Giving birth in Japan

Pregnancy is not covered under general health insurance in Japan. There are two reasons for this. Firstly, because being pregnant is not considered an illness or injury to oneself—the typical remit of health insurance. Secondly, because each pregnancy requires a different level of care there cannot be a fixed fee. Further, hospitals and clinics in Japan offer different levels of “service”, from the hotel-like treatment with your own separate room at the private hospitals to a more standard level of care elsewhere.

To provide financial support to families, Japan offers “maternity vouchers” (妊産婦健康診査費用補助券, ninsanpu-hoken-hiyō-hojoken) to expecting mothers. These maternity vouchers are essentially discount vouchers which can be used at the hospitals and clinics to reduce the cost of the regular check-ups during pregnancy. The discounts offered by the maternity vouchers differ depending on where you live (although in the 23 wards of central Tokyo they are the same), as do the non-medical auxiliary services such as free massages and house cleans post-birth.

With the vouchers, the cost of check-ups roughly breaks down as follows but costs vary depending on the hospital or clinic, as well as the medical diagnosis.

• ¥10,000 to ¥15,000 for the first health check-up which includes multiple blood tests.
• ¥3,000 to ¥5,000 per check-up after that (if blood tests are required this will increase the cost to ¥10,000-15,000)

These maternity vouchers are included as part of a maternity pack expecting mothers will receive from the local city office which also includes the Maternity and Children Health Handbook (母子健康手帳, boshi-kenkō-techō). This little book is very important and will need to be taken to all checkups and hospital visits. English versions of the Maternity and Children Health Handbook are also available.

Maternal handbook

Once a pregnancy test returns a positive result and you get an official confirmation from an obstetrician (This will cost about ¥5,000-10,000, and include a urine test and an ultrasound depending on the number of weeks), the first step is to visit the local city office or public health center to get the Maternity and Children Health Handbook. To receive this you will need to submit a “pregnancy notification form” (妊娠届出書, ninshin-todokeshutsu-sho). Do not lose this pack. In principle, the maternity vouchers cannot be re-issued. Normally, you can get this handbook after a fetal heartbeat is detected, or around six to seven weeks into pregnancy.

Maternal handbooks are designed to keep a complete record of the mother and child, covering all stages of pregnancy, the child’s overall health, complications during childbirth (if any), and records of vaccination and health checkups after birth. Visits are usually made once every two weeks through the end of week 11.

Choosing a clinic

Checkups are called ninshin-kenkō-shindan (妊婦健康診断) in Japanese. You’ll need to find a clinic (more on the medical institutions below) and make your first appointment. 

Clinics usually offer drug-free natural birth plans, but options such as pain-killing epidurals — while common in Western countries — may not be available everywhere. High-risk pregnancies may need to be monitored at large-scale hospitals that have the necessary staff and facilities.

For non-Japanese speakers, hospitals with English-speaking doctors or staff are available. In Tokyo, Aiiku Clinic and Sanno Hospital have fluent English speakers on their staff, while that is also the case with Osaka City General Hospital.

From 12 weeks of pregnancy to 23 weeks, visits to the clinic will be reduced to once every month. Prenatal tests — both invasive and noninvasive — are available for pregnant women to detect chromosomal abnormalities in fetuses. Those tests, which aren’t covered by the national health care program, can be costly, ranging from ¥20,000 to ¥200,000, depending on the type of test.

Municipalities often host free child care classes for would-be parents, offering tips such as how to bathe a newborn safely. It’s also a good place to become acquainted with other expectant mothers in the area and maybe make some friends.

During the last three months/ third trimester, visits to the clinic should be made once every two weeks, and once every week from week 37. Some hospitals may conduct an episiotomy — an incisions in the perineum — during labor, so expectant mothers should check with their doctors beforehand to see if they think such a procedure is needed.

Choosing a Hospital

What may surprise some is that the majority of hospitals, clinics, and maternity homes in Japan require expecting mothers to make a reservation for the birth in advance. In Japanese, this is called bunben-yoyaku (分娩予約). You can begin making enquiries once you know your expected delivery date, which is usually around the 8-10 week stage of pregnancy.

Reservation enquiries need to be made even in the case where you’re going for regular check-ups to the same hospital or clinic where you want to deliver (and thus the doctors and nurses are fully aware of your expected delivery date). This is because some women choose to give birth at hospitals different to their regular check-up place because, for example, they want to travel back to their hometown to give birth so that they can be closer to their parents. In any case, the more popular hospitals get booked quickly so it’s important to act fast. You will need to pay a deposit at the time of reservation. This differs by hospital but it seems that between ¥100,000 ($666) and ¥200,000 ($1,331) is common.

General Hospitals & University Hospitals: General hospitals and university hospitals are favoured by some because they have the facilities and medical staff on hand to deal with any complications that might arise during childbirth. The demerits are that waiting times for checkups can sometimes be longer, you may not see the same doctor each time you go, and the food and general level of “service” might not be as good as at the private hospitals and clinics.

Private Hospitals: Not all private hospitals (個人病院, kojin-byōin) or clinics (診療所, shinryō-sho) have facilities to deliver a baby. Some will be able to provide regular checkups including ultrasounds and blood tests, but require the expecting mother to deliver at another hospital; others will specialize in something else entirely.

Maternity Homes: Maternity homes (助産所, josan-sho) are clinics that specialize only in delivery. They do not accommodate regular checkups. Further, they cannot perform more complicated deliveries such as a Caesarean section. Maternity homes generally provide a more homely environment for natural births, and are typically cheaper than general and private hospitals.

Roughly speaking, just over half of women in Japan choose to give birth in a private hospital; just under half in a general or university hospital; and less than 5% opt for a maternity home.

Register for a “Maternity Taxi”

Many taxi companies offer a maternity service (陣痛タクシー, jintsū-takushii). You register your details online and then you have access to a special hotline which jumps you to the front of the queue and is open 24 hours per day. Websites for a few of the main companies: Nihon Kotsu, Ebara Kotsu, KM Taxi. The companies charge around ¥500 on top of the metered charge for the service.

Childbirth costs

According to the health ministry, it cost around ¥450,000 to give birth in fiscal 2020 through March 2021. The figure is higher in major cities, with Tokyo averaging ¥550,000. If you add all the prenatal checkups, which add up to about ¥100,000, the total cost will likely be around ¥550,000. The cost could be even higher if you opt to stay in a private room at the hospital. These figures are averages and there are some paying considerably more. You can see the statistics by prefecture and type of institution here (Japanese only).

However, what sets Japan aside from some other countries is that a majority of the costs are covered by government and municipality subsidies as said earlier. Municipalities offer coupons for prenatal hospital visits, and the government offers ¥500,000 to women who give birth to a child. However, it’s worth noting that only women who are covered by the national health care program, or a dependent of a spouse who is covered by the initiative, will be eligible for the subsidy. On top of that, the government has started offering ¥100,000 — some ¥50,000 before birth and ¥50,000 after — from January to support expecting mothers and mothers with newborns.

It used to be the case that families would need to pay the full medical costs of childbirth directly to the medical institution where the mother gave birth, but in 2011 a direct payment system was introduced which allows the medical institution to claim the childbirth lump-sum allowance on your behalf, thus reducing the burden of an otherwise large payment.

In comparison, the average costs for childbirth along with prenatal and postpartum checkups in the United States costs about $18,865 (about ¥2.7 million) and the average out-of-pocket payments total $2,854 (about ¥400,000) for women enrolled in large group plans between 2018 and 2020, according to Peterson-KFF Health System Tracker.

Child care leave

Japan offers six weeks of pre-childbirth leave and child care leave of up to a year — or more precisely, up to the day when the child turns 1 year old. But this could be extended to 18 months if parents cannot find a slot at a daycare center, or longer until the child turns 2 years old if slots are still unavailable.

A working mother is eligible for two-thirds of her pay for 42 days before and 56 days after the child’s date of birth. From then on, parents taking child care leave — those who have worked for a company taking leave from for more than a year — are eligible for 67% of their pay for up to 180 days, and then to 50% of pay for the rest of their child care leave.

Part-timers and temporary workers are also eligible for the pay during child care leave as long as they clear certain criteria, including having paid the premium for employment insurance and having worked for 11 days or more for 12 months or more in the past two years.

It is at times necessary to extend child care leave because government-subsidized day care centers are difficult to get into with municipalities screening children based on the parents’ working conditions and employment situation.

In comparison, the U.S. doesn’t have a government-mandated program for child care leave or paid leave, relying more on each individual state to offer such a system. Still, the U.S. is the only country among the Organisation for Economic Co-operation and Development (OECD) member states that does not mandate any paid leave for new parents, according to data compiled by the OECD in December. In the United Kingdom, mothers can take up to nine months of paid maternity leave.

Recently, the government revised the law regarding paternity leave to encourage more men to be actively involved in child care. However, in practice, many companies in Japan offer much shorter periods of paternity leave, typically ranges from a few days to two weeks. Many fathers are reluctant to take advantage of this benefit due to cultural and societal pressure to prioritize their work commitments over their family. Taking leave is often seen as a sign of weakness or a lack of commitment to work, which can be detrimental to a father’s career advancement. The view of mothers as primary caregivers and not fathers is still prominent in Japan.

Source:

https://www.japantimes.co.jp/japan/2023/08/14/giving-birth-in-japan-heres-what-you-need-to-know/

https://www.japanistry.com/childbirth-in-japan/

https://www.mhlw.go.jp/content/11900000/guide_EN.pdf

https://www.mhlw.go.jp/bunya/iryouhoken/iryouhoken01/dl/01_eng.pdf

https://www.tokhimo.com/post/maternity-paternity-and-childcare-leave-in-japan-1