants traveling across borders have access to the same services as they had in their countries of origin," concludes a hopeful Prof. Tanaka.

We hope that this study paves the way for reforming laws and policies that ensure universal access to SRHSs worldwide.