As many as 117 hospitals nationwide now have no permanent obstetrician due to lack of demand and a shrinking pool of obstetricians and gynecologists, according to a survey conducted last year by a medical society based in Tokyo. The number of hospitals in Japan with pediatric wards shrank to 3,473 in 2000 from 4,119 in 1990, according to government statistics.
The list of solutions is short and complicated. The most obvious -- opening Japan to more immigration -- is enormously controversial in a society that is 98.8 percent ethnically homogeneous and, in many respects, still markedly xenophobic. Some farmers in Nishiki who have failed to find Japanese women willing to live traditional lives in rural villages have sought brides in China instead. But village officials said several of the Chinese women fled after they failed to win the acceptance of their new in-laws.
The second-grade class at the Kami Hinokinai school has only three children and their teacher, due to Japan's low birthrate. The school is to close in 2007.
(Anthony Faiola -- The Washington Post)
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_____Population Decline_____
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Charts show the decline of Japan's population, which has hit rural areas and small towns particularly hard.
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Although it is a national problem, depopulation is most severe in rural areas such as Nishiki, a proud farming and forestry town 248 miles north of Tokyo where the population peaked at 9,180 in 1956. Over the years, families left Nishiki, seeking better fortunes in Japanese cities. The population stabilized in the 1980s, but the birthrate began declining in the 1990s.
It has happened in part because towns such as Nishiki suffer from a shortage not only of children, but also of eligible women. When Japan's economic bubble burst in 1990, Japanese companies seeking less expensive alternatives to men began hiring women for contract and part-time jobs. Gender roles have changed as a result. With increasing financial independence, more women are avoiding marriage. According to a poll released this week by Japan's Yomiuri newspaper, seven out of 10 single Japanese women say they have no desire to become wives -- a role that in Japan still largely means staying home and raising children.
In Nishiki, daughters are now more likely to leave to seek work in big cities, while their brothers stay behind to claim their family inheritance rights. Single men in the village exceed the number of available women by a ratio of about 3 to 2. "It's hard here," said Kazutsugu Asari, 47, an unmarried employee of the city's construction department. "There are lots of single men but fewer women. And many are not interested in traditional lives. I can understand why the women would leave town. But I have an obligation to stay as the eldest son."
Japan has tried just about everything to boost the fertility rate, or number of children per woman, which hit a record low of 1.29 in 2003, compared with 2.01 in the United States. Nishiki is offering cash awards to families that have more than one child, even sponsoring mixers to bring young couples together. But so far, officials concede, most attempts have failed.
Kami Hinokinai Elementary School, where the number of students peaked at 266 in 1960, awaits closure. Today, there are 33 students left, 11 of whom will graduate this year. Only five new students will enter the school this year. Those numbers prompted the decision to shut Kami Hinokinai in 2007 and bus the remaining children to a school about 40 minutes away.
With no other children their age, the two girls and boy in the second grade have learned to make do. Tatsuya Wakamatsu, 8, a quiet boy in a black sweatshirt, says he persuades the girls to play baseball with him at recess and after school. In return, he grudgingly agrees to jump rope with them. "There aren't so many kids for us to play with in the neighborhood and sometimes the older kids tease us, so the three of us always play together," he said.
Adults take part in sporting events to help the students form soccer and baseball teams. Last year, first-grader Takuya Suzuki, 7, had to play two roles in the school play. "I was a mouse and a grandfather," he said, laughing.
When a baby is born in Nishiki, it is huge news. Last August, Yuna Wakamatsu arrived in a part of the community where no child had been born for 10 years. Traditionally, only women would come calling, offering gifts of food and money. But the men also turned out this time, showering Yuna with so many gifts that they now fill most of one room in the Wakamatsus' wood-frame home. "They all wanted to see the face of a baby again," said her beaming grandmother, Tazuko Wakamatsu, 59, who takes care of the infant because both parents work.
In Nishiki, the last pediatrician switched careers in the 1990s, becoming a geriatric specialist. The nearest doctor for Yuna Wakamatsu is almost an hour away in bad weather. "But I suppose there is nothing that can be done about it," said her grandmother. "It's just how it is."
Special correspondent Sachiko Sakamaki contributed to this report.
