| Research Abstract |
<Introduction>This paper concretely describes factors which led to the development and eventually the decline of "government-funded", or public maternal child health care centers (henceforth, MCHCCs) and examines the characteristics and problems of "government-funded" facilities along with their capacity to perpetuate themselves and limitations. Through this analysis, it aims to identify the issues to be addressed in the process of formulating and promoting maternal and child health policies in Japan, drawing on my questionnaires distributed to existing MCHCCs. At their initial phase from 1957 to 1974, MCHCCs consisted of two sections, Delivery Section, where locally-based midwives took major responsibilities, and Health Guidance Section. At present, those facilities officially registered as MCHCCs total 126 nationwide (Association of Maternal and Child Health Care Centers, 2001, Zenkoku Shichoson Hoken Senta Yoran (A Handbook on Health Care Centers in Cities, Towns, and Villages in Ja
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pan), fiscal 2001, Association of Health Care Centers).
<Questionnaire survey>Among 55 out of 126 facilities, which returned the sheets, as of 2004, two local governments retained the initial form of MCHCCs, that is, maintained and operating Delivery Sections, whereas 34 of them had already abolished those Sections and the rest of 19 local governments had facilities lacking Delivery Sections from the very beginning, according to the responses given by local government officials responsible for maternal and child health. The main reasons for this elimination lie in the aging of midwives in charge, the unavailability of incoming midwives, and a decrease in the number of users of local government facilities.
<Interviews >The review of a series of my interviews with midwives working at existing MCHCCs intwo local governments as well as midwives, public health nurses, and local government employees who used to work at MCHCCs during their pioneering stage in eight local governments demonstrates that the first two MCHCCs shared the following characteristics : 1)The mayors or village/town heads recognize the necessity and importance of MCHCCs ; 2)A system of cooperation between local governments (including midwives) and part-time medical doctors stationed at MCHCCs is fully established ; 3)Senior midwives are training younger midwives ; 4)The midwives working at MCHCCs share the information concerning women users among themselves, ready to support each other if need be ; and 5)The linkage and counseling system between midwives and public health nurses is smoothly maintained.
On the other hand, the eight MCHCCs interviewed closed their Delivery Sections one after another in the 1990s, partly because local governments were in disagreement with part-time medical doctors due to the difference of views toward child delivery and/or the rivalry in their job categories, and partly because the aging of midwives was accelerating resulting from the unfavorable method of employing midwives and the instable status of midwives as occupation. In other words, these two causes for abolition and the points 2) and 3) raised above as the factors for growth are the two sides of the same coin. My interviews further suggest that the decline in the number of MCHCC users is explained by the fact that not only women users themselves came to choose hospitals, judging that they are safer than MCHCCs, but also various testing by and advices from medical doctors during antenatal medical checkups now rendered compulsory make them hesitate to give birth at MCHCCs.
<Conclusion>In sum, my nationwide research on MCHCCs has revealed that the launch on and elimination of maternal health policies in terms of MCHCC programs is predominantly controlled by government administrators, regardless of the opinions of midwives and women users as main actors utilizing facilities and that medical doctors play a chief role in deciding whether or not to continue MCHCC's Delivery Section. Less
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