FUKUOKA -- When a woman in western Japan visited a hospital several years ago to seek an abortion after being sexually assaulted, she heard a shocking response from her doctor: "We cannot proceed without consent from the father."
She had noticed she was pregnant about a month and a half after she was assaulted by an acquaintance. She was so shocked that she did not report the incident. She explained her situation over and over again, but the doctor refused to budge.
"You know him, so you should be able to get him to sign off," the doctor said.
The woman searched for other medical facilities that were more understanding, but received a similar response every time. It was only a month later, with the recommendation of a support group for women like her, that she was able to finally receive an abortion.
By that point, her case was considered a second-term abortion -- a significantly riskier and costlier procedure, which she was required to report to the government as a stillbirth.
She said the process was physically and emotionally traumatizing. "Why do victims have to suffer again and again?" she said.
The woman is one of many sexual assault survivors denied abortions across Japan by hospitals that require consent from their attackers. Support groups have made some headway toward overturning these requirements that retraumatize victims, though they face a long road ahead.
At the end of June, the Lawyer Forum for Victim Support submitted a written request to the Japan Medical Association to stop requiring sexual predators' consent for an abortion. The document included four case studies where sexual assault survivors were blocked from the procedure due to this requirement.
The controversy is rooted in the Maternal Health Act, which requires consent from both the mother and her "spouse" to perform an abortion. Critics argue that the law pushes some doctors to seek a signoff from the male party, even in potential sexual assault cases.
Many hospitals model their paperwork for abortions on a template provided by the Japan Association of Obstetricians and Gynecologists, which has a dedicated field to be filled by a "spouse."
"The template is a big part of the problem," said attorney Sakura Kamitani, a member of the Lawyer Forum for Victim Support. "Doctors may seek consent from the attackers because they don't want to leave part of the form blank."
Japanese law permits abortions for various reasons, including for pregnancies caused by rape. But doctors on their own cannot determine whether a sexual assault has taken place. At a December workshop in Tokyo, the Japan Medical Association instructed gynecologists to request documentation like a bill of indictment or a court sentence from sexual assault victims seeking an abortion.
There are also cases where the perpetrators do not recognize that they assaulted their victims.
"We want to perform the abortions, but we can't rule out the possibility that we will be sued by the male party," said JAOG Vice Chair Isamu Ishiwata.
Many sexual assault survivors are reluctant to contact the authorities. According to the White Paper on Crime published last year by the Ministry of Justice, only about 14% of sexual asault victims had brought their case to the police in the five years prior.
"Being denied an abortion at the hospital could be a form of 'second rape,'" or a secondary victimization, said Hisako Ura, head of the Fukuoka Victim Support Center.
In response to growing scrutiny over the issue, the Ministry of Health, Labor and Welfare in August sent a letter to the Japan Medical Association clarifying that the Maternal Health Act does not require consent for abortions from rapists.
Still, Kamitani believes this does not go far enough. "Doctors on the ground could keep asking for a signoff unless they are explicitly told that they must not do so," she said. Her organization is urging the Japan Medical Association to conduct a nationwide survey to assess the situation.