Aug 22, 2024 (East Asia Forum) - As Japan’s fertility rate continues to reach new lows — with a total fertility rate of 1.2 in 2023 — the Tokyo Metropolitan Government has begun to subsidise elective egg freezing (EEF). The goal of this strategy is not to strengthen women’s autonomy, but rather to encourage the continued creation of traditional families in a changing society that makes having and raising children more difficult.
In 2020, the Tokyo Metropolitan Government began a subsidy program for EEF, which was incredibly popular from its implementation. In March 2024, plans to expand the subsidy program were approved by the Tokyo Metropolitan Assembly’s 2024 revenue and expenditure budget, with the program going into effect in April.
Egg freezing in Japan costs an average of 300,000–600,000 yen (US$1904–3808) and is usually paid out of pocket. The expanded subsidy program was overwhelmed with over 7000 applicants, well above the anticipated maximum of 300 that the city had originally budgeted for in October 2023.
Though many women have expressed interest or followed through with freezing their eggs, few women return to use their frozen eggs later in life. A study conducted over eight years of EEF at Junetendo Urayasu Hospital, which the Urayasu City government funded rather than giving funds directly to women pursuing the procedure, concluded that despite the high usage rate for egg freezing, the utilisation rate of frozen eggs was only 15 per cent. The live birth rate per egg thawed was 21 per cent. Birth rates in Japan continue to decline, with births from assisted reproductive technology only marginally increasing total live births.
Before the 2024 changes to Tokyo’s EEF subsidy program, both anti-mullerian hormone tests and a cap on the number of applications were in place. The subsidy is available for unmarried and married women between the ages of 18–39 who reside in greater Tokyo at the time of egg retrieval.
But while other East Asian nations, like South Korea and Taiwan, begin rolling out egg freezing subsidy programs on a local level, Japanese regulations on using frozen eggs collected both in and out of the confines of the subsidy program remain strict. Women must have the written consent of their legal spouse before they are able to access their frozen eggs. This caveat bars both single women and LGBTQ+ persons in Japan from using frozen eggs to have children. Though it is rare for women to have children outside of the confines of marriage in East Asia, attitudes are slowly changing.
Even though EEF is not advised by the Japan Society of Obstetrics and Gynecology in principle, government subsidies have influenced the growth in demand for egg freezing. The popularity of the program can be attributed to a combination of factors, including the increasing average age of women having children in Japan, economic and societal pressure for women to pursue higher education and careers, as well as declining marital rates.
In addition to the cultural and economic hurdles to having children in Japan, older women pursuing any form of assisted reproductive technology often need to undergo multiple cycles to achieve a live birth due to decreased success rates as women age. Egg and embryo donations are still not available in Japan, putting more pressure on women to preserve their own fertility should they choose to have children.
Though the use of assisted reproductive technology in Japan is driven by a narrative of choice, in practice it is oppressive to women. Japan is still heavily influenced by traditional gender and family norms. This extends into the public discourse around egg freezing, strengthening the notion that specific biological roles differentiate men and women.
Egg freezing is seen as a way to solve the growing problem of infertility by adapting to the societal changes that have led women to have children later in life. It is not seen as a liberating choice that women have to take control of their fertility, but a way for women to reassume their roles as mothers through a traditional family dynamic.
This could explain why there is not a strong feminist discourse that encourages EEF in Japan. The purpose of the procedure is not to empower women’s choices and fertility autonomy but rather to realise the same traditional family expectations in a changing society that has made having and raising children more difficult.
This traditional family dynamic also aligns with the Japan Society of Obstetrics and Gynecology’s family registration ideology, which influences medical professionals’ understanding of assisted reproductive technology in Japan. In March 2023, Prime Minister Fumio Kishida held a press conference where he outlined Japan’s goal of creating a ‘children first society’ with a completely restructured approach to fertility policies in Japan. Expanding EEF access is one of these small yet important policies.
But despite its popularity, data is beginning to show that subsidising EEF is not cost-effective for governments. EEF and subsidies for the procedure can offer reproductive choices for individuals facing infertility. But presenting EEF as a way to increase birth rates or promote gender equality is an expensive misstep that Japan should avoid.
