JAPAN: WITHOUT OBSTETRIC CARE, PREGNANT WOMEN LIVE IN FEAR Suvendrini Kakuchi. Global Information Network.

New York: Apr 12, 2007. pg. 1

TOKYO, Apr. 12, 2007 (IPS/GIN) -- Mayu Sasaki, 32, is expecting her second baby in May, but rather than making happy preparations the former economics researcher is filled with anxiety. "We are so desperate that my husband and I have taken the decision to move to the neighboring city of Kyoto, where care is a little better than where we live now," she said, citing the lack of hospitals that offer delivery services to women. Sasaki lives in Takanohara, a small town in Nara prefecture, Japan's oldest capital located 322 km west of Tokyo. Nara became notorious due to a scandal that occurred last November, when a 32- year-old pregnant woman died as a result of being denied emergency care. Following complications during childbirth the woman died after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies. The case has shaken public confidence in Japan's highly sophisticated medical industry. Reproductive rights activists say that it has also highlighted the ugly fact that obstetrics seems to have become a low priority for the government. They point to the recent heated debate over remarks made by health minister, Hakuo Yanagisawa, who called women "birth-giving machines," drawing wide criticism from women who accused him of ignoring their reproduction rights. "There is a lot of pressure to improve national birth rates to boost the economy. But authorities refuse to give the necessary support for safe child delivery," said Dr Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara. Idou launched a health center for children and mothers at his hospital in 2003 to help out against what he describes as a crisis facing that sector in Nara. The center offers counseling and care for new mothers and their babies and is well attended in a country where female reproduction services are losing ground due to low birth rates. Japan's birth rate has fallen to 1.32 per woman. Idou explained that as more women opt to have children in their later years, child birth has become riskier, making it all the more important to provide safer maternity and infant care facilities in Japan.

"There are no large hospitals providing gynecological services in Nara, creating a dangerous situation for women living here," Idou said. More than 1,000 new births were registered in Nara in 2005. The Nara scandal has, say experts, finally spotlighted the dire situation in Japan. Statistics now reveal that the number of hospitals handling deliveries dropped to 914 from 1,009 in 2005 alone. Other data also show that only 40 percent of university-related hospitals in Japan have one or two full-time obstetricians. A survey by the Japan Association of Obstetricians and Gynecologists reported that Japan faces a shortfall of 6,700 midwives. According to the health ministry, 62 mothers died in 2005 during deliveries, up from 32 in 2004 recorded in a study of 125,000 childbirths. Also, the risk factor among expectant mothers is much higher, analysts say. "Having a baby in Nara is like being strapped to a time bomb," said Sasaki, who has been diagnosed as a high-risk expectant mother because she suffers from asthma. She added that it is "hard to believe that Japan is an industrialized country." While authorities are focusing on the lack of medical personnel, doctors also point to the urgent need for government to establish better working conditions for gynecologists and pediatricians in particular. Surveys in hospitals show that more than 40 percent of female gynecologists stop working when they start families because they cannot cope with the long hours of work and raising their own children. Dr. Yuriko Marumoto, who runs her own clinic for pregnant women, said that "adding to the high stress of their work, gynecologists also face arrest and imprisonment if there is a problem. Thus, the job is shunned by new doctors creating a very difficult situation for pregnant women." Idou said the shortage of medical staff can be met by increasing funds for mechanisms that support such steps as paid holidays, hospital nurseries and a rotation and sharing system between hospitals. Experts also point to the reluctance in Japan to open its doors to foreign doctors, as other industrialized countries have. Facing increasing pressure, last month Prime Minister Shinzo Abe promised the Japanese Diet (parliament) that he would establish a Women's Doctors Bank as a means of offering support for female obstetricians and gynecologists.

SUMMARY
In an article published in ProQuest last April 12, 2007, a lack of obstetrical care becomes imminent. This is after a scandal involving the death of a 32-year-old pregnant woman as a result of being denied emergency care last November. The womans death is the end result of subsequent complications during childbirth after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies. In another incident, a recent heated debate became a controversy when Hakuo Yanagisawa, the health minister, addressed the women as "birth-giving machines," thus, anchoring ample criticism from women who accused him of ignoring their reproduction rights. Such incidences shows lack of priority over obstetrical care hence, increasing the anxiety levels of pregnant women who cannot expect optimal and efficient care during childbirth. Dr. Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara claims that there is a need to improve national birth rates in order to boost the economy but authorities refuse to give support for safe child delivery despite of the health center for children and mothers established in 2003. Furthermore, Idou says that as more women decide to have children later in their life, childbirth becomes riskier, thus safer maternity and infant care facilities are imperative as no large hospitals offering gynecological services were available in Nara, which imposes a dangerous situation for women living in the area. The poor gynecological services in Nara, Japan can be partially attributed to the shortage of medical staff where working conditions adds to the high stress, and gynecologists also face arrest and imprisonment if there is a problem. Thus, doctors create a very difficult situation for pregnant women.

In response, Prime Minister Shinzo promised the Japanese Parliament that the establishment of a Women's Doctors Bank would be pursued as a means of offering support for female obstetricians and gynecologists.

REACTION
Lack of obstetrical care services and facilities is not something to be ignored but is something that requires immediate attention as the worlds population largely depends on the birthrates of each location. It isnt true that the world is overpopulated; rather, the world faces its huge problem of being under populated after the introduction of the DEATH culture. This is evident in the rising population of the elderly, involving a total of 10% of Americas total population and is therefore expected to rise to 22% by the year 2030. This means that as death rate rises, birth rate decreases. Years from now, it can be perceived that the world itself will be emptied, with deteriorating population and progressing death of its people. Little problem as it may seem to others, the existing anomalies in maternal and childcare imposes complex problems that may be irreversible if not counter-acted. The primary goal of the medical team is the provision of efficient and quality care, and the adherence to this mission is a lifetime responsibility. Lack of facilities may be a great deal, but the skills and knowledge themselves speaks for being liable of whatever may be the consequences, it is still better to work on a problem knowing that interventions are rendered to the best of the health providers ability.

RECOMMENDATION
This article is primarily recommended to the medical professional, particularly those who are under the Obstetric and Gynecology Department, that they may uphold see in better point-of-view those who are in most need of their care, assuring quality

and efficient care each and every patient deserves. To the nurses of around the world, that they may uphold faithfully to the primary mission of their profession and therefore bound to submit themselves in service of others, not seeking for self-benefits but of others-directed, and that they may develop compassion and genuine concern to all kinds of patients regardless on race, religion, economic status, and physical attributes.

SOURCE
http://proquest.umi.com/pqdweb? index=4&did=1253742231&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&R QT=309&VName=PQD&TS=1250240706&clientId=57020