Immediately improve emergency obstetric care system!

Akahata editorial (excerpts)

   Amid public concern over the declining birthrate, more than one million babies are born each year nationwide. However, the medical care system to support expecting mothers has critically deteriorated.

   Painful accidents occur one after another; some patients have stillbirths or even die because of difficulties for ambulances to find hospitals that will accept them.

   According to a survey on ambulance services for pregnant women, in 2006 the number of cases in which ambulance requests of hospitalization were turned down more than five times was 220 and more than ten times reached 45.

   In 84 cases it took 60 to 90 minutes for ambulances to be able to find hospitals to go to, and in 21 cases more than 90 minutes.

   Such difficulties were mostly caused by the defective medical care system in which hospitals were unable to treat patients with serious conditions or no doctors were available at the time.

   The underlying cause is the shortage of physicians. Japan has 200 physicians per 100,000 population, ranking 27th among 30 OECD countries that have 310 on average. This is a result of the policy of restraining the number of physicians that the government has implemented since the 1980s to reduce medical costs in the name of “administrative reform.”

   The number of obstetricians, in particular, decreased by seven percent between 1994 and 2004. Obstetrical sections that requires 24/7 attendance have been in a vicious circle of a shortage of doctors and the harsh working conditions of doctors.

   Some hospitals are making voluntary efforts such as organizing doctors in teams to shorten working hours of child-raising female physicians and exempt them from overtime and night duty. To promote such efforts, the need is for the government to improve the working conditions of doctors and drastically raise the amount of remuneration for emergency room doctors.

   The national and local governments’ policy of promoting consolidation and abolition of national and other public hospitals has deprived local communities of hospitals with obstetrics sections.

   While the number of hospitals with obstetrics and gynecology sections decreased by 28.7 percent between 1996 and 2005, the number of state-run hospitals with such sections decreased by 35 percent.

   The government should put an end to its policy of restricting the number of physicians and systematically take measures to increase the number of them along with measures to improve their working conditions.

   In response to lawsuits over childbirth deaths and complications, it is necessary to create a third-party body to objectively investigate into the causes of such incidents as well as create a system of no-fault compensation.

   Prime Minister Fukuda Yasuo in his policy speech promised to “enhance emergency medical care by taking measures to address the shortage of doctors, especially pediatricians and obstetrician-gynecologists.”

   The government must immediately start to improve the emergency medical care system by establishing a rotation system of physicians staying at home, assigning doctors to ambulances, and establishing hospital information exchange systems.

   It must also proactively take measures to improve the medical care system for expecting mothers such as enhancing coordination between hospitals and midwifery centers, giving subsidies to hospitals providing outpatient services by midwives or in-hospital midwifery childbirth, and maintaining and increasing the number of centers providing care to mothers in the period before and after childbirth.
- Akahata, November 15, 2007