childbirth in japan childbirth in japan this article deals with childbirth in japan, and the specific details of childbirth exclusive to japan in relation to beliefs, attitudes and healthcare. background history legend attributes the creation of japan to a sun goddess from whom the original emperors are said to be descended beginning in 660 bc. japan was, for the next one thousand years, a largely heterogeneous culture with diverse regional social patterns. contact with korea and china during this time brought aspects of both cultures to japan, including rules of rank and etiquette, the chinese calendar, astronomy, and a healing system based on traditional chinese medicine. military dictators, or shōguns, ruled for roughly the next seven hundred years, culminating in military reunification, and widespread implementation of civil order consistent with the ethos of the samurai class, e.g. rules of loyalty, social hierarchy, and filial piety. western attempts at trade with japan were largely unsuccessful until 1853 when an american fleet led by commodore perry arrived in japanese waters and forced japan into unfavorable trading agreements. this event coincided with the fall of the shōguns and the subsequent meiji restoration that ended a system of feudal landholders, and helped unify the nation. japan quickly transitioned to a modern power with an imperial army. japan then began to extend its empire and seize various pacific islands and parts of russia. this militarism carried over to the 1920s when japan invaded china, to the 1930s when japan joined the axis powers, and finally into the 1940s when japan attacked pearl harbor. in 1945, the historic drop of two atomic bombs by the us on hiroshima and nagasaki resulted in the disastrous outcomes that ultimately forced retreat. the us then occupied japan from 1945 to 1952 under general douglas macarthur. a new constitution took effect in 1947 according to which the emperor became largely a symbolic head of state. japan regained its sovereignty in 1952, and in 1972 the us gave back some islands, the ryukyu, that included okinawa. japan's economic growth was swift, relying on new technologies, manufacturing and a protectionist attitude. in 1998, japan – like much of the region – suffered the worst recession since world war ii, which led eventually to the resignation of the prime minister. since then the economy has improved, but is still plagued by stagnation, a fact that the recent 23-foot tsunami and the largest earthquake in japanese history that struck on march 11, 2011 did not help. a tsunami triggered by a huge earthquake in 2011 struck the nuclear power plant (npp) in fukushima and lead to the leakage of harmful radioactive materials, such as 131i, 137cs, and 134cs, into the environment. as a result, more than 170,000 people in japan evacuated from the area at the time. the radioactive materials from fukushima incident were released into the air and water, possibly polluting agriculture and marine life in japan and other nearby countries. social structure and organization the population of japan in 2009 was 127.51 million. it is the tenth largest population in the world with the fifth highest population density. the country is increasingly urban. about 45% of the population was, in 2005, centered within 50 kilometers of the three largest cities in japan: tokyo, osaka, and nagoya. in 2005, 20.1% of the population was over 65 years old. this figure is projected to increase to 31.8% by 2030, higher than any other industrialized nation. the fertility rate, at 1.21, is below the replacement level. the percent of three-generational households has steadily declined since the 1970s while the proportion of one-person and nuclear households has increased steadily in the same time period. social interactions in japan are traditionally guided by the opposing dynamics of intimacy and hierarchy. in social situations, a commitment to group harmony, solidarity and intimacy must be balanced by deep respect for hierarchy. rules of hierarchy are guided by age, social status and type of employment. appropriate behavior therefore depends on a person's ability to assess the relative hierarchical distinction between individuals. distance naturally decreases intimacy, and appropriate language must be used to communicate deference and avoid offending the other party. traditionally, any behavior that fosters conflict or suggests deviance is not acceptable in japan. political and economic system since its constitution was adopted in 1947, japan has been a parliamentary government with a constitutional monarchy. the monarchy is hereditary while the prime minister must be elected by the diet, or a bicameral legislative branch consisting of the house of councilors and house of representatives. japanese local administration is by prefecture. the country is divided into 47 prefectures, each of which is further subdivided into cities with respective wards and blocks. suffrage is granted at age 20 japan boasts the fourth largest gdp in the world after the european union, the united states, and china. while japan was for centuries a largely agricultural economy, the percentage of the total labor force shifted dramatically in the twentieth century from agriculture to industrial occupations. consequently, japan must import about 60% of its food. japan is one of the world's largest, most technologically sophisticated producers of automobiles, electronic equipment (including digital cameras), machine tools, steel and nonferrous metals, ships, chemicals, textiles, and processed foods. the unemployment rate is stable at less than 5%. nevertheless, the economy is challenged by japan's huge government department, exceeding 200% of the gdp, unrelenting deflation, reliance on exports, and graying, diminishing population. a classic "m-shaped curve" notably marks female employment as many women drop out of the labor force to raise children. three times as many women are employed part-time as men. the japan council for quality health care administers the japan obstetric compensation system for cerebral palsy, a no-fault compensation system for the care of delivery-related cerebral palsy. religion religion, as practiced in japan today, includes shinto (83.9%), buddhism (71.4%), christianity (2%), and other (7.8%). total adherence exceeds 100% because many identify with both shinto and buddhism. shinto shrines, honoring gods and goddesses of ancient japanese mythology, decorate the landscape of japan. shinto is based on earlier animistic and shamanistic traditions, and contains many concepts crucial to daily japanese life today including cleanliness of the body and home. shinto was for a long time considered the "people's religion" while buddhism was adopted originally by the elite. fundamental to zen buddhism are values such as personal effort, personal sacrifice, dedication, exertion, attunement to the body as well as meditation centered upon daily activities such as tea drinking, flower arrangement, and gardening. confucian philosophical traditions, while not specifically religious, are also embedded within japanese culture. the five essential relationships according to this philosophy are father-son, ruler-son, husband-wife, older brother-younger brother, and between friends. clearly this system leaves out woman-centered relationships (e.g. mother-daughter). physical environment japan is a country of islands with korea to the west, china to the southwest, and russia to the north. most of the population lives on the four main islands located between the pacific ocean and the sea of japan. these islands are called hokkaido, honshu, shikoku, and kyushu. the entire land mass of japan is slightly smaller than california, but the climate varies dramatically from cool and temperate in the north to tropical in the south. this mostly mountainous country is, based on its location, vulnerable to a variety of natural hazards including volcanoes, earthquakes, tsunamis, and typhoons. health and illness theories japan's primary medical system is biomedicine. in the late 1800s, the japanese government formally adopted the german system of medical training and medical care delivery. this system of health care exists side by side with a uniquely japanese system of healing called kampo the government granted kampo official status in the 1950s, a landmark event which came with both government regulation as well as national insurance coverage for certain types of treatment. kampo is centered on establishing balance of physical, mental, social, and emotional states. an imbalance may be due to changes such as heat (e.g. overactivity), poor diet, dampness, or pathogens. balance and imbalance are understood according to three main sets of contrasting states: hot/cold, excess/deficiency, and internal/external. a practitioner of kampo gathers extensive personal information about physical and emotional experience and focuses on restoring balance. treatments include moxibustion and acupuncture. kampo treatment is generally considered appropriate for chronic conditions, when multiple organs are affected (e.g. immune disorders or age-related decline), or when biomedicine cannot diagnose or effectively treat a condition. women's health statistics while the social status of women is relatively low, the status of mother is very high in japan. the concept of ryosai kenbo (good wife and wise mother), while contributing to the positive perception of and respect for the mothering role, has been the focus of some resistance by women in the past 25 years. the mean childbearing age is 29.7, an approximately four-year increase since 1979. mean age of first marriage is 28.6 for women, representing an over five-year increase since 1950. marriage rates have decreased since 1970; divorce rates, while remaining low, have slightly increased since 1970. nevertheless, most women in japan still have one or two children and devote enormous amounts of time and energy into raising them. citizenship is notably guarded: a child born in japan does not receive japanese nationality if both parents are non-japanese, or if a japanese father denies paternity of a child born to a non-japanese woman. the availability of the birth control pill in japan is a highly contentious issue due to the government's concern for its many potentially negative systemic side effects and worry that it may contribute, through lack of condom use, to a rise of hiv. while the pill is now available, usage continues to be lower than many other countries. a 2001 survey of 1500 women, for example, found that only 4% of japanese women use this method compared to 87% in the us and 93% in germany. abortion has been legal in japan since 1948. a 1982 survey by the kyodo news service reported than 75% of women in their fifties had undergone abortions at some point in their lives. abortion became legal during the postwar period when the needs of survival limited the number of mouths a family could feed. nevertheless, abortion is not taken lightly and is traditionally marked by various buddhist rituals in which parents express regret and gratitude to their aborted children for their sacrifice for the family. a 2005 study by osaka university graduate school of medicine reported that there were 341,588 induced abortions in 2001. in addition, the abortion rate has been gradually increased by 5.4% to 292 per 1,000 live births from 1998 to 2001. women's health related figures in japan are inspiringly positive. japan boasts one of the longest life expectancies for women in the world at 82.25 years. according to who statistics, life expectancy rate were 83 for both sexes and 86 for women in 2011. and the infant mortality rate is 2.78 deaths per 1,000 live births, one of the lowest in the world. whether these two facts are related to a final figure, the 2011 estimate of fertility rate of just 1.21 children, is as yet undetermined. infant mortality rate has decreased to 2.13 per 1,000 live births in 2014. maternal mortality rate is 5 deaths per 100,000 live births, one of the lowest in the world pregnancy behaviors and beliefs prenatal care the vast majority (or, approximately 99%) of women who carry pregnancies to term in japan are married. the majority of these women stop working once they become pregnant. japanese women are required by the maternal child health act to register their pregnancies with the local government, and encouraged to be vigilant of their pregnancy by utilizing the maternal and child health handbook (boshi techo) distributed upon registration. over 90% of pregnancies are registered before the 20th week of gestation, suggesting that most women are visiting a doctor and receiving support from public health services. japanese women are advised to have prenatal visits every 4 weeks through 23 weeks gestation, every 2 weeks from 24 to 35 weeks, and every week after 36 weeks, for a total of 14 prenatal visit for a low to medium risk pregnancy. ultrasound is used routinely to monitor the development of the fetus; most women have at least five fetal ultrasound exams during