Reproductive and Sexual Health/Rights
Although, as noted earlier, maternal mortality rates have gone down over the course of time, the number of obstetricians/gynaecologists has fallen nationwide; in 2004, the number decreased in 35 of 47 prefectures (Social Security Council, 2007). This is due to a combination of factors including the long work hours, the heavy financial burden incurred by low wages, and the need for increased insurance against lawsuits (Ministry of Health, Labour and Welfare, 2007b). The number of private maternity clinics run by authorized midwives is also declining. Article 19 of the Medical Services Law provides, “the founders of maternity clinics ... shall designate commissioned doctors and hospitals/clinics.” However, as fewer and fewer doctors accept the commission, maternity clinics are forced to close.
This situation makes it difficult for pregnant women to make an appointment for their delivery. In some cases, they move to another municipality in order to reserve a bed. Recently the nation has been shaken by a number of incidents involving women in labor who were taken to hospital by ambulance due to their exhibiting symptoms of a serious condition, but who were initially refused admittance for reasons ranging from no spare beds to no available doctors. Some of them lost their lives. There are only a small number of places where an appropriate network has been built among public hospitals, university hospitals, medical practitioners, and fire departments in charge of ambulances in order to minimize the occurrence of such incidents.