Monday, April 23, 2007

Birth in Japan

I thought the below news story was an interesting one, especially given the fact that Japan has among the lowest maternal and newborn death rates in the world.

Obstetric Care Hits Crisis Levels

Suvendrini Kakuchi

TOKYO, Apr 12 (IPS) - Mayu Sasaki, 32, is expecting her second baby in May, but rather than making happy preparations the former economics researcher is filled with anxiety.

''We are so desperate that my husband and I have taken the decision to move to the neighbouring city of Kyoto where care is a little better than where we live now,'' she explained to IPS recently, citing the lack of hospitals that offer delivery services to women.

Sasaki lives in Takanohara, a small town in Nara prefecture, Japan's oldest capital located 322 km west of Tokyo. Nara is now battling a scandal over the death of a 32-year-old pregnant woman who died last November as a result of being denied emergency care.

Following complications during childbirth the woman died after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies.

The case has shaken public confidence in Japan's highly sophisticated medical industry and raised the ugly prospect, say reproductive rights activists, that, indeed, obstetrics has become a low priority for the government.

They point to the recent heated debate over remarks made by health minister, Hakuo Yanagisawa, who called women "birth-giving machines," drawing wide criticism from women who accused him of ignoring their reproduction rights.

‘'There is a lot of pressure to improve national birth rates to boost the economy. But authorities refuse to give the necessary support for safe child delivery,'' said Dr Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara.

Idou launched a health centre for children and mothers at his hospital in 2003 to help out against, what he describes as, a ‘crisis' facing that sector in Nara.

The centre offers counselling and care for new mothers and their babies and is well patronised against a backdrop where female reproduction services are losing ground due to low birth rates -- now 1.32 per woman.

He explained that as more women opt to have children in their later years, child birth has become riskier, making it all the more important to provide safer maternity and infant care facilities in Japan.

‘'There are no large hospitals providing gynaecological services in Nara, creating a dangerous situation for women living here,'' Idou told IPS. More than 1,000 new births were registered in Nara in 2005.

The Nara scandal has, say experts, finally spotlighted the dire situation in Japan. Statistics now reveal that the number of hospitals handling deliveries dropped to 914 from 1,009 in 2005 alone.

Other data also show that only 40 percent of university-related hospitals in Japan have one or two full-time obstetricians and a survey by the Japan Association of Obstetricians and Gynaecologists reported that Japan faces a shortfall of 6,700 midwives.

According to the health ministry, 62 mothers died in 2005 during deliveries, up from 32 in 2004 recorded in a study of 125,000 childbirths. Also, the risk factor among expectant mothers is much higher, say analysts.

''Having a baby in Nara is like being strapped to a time bomb,'' says Sasaki, who has been diagnosed as a high-risk expectant mother because she suffers from asthma. She added that it is ‘'hard to believe that Japan is an industrialised country.''

While authorities are focusing on the lack of medical personnel, doctors also point to the urgent need for government to establish better working conditions for gynaecologists and paediatricians in particular.

Surveys in hospitals show that more than 40 percent of female gynaecologists stop working when they start families because they cannot cope with the long hours of work and raising their own children.

Dr Yuriko Marumoto, who runs her own clinic for pregnant women, told IPS that ‘'adding to the high stress of their work, gynaecologists also face arrest and imprisonment if there is a problem. Thus, the job is shunned by new doctors creating a very difficult situation for pregnant women.''

Idou says the shortage of medical staff can be met by increasing funds for mechanisms that support such steps as paid holidays, hospital nurseries and a rotation and sharing system between hospitals.

Experts also point to the reluctance in Japan to open the door to foreign doctors, as is the case in other industrialised countries.

Against increasing pressure Prime Minister Shinzo Abe promised, last month in the Japanese Diet (parliament), to establish a ‘Women's Doctors Bank' as a means of offering support for female obstetricians and gynaecologists. (FIN/2007)

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