Helping Mothers and Children at the Beginning of Childrearing: Continuous Support for Pregnancy, Childbirth, and Childrearing
2. [Lecture] Continuous support from before and after childbirth to childrearing: Aiming for a society where kindness circulates
Why we need continuous support for mothers before and after childbirth
I will explain the continuous support for mothers before and after childbirth that government and local municipalities are currently aiming for as well as its background. Care for mothers during pregnancy and at the time of childbirth is mostly provided by medical institutions; and mainly welfare facilities deal with childrearing and child abuse countermeasures. Different organizations take care of prenatal/postnatal support. Meanwhile, pregnancy, childbirth and childrearing are a continuous activity for mothers. After they give birth at a hospital, they are discharged after a short while and return to their ordinary life and childrearing.
Mothers' factors of concerns regarding childrearing are:
(1) I can't bathe the baby well.
(2) I can't get enough sleep because of the baby crying at night.
(3) I am not confident about childrearing.
We can see that mothers need not only medical care at hospitals but also support for themselves and their children at home in daily life.
Recently, infant abuse is increasing, and the cases where abusers are often mothers also indicate that we need appropriate care for mothers after childbirth. The government currently aims to establish continuous support for mothers during pregnancy, childbirth and childrearing.
An island where the total fertility rate exceeds three
What is appropriate care for mothers before and after childbirth? In FY2003, research on a policy to cope with a society with a declining birthrate suggested measures centering on interpersonal relationships between people. In 1990, the total fertility rate in Japan had decreased to 1.57, and the issue of the dwindling birthrate and aging population had become serious. Late marriage and birth, and an increase in female employment, etc., were suggested as reasons.
Research leading up to the findings in 2003, showed that in some geographical areas, the total fertility rate exceeded 3. One such region was Tarama Island in Okinawa with a fertility rate of 3.14. Our study group conducted research on Tarama Island for three years. We found that on the island, people still help each other. They have an environment where children are raised not only by natural parents but by others surrounding them. The concept of social capital is pertinent here. This can be simply understood as "trust," "a network," or "otagaisama (helping one another)." Such understanding had existed more or less in old Japan, but gradually disappeared. The research on Tarama Island found there was still a life with rich human relationships, which seem to have a positive effect on childrearing.
Based on this research, our study group suggested support for community planning to build human relationships, and local policies to reinforce interpersonal relationships. For instance, we drew up a plan for a postnatal support center where mothers stay overnight, which was established in Setagaya ward, etc. The center's functions are similar to those of local maternity centers or the health centers for mothers and babies after the war.
The basis of social capital is the mother-child relationship
The American sociologist, James Coleman, states that the social capital originates in the family. Its source is the formation of attachment between the mother and child. Babies are not able to do anything themselves. The mother or father fulfills the needs of babies by judging from their crying and other perceived behavior. This repetition makes babies sense that they can "trust people."
I hope we can set up a support system that will equip mothers with the mental and physical strength to happily raise children. According to an earlier study, mothers worry about childrearing the most right after being discharged from the hospital for about three months. I believe that supporting mothers especially during this period will make it easier to establish a stable life for them and their children.* For this, it is important for mothers to receive support from others, but at the same time they themselves need to make their own preparations in daily life.
I was involved in establishing a postnatal support center in Setagaya ward, Tokyo, which has creative ways for mothers to connect with each other. Mothers stay in private rooms and get together at meals in the dining room on the first floor. They do not seem comfortable at the beginning, but by the end of the meal, they exchange email addresses. Through such an interpersonal interactions, mothers learn to connect with others and take the opportunity to join the local community.
"Continuous support for pregnancy, childbirth and childrearing" is not a narrow sense of supporting individual mothers within a medical context. Rather, it is a new concept to help mothers in their contextual environment and to nurture social capital by re-establishing relationships with local communities. Local communities support families with small children, and this system is carried over to the next generation. This, I believe, is the "society where kindness circulates."
Aiming for a "Japanese neuvola"
In FY2014, the government announced a five year budget that included measures to deal with the declining birthrate as part of a regional revitalization policy. As such, it recognized the significance of a continuous support system for pregnancy, childbirth and childrearing on the basis of social capital. The plan aims to establish "Japanese neuvola" as a policy for continuous support. "Neuvola" is a Finnish maternity and childrearing support system for families during pregnancy, at childbirth and with children. Within the system, the same public health nurse or midwife takes care of the same mother throughout each phase. Based on this model, in Japan, we need to implement a "Japanese neuvola" which encompasses the concept of nurturing social capital and creating communities.
As a model project, the government is considering the following objectives:
(1) Setting up mother and child health coordinators who help the child from the time when mothers receive maternity handbooks until the child starts school.
(2) Providing prenatal/postnatal support (cooperation with NPOs, the private sector, and the senior generation in the community).
(3) Providing postnatal care (physical recovery and breastfeeding care at birth centers, etc).
Of the above, (1) is regarded as a necessity. A coordinator interviews the pregnant woman regarding her living conditions and gives her a maternity handbook. If necessary, the coordinator will pass information to the support provider of (2) and (3) before childbirth, and aims to maintain continuous care.
Fifty local municipalities (cities, wards, towns and villages) took up the model (1) project in FY2014. The number of participating local municipalities will be 150 in FY2015. Now it is important to inform as many local municipalities in the country as possible about the "Japanese neuvola" and the importance of continuous support for pregnancy, childbirth and childrearing, and to take action.
- * Masafumi Harada, et.al. "Structural Analysis of the Factors Generating Child Abuse and the Development of Effective Preventative Methods in the Community" Study on the Resolution of the Factors Generating Child Abuse and the Development of Preventative Support Methods in the Community Research Report 2004 [published in Japanese]