Future Prospects
The total fertility rate in Japan has been decreasing since 1985, marking 1.29 in 2003. Major factors underlying this trend are the increasing number of men and women who do not get married throughout their life course or who get married late in their life time, and increasing number of couples who do not bear children. This trend is supposed to continue furthermore, making the total fertility rate much lower and turning the whole population toward the direction of decrease. The acute decrease in the number of children causes such problems as stagnation of growth in economy, increase in the individual payment for the tax and social security, decrease in community's vitality and formation of the society where child-rearing is difficult, just to name a few.
The background of the decrease in the number of children is multi-faceted. Such factors as increase in female employment, difficulty in managing individual work-life and family concern at the same time, delay in establishing a gender-free society and employers' support for those who'd bear and rear children may all contribute to the present situation. The society with less number of children, in turn, causes such issues as isolation of mother and children in the community, loss of community's function to take care of children, mother's sense of burden and anxiety regarding child-rearing, and child abuse.
Given this state of affairs, the government proposed "the Grand Design for the Society with Less Children" in June, 2004 and designated four primary objectives of emphasis and 28 specific activities.
Primary Objectives of "Healthy Parents and Children 21"
- Strengthening of adolescent health care and promotion of health education
- Ensuring safety and comfort in pregnancy and delivery, and providing support for infertility
- Development of a system to maintain and improve the level of child health care
- Promotion of healthy mental development of children and mitigation of concerns about raising children
Midwives must respect the decisions and feelings of pregnant women and their families, and must provide the support necessary to allow them to lead a healthy life, enabling a safe and satisfactory pregnancy and delivery and a successful transition to parenting; therefore, midwives are expected to be wholehearted in sympathizing sincerely with the joys and sorrows of all involved, in addition to making accurate diagnoses and providing an appropriate level of care. Furthermore, it is of high importance for midwives to promote comprehensive measures for lifelong support of women's health in consideration of reproductive health and rights, in addition to the primary function of the midwife in assisting delivery.
For the enrichment of maternal and child health care, midwives are expected to take on the following challenges.
- Lifelong support of women's health
- Training of midwives for advanced practice
- Stipulation of standards for midwifery practice and the functions of midwives
- Experimental establishment of innovative facilities: e.g., open system hospitals and in-hospital birth centers.
- Implementation of primary care inside and outside facilities (in-hospital birth centers)
- Stipulation of standards for midwifery education
- Systematic continuing education programs for the midwives
- Posting of midwives for work in communities
- Coordination and collaboration among maternal facilities, local communities and other healthcare professionals
- Posting of midwives in administrative arenas
- Development of the ability to participate in the policy-making which affects the practice of midwifery and in the development of social and political activities to provide sufficient care for consumers
A new mother gives her first milk to her baby
[ Conclusion ]
Regardless of the era, as long as humans exist, there will be childbirth. And there will be needs for midwifery as long as there is childbirth. Midwifery is deeply related to the woman's reproductive life cycle, and should be regarded as a stronghold in the protection of total family health, in addition to their maternal and child health focus. Even in a society with a decreasing birthrate, the importance and necessity of midwives do not lessen.
Japan is facing the problems of both an aging society and a decreasing birthrate. In this difficult situation, midwives, with their specialized skills, are expected to play an important role in promoting women's reproductive health and rights. It is time for midwives to consider once again the variety of events during the period from adolescence to menopause, which include pregnancy and childbirth but also call for an expansion of the midwife's activities by focusing on the intrinsic issues of female sex and reproduction.
A new father bathes his baby instructed by the midwife.
[ References ]
- Statistical Data on Nursing Services in Japan. Nursing Issues Study Group (ed.), Japanese Nursing Association Publishing Company, Tokyo, 2003.
- Regulations Designating the School and Training Institute for Public Health Nurses, Midwives, Registered Nurses and Assistant Nurses. Toyoko Kadowaki, Kayoko Shimizu and Hiroko Moriyama (eds.), Japanese Nursing Association Publishing Company, Tokyo, 2004.
- Certified Nursing Specialist Evaluation Requirements, Maternity Nursing Concentration Program, 2001 Edition. Japanese Association for Nursing Programs in University, 2001
- National Hygiene Trends, Maternal and Child Health, Health and Welfare Statistics Association, 90-97, 2004.
- Maternal and Child Health Study Group: Major Statistics in Maternal and Child Health. 2004.
- Maternal and Child Health Study Group: Maternal and Child Health in Japan. 2004.
- Endo T, Watanabe H, Yamamoto A, Sayama S, Ishikawa N, Saito M, Miyazaki F, Kasai K, Kakinuma Y: State of Essential Competencies for Midwives in Japan. ICM 7th Asia Pacific Regional Meeting, Hong Kong, 2002.