Maternal Deaths in Japan From the perspective of Social medicine YASUHIDE NAKAMURA Department of International Collaboration Research Center for Civil Society Graduate School of Human Sciences Osaka University, JAPAN ---------- Birth Rates in Japan Sources: Ministry of Health, Labor and Welfare, Japan Birth per 1000 populations YEAR ---------- Infant Mortality Rates in Japan Sources: Ministry of Health, Labor and Welfare, Japan IMR ---------- Infant Mortality Rates in Japan (logarithmic graph) Sources: Ministry of Health, Labor and Welfare, Japan IMR (logarithm) ---------- IMR in Japan and the United States IMR YEAR - Japan - US Sources: U.S. Department of Health and Human Services Ministry of Health, Welfare and Labor, Japan ---------- Infant Mortality Rates in Urban and Rural Areas in Japan Sources: Ministry of Health, Labor and Welfare, Japan IMR YEAR - URBAN - RURAL ---------- Maternal Mortality Rates in the 20th century in Japan MMR (per 100,000 births) YEAR Source: Ministry of Health, Labor and Welfare ---------- Maternal Mortality Rates in Japan MMR: Maternal deaths per 100,000 births MMR YEAR Source: Ministry of Health, Labor and Welfare ---------- Maternal Mortality Rate in Japan MMR (logarithm) YEAR ---------- Institutional and Home Deliveries in Japan Percentage - INSTITUTIONAL DELIVERY - HOME DELIVERY Source: Ministry of Health, Labor and Welfare ---------- Maternal Deaths by Main Causes in Japan (1950-75) No of Deaths - Others - Sepsis - Ectopic - Hemorrhage - Toxemia Source: Ministry of Health, Labor and Welfare ---------- Maternal Deaths by Main Causes in Japan (2000) The number of Deaths: 76 cases - Obsteric embolism: 17 - Placenta previa: 10 - Toxemia: 8 - hemorrage: 7 - others: 17 - Indirect: 15 - Unknown: 2 Source: Ministry of Health, Labor and Welfare ---------- MCH Program in Japan Pregnancy Delivery Newborn 1year 6year <----------------------------------------------------> MCH Handbook <---------> <-----> <---------------------> mothers newborn Health checkups class home visiting <-------------> <-----> <---------------------> Exam. for medical aids medical aids for pregnant women for premature the handicapped baby & chronic diseases ---------- Possible Explanations for Japan's Low Infant Mortality Rate 1 Narrow socio-economic distribution 2 National health insurance 3 Maternal and Child Health Handbook 4 Population-based screening and health check-ups 5 High value placed on childbearing Source: Health and welfare for families in the 21st century, by Kiely M, Wallace HM, Nakamura Y et.al., Jones and Bartlett Pub., 1999 ---------- Japan's Experience to Reduce IMR and MMR 1 Outreach activities home visiting to all newborns 2 High education level of women senior high school enrollment 60 % in 1960 3 Training program through existing system regular meeting for nurses 4 Community-based activities CBO, People's organization (PO) 5 Discretion in front-line health service ---------- Discretion the ability to make responsible decisions 1 make choice about what will be done and how it will be done 2 make choice among alternatives 3 discretion is constrained by external factors Street-level leadership (Vinzant JC, Crothers L) Georgetown Univ. 1997 ---------- The Role of Public Health Nurses (PHN) in Japan 1 PHN in the villages without doctors 2 The roles of PHN: health education, prevention, emergency care and delivery 3 Improvement of quality of life: nutrition, water supply, toilet, family planning, nursery care, income generation 4 Intersectoral collaboration among the front-line workers: agriculture improvement, school teacher, livelihood extension workers (Sei-kai) etc. 5 People's Organizations: Women's Association (Fujin-kai), Child-rearing Association (Aiiku-kai) etc, The application of Japan's experience in health development to developing countries (2003: the Research on International Cooperation for Caring Society, Ministry of Health, Labour and Welfare, Japan) ---------- The Role of Midwife Practitioners in Japan 1 Midwives in the villages without doctors 2 The roles of midwife: health education, prevention, emergency care and delivery, covering all the cares concerned to maternal and child health 3 Intersectoral collaboration among the front-line workers: agriculture improvement, school teacher, livelihood extension workers (Sei-kai) etc. 4 Ensuring the quality of life of women: to educate grandmothers and fathers, to build bridges between traditional customs and modern technology The application of Japan's experience in health development to developing countries (2003: the Research on International Cooperation for Caring Society, Ministry of Health, Labour and Welfare, Japan) ---------- History of MCH Handbook in Japan 1942 Handbook of Pregnant mothers 1947 Law of Child Welfare 1948 Mother and Child Handbook (20 pages) 1966 Law of Maternal and Child Health 1970 Maternal and Child Health (MCH) Handbook　 1996 Upgrading of MCH Handbook (72 pages) Mother and Child Handbook in 1948 ---------- The Contents of MCH Handbook (1948) ←Sugar ← Milk 7 pounds ---------- Benefits of MCH Handbook 1 Strengthen the continuity between maternal care and child health care 2 Provide health records kept by parents 3 Improve communication between providers and users 4 Promote behavior change of parents and family through health educational materials 5 Provide minimum standard of reproductive health to field health workers 6 Encourage integration in health sectors ---------- Management Information System Home-based recording - Maternal card - Under-Five card - Development card - Immunization card - Child Growth Chart - MCH Handbook Facility-based recording & reporting - Health center record - Hospital record - Village registration - Health center information system ---------- Disadvantages of MCH Handbook 1 High cost of printing 2 Training for health workers needed 3 Risk of Handbook lost 4 MCH service delivery system required 5 Collaboration among health professionals essential 6 Disadvantage of Illiterate parents ---------- MCH Handbook in the World Japan commonly used from 1948 Korea, Thailand, Tunisia, Cote d'Ivoire commonly used Indonesia expanded through the joint project Mexico, Viet Num, Laos, Brazil, Bangladesh developed by the projects with JICA or NGOs ---------- MCH Handbook program is effective; 1 Where the community and its health workers can manage the program 2 When health care delivery system exists 3 What: The contents to be appropriate for the community 4 To Whom: Parents and children with awareness ---------- Bi-Regional Consultation on Global Reproductive Health Strategy Development WHO: Colombo, Sri Lanka, 2-4 June 2003 Objectives: 1 To review country-level experiences and lessons in implementing reproductive health strategies, policies and programs 2 To critically review the draft global reproductive health strategy and propose key issues and implications for incorporation in the draft document Participants: WHO (Geneva, WPRO, SEARO), ADB, UNFPA 40 participants from 15 Countries ---------- Sexual and reproductive health: a holistic concept Health Systems Families and Communities - Reduce STIs/RTIs and HIV/AIDS - Promote healthy sexuality - Ensure contraceptive choice and safety - Improve maternal and newborn health - Eliminate unsafe abortion ---------- Sexual and reproductive health: from concept to results 1 Diagnostic the health problems 2 Designing a useful strategic plan 3 Selecting among sexual and reproductive health priorities for action 4 Protecting the sexual and reproductive health of adolescents 5 Removing legal and policy constraints 6 Mobilizing political will, visibilities and accountability 7 Making good use of human resources 8 Adopting and scaling up good practices 9 Addressing the reasons for under utilization of existing services in families and communities