Contemporary debates surrounding NorLevo and earlier restrictions on oral contraceptives both relied on the construction of women’s sexuality as socially dangerous, irresponsible, and in need of institutional supervision. In these discussions, increased access to contraception was repeatedly associated with fears of “free” or morally improper sex, allowing medical authorities and government officials to frame reproductive control as a matter of public protection rather than women’s bodily autonomy. The final section examines how moral rhetoric surrounding contraception was reinforced through the suppression of sexual education in the 2000s and through gendered double standards that normalized male sexuality while stigmatizing women’s sexual autonomy.

 
Committee discussions surrounding NorLevo frequently portrayed emergency contraception not merely as a medical issue, but as a potential facilitator of morally irresponsible sexuality. For instance, one committee member warned against the possible “exploitation” (悪用) of the pill’s contraceptive effects and argued that easier access through pharmacies or online retails could reduce condom use and consequently increase the spread of sexually transmitted diseases. The same speaker further emphasized the need to protect underage girls from the casual sexual behavior that over-the-counter access might supposedly encourage. These concerns closely echoed earlier arguments used to oppose oral contraceptives in the late twentieth century, when medical authorities similarly warned that accessible contraception would promote “free sex” among young people and threaten public morality. In both historical and contemporary discussions, anxiety about the possibility that women might exercise sexual autonomy outside institutional supervision. Increased contraceptive access was therefore framed as a threat not only to public health but also to existing “moral” order. These moral anxieties were further intensified by broader political efforts to suppress open discussions of sexuality and reproductive knowledge in Japan.

 
Hiroko Hirose examines the widespread political backlash against school sex education in the early 2000s, which resulted in the long-lasting censorship surrounding discussions of sexuality and reproduction. During a Diet debate, Democratic Party politician Eriko Yamatani criticized what she described as “excessive” sex education in schools, even questioning the validity of teaching “self-determination for sexuality.” Arguing that such instruction failed to consider students’ developmental stages, she insisted that “parents, religious leaders, and developmental psychology experts” should determine what kinds of sexual knowledge appropriate for children. Her criticism received broad support from Diet members as well as Prime Minister Junichiro Koizumi. Yamatani also specifically targeted the authorized textbook Love and Body, which was widely used in primary and secondary school sex education. She condemned the textbook for teaching girls “secret ways” to obtain oral contraceptives by using menstrual pain as an excuse and accused it for “encourag[ing] girls to take the Pill.” Such criticisms framed contraceptive access as immoral and essentially pathologized sexuality of teenage girls. The textbook was ultimately withdrawn and went out of print following the controversy.

 
Criticism of sex education did not stay within the Diet but extended into a state-led disciplinary action against educators accused of promoting “excessive” sex education. In 2003, Nanao Special Education School came under investigation after criticism from a member of the Tokyo Metropolitan Assembly. Education materials were confiscated, and two months later, 102 teachers in Tokyo—including educators at Nanao Special Education School—were formally punished in part because of their sex education programs. Hirose argues that these campaigns produced a lasting “depressing atmosphere” surrounding sex education, encouraging widespread self-censorship among educators. This history reveals that the lack of sexual education frequently cited during NorLevo debates as evidence that Japanese women were unprepared for autonomous contraceptive access was not merely cultural or individual, but institutionally produced. In other words, the state first restricted access to comprehensive sexual knowledge and later used women’s supposed lack of reproductive literacy to justify continued medical supervision over contraception.

 
This contradiction also exposes the fundamentally gendered nature of sexual regulation in Japan. As the previous discussions demonstrate, women’s sexuality was frequently stigmatized as immoral. At the same time, male sexuality remained broadly normalized and commercially visible through the widespread circulation of pornography and the hypersexualization of women and girls in popular media culture. Although these broader cultural dynamics extend beyond the scope of this paper, a similar double standard can be observed within pharmaceutical governance itself. The most striking example lies in the contrast between the nearly forty-year delay in approving oral contraceptives and the remarkably rapid approval of Viagra, a medication for erectile dysfunction in men, in only six months. In January 1999, Viagra was approved despite some remaining medical concerns. At this time, the low-dose oral contraceptive pill was still stalled in evaluation after nearly forty years since the original authorization request in 1961. This double-standard provoked fierce criticisms from female politicians, feminist activists, and the global world, embarrassing the Japanese government and reportedly contributing to the eventual approval of the low-dose pill later that same year. This disparity demonstrates that Japanese institutions did not oppose sexuality itself, but rather sought to regulate women’s sexual autonomy in particular. While pharmaceutical interventions supporting male sexuality were treated as legitimate medical concerns deserving swift approval, contraceptives associated with women’s sexual agency remained subject to prolonged institutional surveillance and paternalistic control.

 
Throughout the paper, I examined the politics surrounding the recent conversion of the emergency contraceptive pill NorLevo to behind-the-pharmacy-counter status in Japan. Analysis on institutional discourse throughout the decade-long approval process revealed the persistence of medical paternalism and patriarchal governance that extends far beyond a single policy debate and is deeply rooted in Japan’s postwar reproductive governance. Male-dominated political and medical institutions have historically regulated and stigmatized women’s sexuality and bodily autonomy through restrictions on contraceptive access and comprehensive sex education while simultaneously normalizing male sexuality. Both historical and contemporary debates surrounding reproductive healthcare demonstrate how policy makers and medical authorities repeatedly prioritized notions of “public good”—including demographic management, economic concerns, and the maintenance of socially disciplined sexuality—over women’s reproductive rights and bodily autonomy.

 
Positioned within the reproductive justice framework, this paper sought to move discussions on NorLevo beyond the narrow issues of contraceptive access toward a broader examination of institutional control over women’s bodies and sexualities. At the same time, this paper does not address the ongoing reproductive justice issues that disproportionately affect economically and racially marginalized women in Japan, including part-time workers, single mothers, and migrant women, and women living in rural areas. These inequalities continue to shape who can meaningfully access reproductive healthcare even after formal policy changes such as NoeLevo’s approval as behind-the-counter medicine.

This research also carries personal significance for me as someone who grew up within the very silence surrounding sexuality and reproductive knowledge examined in this paper. Throughout my education in Japan, sex education classes separated by gender consistently presented condoms as the primary—and almost the only—form of contraception. Even when low-dose oral contraceptives were discussed, their contraceptive function was largely omitted in favor of emphasizing their therapeutic use for menstrual symptoms. I vividly remember the shock I felt during orientation at the high school in Connecticut to which I transferred, when students were openly introduced to multiple forms of contraceptive care available through the school health center. What struck me most was not only how little I knew about contraception, but also how openly and confidently these topics could be discussed. Conducting this research led me to recognize that the stigma, silence, and lack of confidence surrounding sexual literacy that I continue to internalize were not individual shortcomings or merely “cultural” legacy. Rather, they were systematically produced through institutional restrictions on sexual education and reproductive healthcare later mobilized to justify continued medical paternalism over women’s bodies.