In Japan, New Pains Suffered at Childbirth

Erika Yamauchi, now eight months pregnant, will have to leave her husband and 16-month-old toddler behind to fly to a functioning maternity ward.
Erika Yamauchi, now eight months pregnant, will have to leave her husband and 16-month-old toddler behind to fly to a functioning maternity ward. (By Anthony Faiola -- The Washington Post)
By Anthony Faiola
Washington Post Foreign Service
Monday, May 1, 2006

OKI ISLAND, Japan -- If childbirth could be conveniently timed, then Erika Yamauchi, a ruddy 22-year-old housewife eight months pregnant with her second child, would make a note in her planner to go into labor on a Monday. Preferably around 10 a.m.

In a nation where a chronically low fertility rate is causing the bottom to fall out of the baby-birthing business, this fishing community of 17,000 was forced to mothball its only maternity ward last month after losing its last local obstetrician. Now Yamauchi and 57 other expectant mothers here have to make do with temporary obstetricians flown in from another island on Mondays -- when they attend from 10 a.m. to 5:30 p.m. before boarding evening flights back home.

Pregnant women are being asked to give birth at faraway regional hospitals and babies are unlikely to cooperate with their new deadlines. If Yamauchi or the others go into early labor, they have been warned to expect an emergency helicopter ride across 40 miles of water to the nearest functioning maternity ward. "A helicopter! Can you believe it?" Yamauchi exclaimed, clutching her belly with a nervous laugh.

The expectant mothers of Oki Island have joined thousands of other pregnant women across Japan who are now facing a major complication: a national shortage of obstetricians. In a rapidly aging nation with one of the world's lowest birthrates, the number of doctors entering child-related specialties is plummeting -- stretching those who are left so thin that they can no longer manage existing caseloads.

Analysts attribute the shortage partly to a declining interest in obstetrics among medical students, who are wary of the long hours, high malpractice risk and relatively average pay. But whatever the cause, the shortage is turning the miracle of birth into a logistical nightmare.

Yamauchi, for instance, will have to leave her family behind on this island 375 miles southwest of Tokyo when she departs to deliver her second child. Her 26-year-old husband, Yuuhi, cannot get the time off from his job as a car salesman to accompany his wife. He anguishes about missing the birth, and perhaps going a week or more before getting a glimpse of his newborn. When Yamauchi leaves, she will also be kissing goodbye to Hinase, the couple's rambunctious 16-month-old toddler.

"I'm scared about the possibility of being alone when I give birth," she said. "I knew this was happening in other parts of Japan, but you never expect it to happen in your own town. This is not the kind of stress I should be under right now. It makes you think seriously about having another child."

The obstetrics crisis, health officials say, has emerged as one of the biggest obstacles in the struggle to avoid Japan's date with depopulation. Japan's fertility rate, the average number of children born to a woman over a lifetime, is at a record low of 1.29 -- compared with 2.1 in the United States. As more Japanese die than are born, the population fell by nearly 20,000 to 127,776,000 in 2005 -- the first decline since the census started in 1920. If nothing is done to reverse that trend, the population is projected to fall to about 100 million by 2050, according to government statistics.

With Japan stridently opposed to large-scale immigration that could alleviate the problem, the obstetrics crisis has raised serious questions about how this country can continue to operate the world's second largest economy and cover the costs of its huge elderly population. One in five Japanese are 65 or older.

Meanwhile, having a child here has become more complicated than at any point in the post-World War II era. In 2004, 163 hospital maternity wards, or 10 percent of the national total, closed and hundreds more are planning to cease operation.

That is partly because fewer babies are being born, making it financially untenable for hospitals to provide care for the dwindling number of pregnant women. But health officials are also citing an alarming drop in the pool of obstetricians -- whose ranks are shrinking faster than demand is declining.

Even as the overall number of new doctors has steadily risen, the number of practicing obstetricians plunged 40 percent from 1992 to 2004, the most recent year for which statistics are available, according to Japan's Health Ministry. That plunge is set to dramatically accelerate. About 40 percent of Japan's 727 obstetricians are now 60 or older, leaving officials bracing for a wave of retirements.

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