161. The Government has been undertaking the following measures under the provisions of the Maternal and Child Health Law on the basis of the idea that the health of infants and toddlers must be maintained and enhanced so as to ensure their sound growth both in mind and body. (A variety of other maternal and child health measures are taken. Refer to VI. C. for details.) Consequently, the infant and neonatal mortality rates have drastically improved.
(Table 10)
(Source: Survey by the Ministry of Health and Welfare)
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(a) Measures for Underweight Infants
162. In Japan, if a newborn baby weighs less than 2,500g, the Health Center shall be notified to that effect, and if necessary, the Government will provide call-at-home guidance for premature babies and medical allowances for child rearing.
(b) Measures for Premature Babies
163. As a premature baby tends to be physiologically immature and prone to illness, the death rate is higher compared to average babies. Because of the fact that premature babies require extensive medical treatment, the Government bears medical expenses involved and, if necessary, provides call-at-home guidance services.
(c) Pediatric Support
164. Physically handicapped children are provided with rearing and medical benefits and artificial body parts. Children suffering from tuberculosis receive rearing/medical allowance. Additionally, 33 institutions for physically weak children are established throughout Japan aiming to engage in medical control of their health. The Government gives aid for medical expenses to children suffering from cancer and chronic diseases.
(d) Consolidation of the Pregnancy Care System
165. The Government has been improving Newborn Intensive Care Unit (NICU) and Pregnant and Fetus Intensive Care Unit to cope with unexpected, emergency situations associated with pregnancy and delivery. Moreover, it has been developing the Doctor Car System, for carrying doctors and nurses to give medical treatment, with the aim of facilitating the transportation of newborn babies from hospitals to NICUs. In 1996, it started to subsidize the operating cost of the General Pregnant and Infant Medical Treatment Center, reinforcing care of the health of pregnants and newborn babies before and after parturition, especially for those with high risks.
166. The Fundamental Law for People with Disabilities provides that: as an individual, the dignity of each and every handicapped person shall be respected; he/she shall have the right to be treated in regard of such inherent dignity; he/she shall be afforded the opportunity to participate in social, economic and cultural activities, etc. as a member of society; he/she shall strive to actively participate in socioeconomic activities by utilizing his/her abilities; and his/her family shall endeavor to enhance his/her independence. The Child Welfare Law prescribes that the life of each and every child shall be equally guaranteed and protected.
167. The number of physically handicapped children was 92,500 in 1987 and 81,000 in 1991, showing a downward trend. The population of mentally handicapped children was 100,000 in 1990. Both physically and mentally disabled children will be referred to as "disabled children" hereinafter.
| (Table 11 : Number of Disabled Children) (unit: person)
(Source: Survey by the Ministry of Health and Welfare)
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168. Under domestic laws mentioned above, the Government is applying various measures broadly in such fields as welfare, health, medicine, education, employment and so forth, in order to minimize handicaps and ensure that disabled children are able to lead lives similar to those of non-handicapped children. However, in the social environment surrounding disabled children (persons), there are still physical obstacles in transport facilities buildings and soon, in addition to cultural and information barriers such as the lack of braille and sign-language services. It is crucial to eliminate these obstacles, to encourage disabled children (persons) toward self-support, and to establish a fair society where they could participate in social activities without any difficulties. The Government formulated "The Plan for Disabled Persons" in December, 1995, for which policy targets will be specified and health/welfare measures for disabled persons will be implemented systematically.
Welfare and Medical Treatment
(a) Policies for Health and Medical Care
169. In order to identify retardation and disability in the physical or mental constitution and take swift, adequate measures, the Government conducts medical examinations for infants and mass-screening tests for newborn babies to detect cogenetic metabolic disorders (such as phenylketonuria) and cretinism.
(b) In-Home Welfare Service
170. To consult disabled children and their parents/guardians, Health Centers give health guidance not only on a group basis such as Mother (Parents) Classes, but also on an individual basis through call-at-home counseling. They also give instructions on medical care so that children with physical disabilities and those with risks of functional disorders in the future may receive prompt and proper medical treatment and welfare services. Under the Child Welfare Law, moreover, the Government conducts the In-Home Child-Care Service Scheme, the Child Day-Care Service Program, the Temporary Nursery Care Program and Provision of Appliances for Daily Living.
(i) Provision of Appliances for Daily Living
The Government gives or lends appliances for daily living for the convenience of handicapped children who have difficulties in everyday life.
(ii) In-Home Child-Care Service Program (Home-Helper Program for Disabled Children/Persons)
The Government supports families with severely disabled children who cannot lead normal everyday lives themselves, by sending home-helpers for daily care including housekeeping, medical care and so on, so that those children can enjoy a stable life.
| (Table 12 : Trends in the Number of Home-Helpers) (unit: person)
(Source: Survey by the Ministry of Health and Welfare)
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(iii) Implementation of Children's Day-Care Service Program (Schooling Program for Disabled Children)
Under this program, disabled children attend from homes to receive guidance on how to undertake basic motional tasks required in everyday life and to undergo training to adapt to communal life.
| (Table 13 :Trends in the Number of the Disabled of the Disabled-Children Schooling Program) (unit: number of schools)
(Source: Survey by the Ministry of Health and Welfare)
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171. To lighten the economic burden imposed on families, the Government provides special child-rearing allowances and disabled-child welfare benefits. In 1996, the government-run postal saving program will offer favorable interest rates on fixed-time deposits to families with bedridden children to promote self-support efforts in mitigating their economic burden.
(c) Institutional Welfare Services
172. Various institutions are available for the active remedy and training of children, as homes, in accordance with the degree of disability, and as centers for assisting with employment and promoting social participation. These include: facilities for mentally retarded children and physically handicapped children, nursery homes, institutions for children with auditory/speech disabilities, nurseries for infants with hearing difficulties, and facilities for severely disabled children. Admission to these child welfare institutions is free if the parents' income is below a certain level.
(Table 14 :Current Status of Institutions for Disabled Children) (As of October 1, 1994)
(Source: Survey by the Ministry of Health and Welfare)
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Education
173. The Government provides special education for children who have difficulties attending regular classes or are unlikely to make educational progress through regular classes due to their disabilities, with full consideration paid to the type and degree of disability. Its objectives are to embody individuals' talents and to help them support themselves and participate in society. Moreover, special courses corresponding to each disability are also available at schools for children with visual impairments, children with hearing impairments and handicapped children, in addition to special classes, etc., in elementary and lower secondary schools. In such courses, classes are kept small, teachers with expert experience and knowledge are posted, and consideration is paid to make institutions and facilities "handicapped-friendly."
As of 1994, the number of schools for children with visual impairments, children with hearing impairments and handicapped children, and the number of students, were as follows:
(Table 15: Number of Special Schools and Students)
(Source: Survey by the Ministry of Education)
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(Table 16: Number of Special Classes and Students)
(Source: Survey by the Ministry of Education)
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174. The Government implements various measures to consolidate the special education system. For example, as a new form of special education, the Government introduced a system of teaching disabled children in ordinary classes in 1993, under which students with minor disabilities are given education in regular classes most of the time and receive special guidance corresponding to the disability in resource rooms.
(Table 17: Number of Students Receiving Special Support Services in Resource Rooms)
(Source: Survey by the Ministry of Education)
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175. The Government provides allowances to encourage special education covering part or all of the expenses involved for entering schools for children with visual impairments, children with hearing impairments and handicapped children, depending on the guardian's income capacity. It aims to lighten the economic burden imposed on the guardian and encourage the schooling of disabled children, in consideration of the special conditions for attending such schools. In 1994, for the purpose of expanding the scope of allowances, the Government has raised allowances as well as their frequency to cover travel expenses for children's return to home.
Employment
176. Public employment security offices and employment centers for disabled persons provide employment guidance, vocational training and employment agency services for all disabled persons, including children. These are conducted as employment rehabilitation measures according to the laws for the promotion of disabled people's employment, the New Long-Term Program for Government Measures for Disabled Persons, basic guidelines for measures for handicapped persons and the disabled persons' plan.
Recreation
177. To ensure that disabled persons, including children, have the opportunity to enjoy sports and cultural activities just as non-handicapped people do, the Government is working to promote sports for disabled persons by holding national sports tournaments for physically handicapped persons and the Yu-Ai Pic, which is for mentally handicapped persons. In addition, the Government supports handicapped people's cultural activities and encourages the construction of theaters and concert halls that are "handicap-friendly."
International Cooperation of Medical Treatment for Disabled Children
178. It is effective and important for Japan, in terms of international cooperation, to use its skill and experience in measures for disabled persons in developing countries through Official Development Assistance (ODA) and aid groups in the private sector. The ODA Charter requires Japan to "pay full consideration to children, disabled persons, the elderly and other individuals in a socially weak position." With regard to cooperation related to disabled persons, the Government extends technical cooperation by such means as inviting rehabilitation experts and instructors from developing countries to Japan as trainees of the training programs of Japan International Cooperation Agency (JICA), and dispatching Japanese experts and Japan Overseas Cooperation Volunteers (JOCV). On the basis of the New Long-Term Program for Government Measures for Disabled Persons, basic guidelines for measures for handicapped persons and the disabled persons' plan, the Government holds international seminars and conducts training courses for rehabilitation specialists in Asian countries.
179. The Government contributes to the United Nations Voluntary Fund on Disability which aims to deal with requests from developing countries and organizations for disabled persons to achieve the goals of the "The World Programme of Action Plan concerning Disabled Persons" (adopted at the 37th United Nations General Assembly in 1982), such as the prevention of disabilities, effective rehabilitation, and so on. As of 1994, Japan contributed $900,000 in total to the Fund (the third largest contributor in the world). It also provides aid to the projects implemented by the Economic and Social Commission for Asia and the Pacific (ESCAP), which amounted to roughly $200,000 in 1994.
180. Furthermore, as NGO activities in developing countries have been vigorous in recent years, the Government is conducting international cooperation by providing subsidies for NGO projects and Grant Assistance for Grassroots Projects to those involved in protecting disabled children to prevent children from becoming disabled, exchange information on rehabilitation and transfer technologies and expert knowledge.
181. In Japan, various maternity and child measures are applied under the Maternal and Child Health Law, including those concerning health guidance, medical examination and medical treatment, as shown below, from puberty, pregnancy, delivery to child-rearing. They are based on the idea that the motherhood should be respected and protected as the foundation for the sound birth and growth of the child and that the mother's health should be maintained and enhanced to ensure the healthy growth of infants and toddlers.
In recent years, however, the social environment surrounding mothers and children in Japan has changed drastically owing to the falling number of children per household and the increasing number of nuclear families. Various problems have been arising as a result, such as intense worries about child-rearing. In response, there are loud calls for the promotion of firm policies to satisfy new demand from the people and establish an environment where mothers can bear and rear children without concern, by improving maternal and child health programs in municipalities.
Health Care Measures
(a) Issuance of the Maternal and Child Health Handbook to Mothers Reporting Pregnancy
182. If a woman becomes pregnant, she must immediately report to the municipal authorities to receive a Maternal and Child Health Handbook, which serves as a health record for the mother and baby from pregnancy, through delivery, to the rearing stage. The Handbook can also serve as a certificate proving completion of required preventive inoculations by the recording of necessary matters therein.
(b) Health Guidance for Pregnant Women and infants
183. Health Centers and municipal offices propagate general information on maternal and child health care and give individual guidance to pregnant women and babies through nurses upon request.
(c) Infrastructure of Municipal Activities
184. As bases for various maternity and child health-care activities, maternal and child health centers and municipal health care centers are established in municipalities. As of the end of 1995, the number of centers reached to 410 and 1,503 respectively. Municipal governments hold seminars on child rearing and provide maternal and child health care counseling services to pregnant women and guardians of infants, giving advice according to individual circumstances.
(d) Health Examination for Pregnant Women and Infants
185. Medical examinations during the period of pregnancy are crucial for the smooth delivery of a healthy baby. Pregnant women can have general medical check-ups twice and, if necessary, a close examination once for free at medical institutions. All babies, who can also have general medical check-ups twice and, if required, a close examination twice for free at medical institutions, are subject to mass-screening examinations on phenylketonuria, inborn errors of metabolism and cretinism. In addition, medical examination services for eighteen-month-olds and three-year-olds, as well as health examinations for pregnant women and infants are available whenever necessary.
(e) Vaccination
186. Under the Preventive Vaccination Law, infants are inoculated against diphtheria and whooping cough.
Health Examinations at School
187. Pursuant to the School Health Law, schools give health examinations upon entering school in addition to regular health check-ups and medical advice during the school term.
Nutrition Improvement
188. Under the Community Health Law, the Government provides counseling services ,etc. concerning infants and nutrition improvement to improve and enhance public health. Under the Nutrition Improvement Law, moreover, the Government conducts the National Nutrition Survey on health conditions and nutrition intake of the people, and dietitians are posted at health centers to give necessary advice to residents including children and to institutions providing meals to large numbers of people, such as child welfare facilities.
International Cooperation
189. Based on the ODA Charter, the Government implements international technical cooperation programs in the field of health and medical care through the Japan International Cooperation Agency (JICA): It undertakes various schemes of technical cooperation, for instance, with the support of medical workers, including doctors working for government-run hospitals, especially in the field of maternal and child health care. It also issues grants directed to the health/medical care sector for improving medical institutions, waterworks, sewerage facilities and waste disposal plants, etc. In addition, the Government invites and conducts training programs for specialists in maternal and child heath care from developing countries.
190. Japan contributed to the World Health Organization(WHO) approximately $48.99 million and voluntarily donated roughly $23.05 million in 1995. Accordingly, the Government conducts international cooperation activities to enhance the health of children through information exchange, technological cooperation and special training programs, etc.
191. The Government attaches considerable importance to cooperation on vaccination under WHO's two principal ideas, that is, the "Polio Eradication Plan," which aims to eradicate polio from the earth by the year 2000, and "Children's Vaccine Initiative (CVI)," which aims for the improvement of existing vaccines, the development of new vaccines and the reinforcement of the vaccine supply and demand system. Japan has been actively cooperating in this field by providing polio vaccine on National Immunization Day, vaccine for regular inoculation of children under the Expanded Programme on Immunization (e.g. polio/tetanus/BCG, and DPT vaccine) and "cold chain" (a series of items of equipment for storing and moving vaccines at low temperature), especially for Asian countries. In implementing this cooperation, the Government is actively making efforts to coordinate bilateral cooperation with multilateral cooperation under WHO and UNICEF.
Social Security
192. To ensure social security as provided for paragraph 1 of Article 26 of the Convention, the Government provides both medical and income supports. Medical support is ensured by various medical insurance systems in addition to government subsidy programs for health care of infants and children. Income support, on the other hand, includes child allowance, child rearing allowance, special child rearing allowance, handicapped child welfare benefits, survivor's pension and daily life security.
193. With regard to medical support, all the persons living in Japan, including children, are required to join the national health insurance scheme. Depending on the person's or his/her guardian's solvency, municipal governments bear part or all of the expenses involved in supplying: medication to enable handicapped children to make a living; artificial body parts furnished for children holding handicapped status certification; medical fostering for assisting the education and recuperation of children suffering from tuberculosis.
194. As to social welfare, various benefits such as the Child Allowance, the Child-Rearing Allowance and the Special Child-Rearing Allowance are provided according to the income level of the qualified recipient caring for the child in question, depending on the existence and the number of dependent relatives, which is established by government ordinances.
(a) Child Allowance Scheme
195. Introduced in 1972, the Child Allowance scheme is implemented with the aim not only to stabilize family life by relieving the household's economic burden arising from child rearing, but also to support the healthy growth and enhance the constitution of children, the rising generation. The Government has revised the Child-Rearing Allowance Law to support both employment and child-rearing in view of the changing environment surrounding children and families such as the declining birth rate in recent years. Following the revision, it renamed welfare facilities as "Child-Rearing Enterprises" in the interests of promoting various child-rearing services; the stability and continuity of Enterprises have been ensured by the collection of contributions, mainly from companies, for establishing Enterprises afresh.
(Table 18: Outline of Child Allowance)
| Subject : | Any child |
| Term of allowance : | Expires on child's third birthday |
| Amount : | First and second child: ¥5,000/month Third and more additional children: ¥10,000/month |
| Income Requirement : | Below ¥2,396,000 (per 4-person-household) (enforced on and after June, 1996) |
| Special Allowance : | If the applicant or public officer is unqualified due to the income limit, he/she receives a benefit equivalent to the amount of Child Allowance paid fully by his/her company or public office, provided that his/her income is below ¥4,178,000 (per 4-person-household). (enforced on and after June,1995) |
| Number of qualified children : | 2,485,032 (as of the end of February, 1996) |
(b) Child-Rearing Allowance Scheme
196. To enhance the economic stability and independence of families which are fatherless due to parent's divorce, etc., the Government provides Child-Rearing Allowances for qualified children to facilitate their welfare.
(Table 19 : Outline of Child-Rearing Allowance)
| Subject: | A mother of a fatherless household or a guardian who cares for and rears a child until the first end of March after the child's 18th birthday (up to the child's 20th birthday in the case of handicapped children) |
| Amount: | One child * Full allowance = ¥ 41,390 * Partial allowance = ¥ 27,690 (enforced on and after April, 1995) : Two children = additional ¥ 5,000 : Three children = additional ¥ 3,000 per child |
| Number of qualified : | Approximately 880,000 (as of the end of March, 1995) children |
(c) Special Child-Rearing Allowance
197. Special Child-Rearing Allowances are issued to parents caring for or rearing at home children under 20 years of age with disabilities of medium degree or more.
(Table 20 : Outline of Special Child-Rearing Allowance)
| Amount (per month) | : The first grade = ¥ 50,350 : The second grade = ¥ 33,530 (enforced on and after April, 1995) |
| Upper limit of income | : For the recipient = ¥ 7,410,000 (4-member household) : For the guardian = ¥ 9,041,000 (6-member household) (enforced on and after August, 1995) |
| Number of qualified children | :125,947 (as of March, 1995) |
198. The Public Assistance Law which applies to children as well, stipulates that: the level of aid shall satisfy but not exceed the demands for enjoying the minimum standard of living in consideration of the applicant's sex, age, family composition, living area, and other essential conditions according to the type of aid; and effective, pertinent support shall be provided effectively and appropriately in view of the applicant's age, sex, health condition and the discrepancies between the individual's or household's current status and the required standard of aid in practice.
Provision of Services for Child Rearing
199. The following services are available for child rearing:
(a) Day-Care Centers
200. Municipal governments are responsible for admitting children at day-care centers in cases where it is recognized that neither parents (guardians) nor other family members can take care of the child because the parents are normally at work during the day. As of April, 1994, the number of day-care centers numbered 22,532, and the number of children attending the centers amounted to 1,593,161.
(Table 21 : Trends in the Number of Day-care Centers)
(Source: Survey by the Ministry of Health and Welfare)
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201. The operating costs of day-care centers are calculated, including the labor, service and management, and the rearing cost per child according to the child's age category is determined to ensure that child rearing services are provided adequately. In terms of facilities, it is believed that most day-care centers throughout the nation satisfy the required standards, owing to active efforts made each year to consolidate facilities to meet child-rearing needs. It is necessary, nonetheless, to construct new facilities, especially focusing on suburban areas where the rise in population is dramatic. Moreover, it is necessary to encourage rebuilding of old facilities to deal with disasters and new needs.
(b) Subsidies for Companies
202. To ordinary companies contributing child allowances, the Government provides a subsidy for establishing day-care facilities for employees' children.
203. Additionally, in response to women's diversified needs relating to work and child rearing, the Government actively promotes special nursery measures, such as infant nursery care and extended time day-care services.
(c) Nursery Care for Newborns
204. To ensure the security of newborn babies (less than 1 year old) and their sound development both in mind and body, nursery care must be provided in consideration of such conditions as facilities and staff. On these grounds, the government posts extra nurses to nurseries meeting facility and operation standards. Nurseries with such extra nurses numbered 7,645 in 1994.
(d) Extended-Hour Nursery Care Service Program
205. The Government launched Extended-Hour Day-Care Services in 1994, integrating the conventional extended-hour nursery care with long-hour nursery care. Subsidies are provided to nurseries offering service Type A (two-hour extension), Type B (four-hour extension) and Type C (six-hour extension). 1,649 nurseries were subsidized in 1994.
(e) Night-Time Nursery Care
206. The Government subsidizes night-time nurseries offering services roughly between 1:00 p.m. and 10:00 p.m. The number of night-time nurseries subsidized totaled 37 in 1994.
(f) Day-Care for Children With Disabilities
207. The Government posts extra nurses to day-care centers caring for and admitting a large number of children with disabilities on a daily basis (children subject to Special Child Rearing Allowances). Extra nurses were posted at 4,381 day-care centers for children with disabilities in 1994.
(g) Temporary Nursery Care Program
208. The Government subsidizes nurseries providing flexible nursery care services to deal with diversified working patterns of women who needs services for a few of days per week (due to part-time work, etc.), in addition to those offering emergency nursery care services to respond to urgent needs arising from unexpected illness or sudden injury of guardians. 387 nurseries were involved in the program in 1994.
209. Under the "After-School Child-Care Program" the Government promotes the healthy growth of children in lower grades of elementary school whose parents (guardians) are not present during the daytime (after the classes are over) by fostering, advising, and offering recreation programs to such children after school.
210. In response to the falling number of children per household, the ever-increasing participation of women in public affairs, and other changes in the environment surrounding children, the Ministers of Education, Health and Welfare and Labor and Construction reached an agreement to adopt a program entitled "The Basic Direction of Support for Child-Rearing" (the Angel Plan) on December 16, 1994, for the purpose of promoting comprehensive and systematic policies to support child-rearing. As part of the Angel Plan, furthermore, the Minister of Finance, the Minister of Health and Welfare and the Minister of Home Affairs agreed to implement a plan entitled the "Five-Year Program on Emergency Measures for Nursery Care" on December 18, 1994, with the aim of implementing policies for baby care (0-2 years old) and extended-hour nursery care. (For details, refer to para.19.)
211. The Government protects children deprived of the family environment and those suffering from abuse through sending them to child welfare facilities, etc. (For details, refer to V.F.)
212. The Government promotes the health of infants and toddlers through implementing various maternal and child health programs, and encourages the provision of various welfare services for children with disabilities. (For details, refer to IV A., B. and C.)
Child Commissioners
213. A child commissioner is a private volunteer posted in municipal offices, as provided for in Article 12 of the Child Welfare Law, who is in charge of staying informed about the living conditions and the environment of children and pregnant women in the district. They provide assistance and guidance in relation to protective, health-care and other welfare services, and cooperate in activities undertaken by Child Guidance Centers, Welfare Offices and other administrative offices (e.g. welfare activities for children, maternal and child care, and mentally handicapped persons). In municipal offices across the country, there are approximately 210,000 individuals appointed as district child-welfare commissioners by the Minister of Health and Welfare. Also, since January 1994, about 14,000 individuals have been delegated as chief child commissioners, specializing in counseling and assistance activities for the welfare of local children and pregnant women.
(Table 22 : Counseling and Guiding Activities by the Child Commissioner)
(Source: Survey by the Ministry of Health and Welfare)
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214. Article 25 of the Constitution of Japan guarantees the right of the people, including children, to enjoy the minimum standard of living. The Government takes the following steps to support parents and other guardians responsible for children to ensure the children's rights to enjoy a reasonable standard of living.
(a) Provision of Child Allowance (reference: para.195)
(b) Provision of Child-Rearing Allowance (reference: para.196)
(c) Provision of Special Child-Rearing Allowance and Welfare Allowance for Children with Disabilities (reference: para.197)
(d) Assistance Regarding Nutrition Intake of Newborn Babies and Infants under the Maternal and Child Health Law
: For the purpose of maintaining and enhancing the health and managing the diet of infants and toddlers, group activities are conducted and nutritious foods are distributed.
(e) Livelihood Protection and Housing and under the Public Assistance Law
: The Public Assistance Law is a general law for individuals who are unable to maintain the minimum standard of living due to poverty, under which poverty-stricken individuals are supplied with articles essential to everyday life (e.g. clothing, food), accommodation and other items necessary for the maintenance/repair of houses on a cash basis or, if necessary, by an allowance in kind.
(f) Housing Finance by the Housing Loan Corporation
The Housing Loan Corporation regularly issues long-term, fixed, low-interest housing loans.
(g) Construction of Public-operated Housing
In cooperation with local authorities, the Government constructs public-operated housing sufficient to enjoy a wholesome and cultured life and rents them at a low rate to low-income earners who need houses.