The Lancet, first published in 1823, is considered as one of the most authoritative medical journals in England today. It reports on high-quality clinical experiments capable of healthcare innovation; is actively involved in global health, a issue that requires cooperation and collaboration beyond the boundaries of the world; and presents many studies and analyses in various areas of the world. Currently, it functions as a medium that transmits the latest news on healthcare and clinical studies to the world. Since establishing its website, TheLancet.com in 1996, two million people have registered as users. (Press release of The Lancet, themed issue on Japan)

The themed issue on Japan, published by The Lancet in September, contains the following six articles co-authored by Japanese specialists in various fields of the Japanese healthcare system and international specialists. It proclaims the success in the field of healthcare in Japan and discusses the serious problems that Japan is and will be facing.

Why is Japan the world leader in longevity?

• The position of Japan as the world's No.1 longevity society is shaky. (Comment)
• Setting of healthcare cost: How have healthcare costs been controlled?
• Geriatric care in Japan as a universal standard
• Six months after "Fukushima": The world has supported Japan. Now is the time for Japan to support the world and play a central role in global health.
• Future of Japanese-style healthcare system: innovation based on human security; strengthening of the role of local government; improvement of the quality; active participation in global health; and effective response after the disaster in Fukushima
• Suicide in Japan (Comment)

It presents many insightful and worthwhile discussions on geriatrics and gerontology in Japan. Although these articles raise issues concerning aging society, they rarely cover the low birthrate problems behind it.

While reading these articles, I recalled the days when I started being involved in support activities in the disaster area at the beginning of April.

I remember a mother at an evacuation center who received complaints about her child crying at night and had to stay in a car holding her baby; a mother who had a difficulty handling a baby stroller in the high school used as an evacuation center with uneven surface without any elevators; and a pregnant woman who had eaten only one rice ball and a cup of instant noodles a day for one week after the disaster due to the lack of special consideration in food distribution for pregnant women and children.

When I take the subway with a child in my arms, I am rarely given a seat by another passenger in Japan. Knowing that it causes trouble for other passengers if I get on with a baby stroller, I choose to lead my four children by the hand, with the baby on my back. I do not think that people are willing to have children in a society without kindness toward children, thoughtfulness for parents who undertake risks and a burden to have children and those who smile at children with the thought "How cute your children are!"

Almost six months have passed since the disaster occurred. What we sense through support activities for mothers and children is the universal understanding that a baby's smile, mother's affection, and support among people are more valuable than anything else. I feel that the attitudes of media and industrial world have changed little by little due to such persistent and continuous efforts. More media attention is given to children's psychological care. In addition, Masayoshi Son, the founder of Softbank, established the Children Support Fund with 100 million yen. We helped local mothers to fill out an application form for it.

More and more people have started asking, "Could child-rearing support be put off among community rebuilding framework?" and "Is it OK that family support receives low priority?" Considering the seriousness of the trauma which mothers and children suffered by Tsunami and its future effects, I keenly believe the important role for the support that is attuned to parents and children. I would like to support mothers and young leaders in the disaster area on an ongoing basis with the following ideas in mind: Healing for mothers and children should be given top priority. Community rebuilding should start with creating a sufficient environment that makes young people want to have children and a family, so that they can be treated as valuable.

The following are authentic voices of mothers that we as members of the support team for expectant mothers heard at the child-rearing support center and during our visit to newborn babies during the month of August.

• "I cannot talk about having a baby, because many people around me have lost their family members."
  When they knew we were obstetrician and gynecologist, some women started talking about having a baby. Children's nurses said that they also hesitated to talk about having a baby with pregnant women because of the same reason mentioned earlier, so they appreciated the approach by the specialists.

• "I was forced to live with my parents or parents-in-law because my house has been destroyed. So, I feel stressed."
  This was mentioned by a number of women. The small and crowded living spaces themselves are a source of tremendous stress.

• "Each of the family members feels stress due to an unstable living environment."
  Mothers feel depressed or irritated about a future that is economically and psychologically unknown. They also feel anxious about the relationship with their husbands and relatives. For children, mothers are psychological shelters. So, they will be unstable if they see their mothers unstable. Some children were not able to receive sufficient academic support and psychological care or see friends during summer vacation. With children home all day long, some parents were exhausted. It was before and after this summer vacation that children were separated from friends and teachers who are critical figures in the establishment of identity.

• "I was pregnant when the disaster occurred. I had to live in an evacuation center, and I could not get proper nutrition. I was afraid that would have negative effects on my unborn child."
  She felt anxious after being told by people around her that her baby might have developmental problems or that she had better to take an amniotic fluid test. She was already psychologically unstable, so she was worried that her stress and fear would be transmitted to the fetus. She also thought she was on unhealthy, high-salt diet. She could help blaming herself.

• "My house was not damaged by Tsunami, but the nearby area has suffered a lot. My house is the safest place. So I now hesitate to go out with my children."
  Some mothers cannot go out often. In addition, there are still areas in rubble. Others are worried about air pollution and hesitate to take their children outside.

• "I do not want my children to play on the ground or to swim in a pool."
  Some mothers are worried about the effect of radiation on their children in Miyagi. Although they are worried, they say, "I do not know why I have to be worried." Many mothers have no clear reason for getting anxious. I was asked, "Why is dust bad for our health?" by the person who was confused due to a lack of knowledge. I myself felt like being fed up with the nationwide reportage that expects "zero risk".

• "I want a place for mothers to get together and chat, as well as for children to play."
  Such needs are extremely high. Currently, we often provide mothers with an opportunity to get together and chat in a temporary housing or a child-rearing support center. We also assist maternity nurses and local leaders in holding a session and a handicraft workshop for mothers.
  A child-rearing support center with a day-care has offered the use of its facilities to a damaged day-care center. As a result, the child-rearing support center is currently operating only in a little space at the entrance hall. The visitors are 10 to 20 pairs of mothers and children. Some mothers and children come from far away. However, not all of them can be accepted because of space limitations. Parents and children who live outside the Kahoku area could be rejected even though they used to be frequent visitors. Likewise, some child-rearing support centers use a small number of undamaged public facilities to do their activities, such as a nursery school, a meeting place in temporary housing, or high school. There is a lack of places where children can play without constraint.

• "(Although the staff members had not been decided,) the child-rearing support center which was supposed to open this spring was swept away. Currently, two children's nurses are training at another child-rearing support center so that they can start its operation. They visit a community center twice a week to do the activities and beat their brains out to find the base of operation including prefabrication and a trailer."

• "I want private time. I need a place that I can leave my children in care."
  Mothers are extremely tired, but children who are psychologically unstable due to the fearful experience will not leave their mother. Although some nursery schools are open, they do not offer temporary daycare. As for the family support center, many supporters are inactive because they are also suffering from the disaster. The desire for private time is neither a luxury nor a self-indulgent request. We invite mothers and children to Anpanman Museum (a museum of the animation character, Red Bean Bread Man) where supporters play with children, thus relieving mothers and allowing mothers and children to be separate for a while. Although this is only a short period of time, we try to help mothers in various ways, so that they can rest and have private time.

That is all for now.

I would appreciate any ideas and advice from you regarding what we can do to create the place where people can give birth to children and raise them comfortably.