Part Two: Report by Article
Article 12
1. Maintaining and Promoting the Health of Women Throughout Their Lives
(1) Overview of "Sukoyaka Family 21 Plan"
In 1998, "Study Group on the Health Support Project for Women Throughout Their Lives" was established under the supervision of the Director of Children and Families Bureau of the Ministry of Health and Welfare (currently the Ministry of Health, Labour and Welfare). The group studied the present situation of women's health, evaluated the policies implemented and considered the future directions of women's health policy. In 1999, the group filed and published its evaluation results.
In November 2001, "Sukoyaka Family 21 Plan" was adopted to propose a vision for the principal measures for maternal and child health in the 21st century. The plan is characterized as a national campaign promoted jointly by all the parties concerned such as the Government, local governments, medical institutions and citizens. It has set the objectives that should be achieved by 2010 in the following fields: (i) stepping up health care measures and health care education for adolescents; (ii) assuring safety and comfort during pregnancy and childbirth, and supporting infertile couples; (iii) improving the environment for maintaining and improving the standards of child health care and medical service; and (iv) promoting peaceful mental development of children and alleviating anxiety about child rearing.
Since FY2000, special training on maternal and child health services, reproductive health/rights and other related subjects have been implemented as a new measure to educate people with professional skills working in maternal and child health care; such as public health nurses and midwives.
In response to the need for an environment appropriate for the development of future generations, in FY2001, the National Center for Child Health and Development was established to promote comprehensive health care that includes infantile health care and maternal/paternal health care.
(2) Health Support Service
In FY2000, the services supporting the health of women throughout their lives were implemented in 27 prefectures and designated cities accounting for 31% of the total. Specifically, improvement was made by extending consultation and health education services provided by public health nurses and others concerning health problems peculiar to women throughout their lives (such as gyniatrics problems, menopausal disorders, pregnancy, contraception, childbirth concerns, infertility, etc). Further, training sessions for consultation advisers were continuously organized.
A research study on supporting the health of women throughout their lives was conducted along with a research study identifying the cause and exploring a cure for diseases common to women (such as osteoporosis). From 2002, a research focused on the menopausal disorder will be organized.
(3) Sex Education and Enlightenment
As for school education, efforts have been made to further improve and enhance guidance on sex through classes such as "physical exercise," "health and physical education," "science," "home economics," "moral education" and "special activities." Through this guidance, students, depending on their developmental stage, are expected to acquire a scientific knowledge about sex and reproduction, to understand the value of life, base their view for the other gender on respect for human rights and equality between men and women and behave themselves appropriately. To this end, various policies have been promoted by way of creating teaching materials and guidelines for teachers and holding training sessions.
Further, junior high school students are given instructions about such matters as requires appropriate response to and treatment of sex related information or choice of action. Senior high school students are given instructions about fertilization, pregnancy, childbirth and their subsequent health problems along with the physical and mental effects caused by artificial abortion so that they will understand the need for making appropriate decisions and taking appropriate actions, including an appropriate response to and treatment of sex related information.
Regarding social education, prefectures and municipalities are encouraged to establish lectures and seminars dedicated to issues including sex and women's health problems, which are differentiated according to their purposes and audience.
(4) Supporting the Health of Women Throughout Their Lives
a) Adolescents
As an objective to be achieved by 2010, "Sukoyaka Family 21 Plan" advocates generating a downward trend in the rate of artificial abortion and sexually transmitted disease among the teenage population.
Statistics have shown that undesired pregnancy cases in the teenage population were 7.0 (out of 1000 females) in 1996 and rose to 12.1 (out of 1000 females) in 2000, demonstrating an increasing trend. To prevent this trend, in 2000, the Government has set the basic guideline "Enactment of a handbook of adolescent sex and health" and has notified each government of the guideline so that the local government will prepare its handbook for adolescents regarding adolescent sexual behavior and health. This guideline, taking into consideration reproductive health and rights is intended for adolescents to deepen understanding of the importance of sex education, contraception, the effects of artificial abortion, sexually transmitted disease and other matters. It also intended for them to respect the human rights of the partner and refrain from sexual behavior which is not based on the equal relationship with the partner.
b) Period of Pregnancy and Childbirth
i) Providing maternal and child health services throughout pregnancy until childbirth
As an objective to be achieved by the year 2010, "Sukoyaka Family 21 Plan" is promoting measures to decrease the maternal mortality rate and increase the ratio of people satisfied with their pregnancy and childbirth.
Further, "Sukoyaka Family 21 Plan" is also encouraging medical institutions to provide information so that the users can select pregnancy and childbirth medical service. At the same time, regarding obstetric techniques, considerations are made to respond appropriately to different risk levels and review are to be made in the practice of Evidence Based Medicine (EBM) as a measure to achieve Quality of Life (QOL) and effective medical service.
In 2001, the content of the Maternal and Child Health Handbook was modified to newly include a clause that identifies the importance of the father's participation in childrearing, and a clause that enhances the policy for maternal leave and other pregnancy and childrearing related support measures that will allow working parents to manage both their profession and childrearing. It has been in effect since April 2002.
ii) Enrichment of Consultation on Infertility and Other Services
"Sukoyaka Family 21 Plan" considers support for tackling infertility as one of its objectives, therefore, in FY2000, services were extended by establishing centers for consultation on infertility in 18 locations in prefectures and designated cities.
iii) Enrichment of Perinatal Medical Service
Maternal mortality and perinatal mortality rates in Japan have experienced a scarce change over the past few years. In 2000, the number of maternal deaths was 78 and the maternal mortality rate was 6.3 per 100,000 births. The infant mortality rate was 3.2 per 1,000 births; and the neonatal mortality rate was 1.8 per 1,000 births, which accounted for 55.0% of infant mortality. While the perinatal mortality rate (the number of fetal deaths at 22 weeks and over the gestation period, plus the number of early neonatal deaths, divided by the number of births plus the number of fetal death at 22 weeks and over the gestation period, which was multiplied by 1,000) was 5.8%. All these figures are on the decline year by year.
"Sukoyaka Family 21 Plan" advocates the reduction of the maternal death rate by half and the maintenance of its world highest standard of low perinatal mortality rate as its objective to be achieved by 2010.
The number of babies each woman gives birth to is on the decline, while the number of women becoming pregnant at the age of 35 and older and the number of premature babies weighing less than 1,500 grams are on the increase. Against this background, the Government is promoting improvement of perinatal intensive care units (PICU) and neonatal intensive care units (NICU) across the country to provide advanced health care services for pregnancy, childbirth and infancy as a part of its efforts to create an environment where people can give birth to babies and bring them up in peace. Since 1996, the Government has been promoting the establishment of a medical system for pregnant women and newborn infants in the prefectures.
iv) Environment and Conditions for Women's Contraception
Low dosage pills were approved for use in 1999 and the female condom and other contraceptive devices in 2000.
In 2000, the Maternal and Child Health Law was partially amended, to extend the deadline, by which the Reproductive Health Advisor, such as a midwife, can sell medication and use devices necessary for birth control, from 2000 to 2005.
c) Adulthood and Senility
Osteoporosis is a disease of bone fracture and others, and in a progressively aging society, it is expected to become more common. Thus, early diagnosis of people with decreasing bone density and prevention of osteoporosis is needed.
For this purpose, since 1995, a checkup for osteoporosis for females in their 40's or 50's, or those shortly before or after menopause, has been included in the overall health examination under the Health and Medical Service Law for the Aged. Moreover, since 2000, as part of the Elderly Health and Medical Service 4th Plan, efforts have been made to achieve early diagnosis and prevent osteoporosis, by separating checkups for osteoporosis from others for easier access along with providing health education and consultation on osteoporosis (prevention of falling down). Municipalities are in charge of implementing these services, and the national, prefectural and municipal governments each pay a third of the expenses.
2. Measures against Problems that Threaten the Health of Women
(1) Measures against HIV/AIDS, Sexually Transmitted Disease
As of 2001, the number of human immunodeficiency virus (HIV) infected people reported was 534 males and 87 females and as for the acquired immunodeficiency syndrome (AIDS) patients, 282 males and 50 females. The number of AIDS patients is now the highest ever and the infection is still increasing (As of December 30, 2001).
Comprehensive measures including the prevention of and medical service concerning HIV/AIDS are to be implemented through the cooperation among the Government, local governments, and NGOs including medical service groups and patient groups in accordance with the principles of the "Principles in Prevention of Specified Infectious Disease in Relation to Acquired Immunodeficiency Syndrome" that was formulated in 1999, based on Article 11 Section 1 of the "Law Concerning the Prevention of Infectious Diseases and Medical Care for Patients Suffering Infectious Diseases" (law number 114 of 1998).
Further, in relation to targeted groups who are epidemiologically concerned about having the risk of infection and are thus in need of special care, such as adolescents, foreigners in Japan, homosexuals as well as employees and customers of the sex industry, the Government is to implement additionally effective measures in the highest consideration of their human rights and social backgrounds.
Further, to reduce the risk of infection, a system is to be established to support awareness raising and information disseminating projects meeting the demands of those who need individualized guidelines such as females and pregnant women.
The measures defined by the "Principles in Prevention of Specified Infectious Disease in Relation to Acquired Immunodeficiency Syndrome" are as follows:
i) investigation into the cause, prevention of outbreak and spread;
ii) providing medical services;
iii) promotion of research development;
iv) international cooperation;
v) respect for human rights, awareness raising and information dissemination, education, renewed cooperation with related agencies; and
vi) promotion of measures against HIV/AIDS by prefectural governments and other public agencies.
(2) Education on and Understanding of HIV/AIDS
In view of the importance of education in deepening correct understanding of HIV/AIDS and eradicating prejudices and discrimination against people suffering from or infected with HIV/AIDS, the Government has been enhancing HIV/AIDS education by taking the following measures: (i) producing and distributing textbooks on AIDS to elementary, junior and senior high schools since FY1992; (ii) preparing and distributing teaching materials for teachers since FY1992; (iii) conducting training of teaching staff since FY1993; and (iv) conducting practical research in areas designated as AIDS education promotion areas since FY1993, inaugurating a project to establish an HIV/AIDS education information network in FY1995 to disseminate and utilize HIV/AIDS information nation-wide.
As for social education, HIV/AIDS and other related matters have been taken up in community based learning activities.
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