Japan’s Act on Public Health Nurses, Midwives and Nurses regulates the midwife profession. Only midwives and medical doctors may assist labor and provide health guidance for pregnant women, women in labor, or newborn babies. A midwife must be licensed, which requires a specified education and successful passage of a national examination.
A woman who has given birth to a child receives a lump-sum childbirth allowance from her health insurance. She can use the allowance for any purpose, including payment of a midwife.
Private institutions have established certification systems for doulas and other supporters of women before and after childbirth. As a part of measures being taken to reverse the declining birth rate, the government has initiated programs to subsidize the fees of these childbirth supporters.
I. Alternative Childbirth Care by Midwives
Japan’s Act on Public Health Nurses, Midwives and Nurses states that midwives may assist labor and provide health guidance for pregnant women, women in labor, or newborn babies. No person other than a midwife or medical doctor may practice the profession. If a midwife discovers an abnormality in a pregnant woman or woman in labor, or in the fetus or a newborn baby, the midwife is required to refer the woman or baby to a physician for medical care. A midwife may not personally provide treatment in such cases, other than emergency first aid.
A midwife may work in a hospital, clinic, or birthing center, or provide service at the client’s location. Birthing centers are places exclusively for midwives to perform their services, and must be managed by midwives. Birthing centers may not have in-patient facilities for more than nine pregnant women, women in labor, or women resting after childbirth. They must have contracts with physicians and hospitals or clinics in case clients need to be directed to such places. A midwife who only provides services by visiting clients in their homes must also have a contract with a hospital or clinic. Birthing centers must follow building, facility, and cleanliness standards similar to hospitals and clinics.
To be a midwife, a woman must receive a midwife license from the Minister of Health, Labor and Welfare (MHLW). The MHLW registers midwife licensures in the Midwife Registry. To be licensed as midwife, a woman must acquire the qualification for the national nursing examination and then receive the education for midwifery to qualify for the national midwifery examination. Further, the woman must pass the national nursing examination and the national midwifery examination.
The following persons may sit for the national nurse examination:
(i) A person who has completed the required course of studies for becoming a nurse at one of universities designated by the Minister of Education, Culture, Sports, Science and Technology (MEXT) and graduated from it;
(ii) A person who has acquired credits for becoming a nurse for at least three years at one of the schools designated by the Minister of MEXT;
(iii) A person who has graduated from a qualified nurse training school designated by a prefectural governor;
(iv) An assistant nurse who has practiced for at least three years after obtaining the assistant nurse license, or who has graduated from a high school or junior high school and has been trained for at least two years at a university, school or training school provided for in one of the preceding three items; and
(v) A person who has graduated from a foreign school for nursing or who has received licensure for nurse in a foreign country and whom the Minister of MHLW finds to have knowledge and skill equal to or greater than the persons in items (i) to (iii).
The following persons may sit for the national midwifery examination:
(i) A person who has followed a course of studies in midwifery for at least one year at one of schools designated by the Minister of MEXT;
(ii) A person who has graduated from one of a midwife training schools designated by the governor; and
(iii) A person who has graduated from a foreign school for the midwifery practice or who has been licensed as midwife in a foreign country and whom the Minister of MHLW finds to have knowledge and skill equal to or greater than the persons in the preceding two items.
II. Health Insurance Coverage
In Japan, all legal residents subscribe to one of two types of medical insurance systems. Normal delivery of a child is not regarded as an illness under the Japanese health insurance system, therefore health insurance does not pay medical benefits for normal childbirth. However, under any insurance system, when an insured or dependent gives birth to a child, she is eligible to receive the childbirth lump-sum allowance. In addition, when a child is born by cesarean section, the operation fee, anesthesia fee, medication fee, and in-patient management fee are covered by medical insurance.
The basic amount of the childbirth lump-sum allowance is 404,000 yen (approximately US$3,700). When a woman gives birth at a hospital, clinic, or birthing center that is enrolled in a specified obstetric compensation insurance system, the amount is increased to 420,000 yen (approximately US$3,850). The woman who receives this allowance may use it to cover the bill for the childbirth or any other purpose. If the woman so chooses, the insurance organization may pay the amount of the allowance directly to the hospital, clinic, or childbirth center in order to prevent the women from paying the childbirth bill out of pocket before the allowance is paid.
III. Supporters for Women Before and After Childbirth
Some private organizations and business have established certification programs for supporters for women before and after childbirth. For example, the Japan Doula Association provides training and issues certifications for doulas, who support women before and after childbirth. Doulas cannot assist in the labor or provide health guidance to women before or after the birth, but may provide housekeeping, cooking, childcare, and mental support for the new mother and her family.
As one of the measures being taken to reverse Japan’s declining birthrate, the Japanese government has initiated support programs for marriage, pregnancy, childbirth, and parenting. The national government gives subsidies to prefectural and municipal governments that implement measures to support those programs. Many municipal governments also have programs to pay partial fees to supporters for women before and after childbirth.
Senior Foreign Law Specialist
 保健師助産師看護師法 [Act on Public Health Nurses, Midwives and Nurses], Act No. 203 of 1948, amended by Act No. 83 of 2014, art. 3. The Act in English translation as amended by Act No. 78 of 2009 is available at http://www.japaneselawtranslation.go.jp/law/detail/?printID=&ft=2&re=02&dn=1&yo=nurse&ia=03&ph=&x=0&y=0&ky=&page=1&vm=02, archived at https://perma.cc/37XG-2PNR.
 Id. art. 3.
 Id. art. 38.
 医療法 [Medical Care Act], Act No. 205 of 1948, amended by Act No. 79 of 2018, art. 2.
 See id. art. 19, para. 2.
 Id. art. 12.
 Id. art. 2, para. 2 & art. 14.
 Id. art. 19, para. 1.
 Id. art. 19, para. 2.
 Id. arts. 20 & 23.
 The Act on Public Health Nurses, Midwives and Nurses states that a midwife is a “woman” while a nurse is a “person” (gender neutral).
 Act on Public Health Nurses, Midwives and Nurses art. 3.
 Id. art. 12, para. 2.
 Act on Public Health Nurses, Midwives and Nurses art. 7, para. 2.
 To be an assistant nurse, a certain educational background, passage of the assistant nurse examination, and licensure by a governor are required. Id. arts. 8 & 22.
 Id. art. 21.
 Id. art. 20.
 Health Insurance Bureau, MHLW, https://www.mhlw.go.jp/english/org/policy/p34-35.html (last visited May 10, 2019), archived at https://perma.cc/ES8X-797E. See 国民健康保険法 [National Health Insurance Act], Act No. 192 of 1958, amended by Act No. 45 of 2017, arts. 5 & 6.
 出産に関する給付 [Benefits Regarding Child Delivery], Japan Health Insurance Association (Mar. 8, 2019), https://www.kyoukaikenpo.or.jp/g3/cat320/sb3170/sbb31712/1948-273, archived at https://perma.cc/6RXZ-M3EA.
 健康保険法 [Health Insurance Act], Act No. 70 of 1922, amended by Act No. 79 of 2018, art. 101; National Health Insurance Act art. 58.
 出産時の健康保険適用診療費 [Medical Fees of Childbirth Covered by Health Insurance], Natatsu City, https://www.city-nakatsu.jp/categories/kosodatemokuteki/okane/jikofutangendogaku/ (last visited May 13, 2019), archived at https://perma.cc/TJU2-AQT7.
 健康保険法施行令 [Enforcement Order of Health Insurance Act], Cabinet Order No. 243 of 1926, amended by Cabinet Order No. 213 of 2017, art. 36. See also 平成23年4月以降の出産育児一時金制度について [Regarding Lump-sum Allowance for Childbirth System after April 2011], MHLW, https://www.mhlw.go.jp/file/06-Seisakujouhou-12400000-Hokenkyoku/0000075020.pdf (last visited May 10, 2019), archived at https://perma.cc/M6QJ-K28R.
 MHLW,「出産育児一時金等の医療機関等への直接支払制度」実施要綱 [Practice Manual for “Direct Payment of Childbirth Lump-sum Allowance to Medical Institutions and the Like”] (Jan. 31, 2011, amended Dec. 16, 2016), https://www.mhlw.go.jp/file/06-Seisakujouhou-12400000-Hokenkyoku/0000152341.pdf, archived at https://perma.cc/49TT-U4PA.
 「みんなで子育て」が人気！産前産後のママを支える資格3選 [Popular Concept “Child Rearing by Community”! 3 Best Qualifications to Support Mamas before and after Child Birth], Womore (Oct. 21, 2016), https://shikaku.hoiku-me.com/guide/archives/2276/, archived at https://perma.cc/K3T7-RWBB.
 少子化対策 [Measures against Declining Birth], Cabinet Office, https://www8.cao.go.jp/shoushi/ shoushika/index.html (last visited May 10, 2019), archived at https://perma.cc/FKT2-ZYR8.
 平成31年度地域少子化対策重点推進交付金交付要綱 [ Summary of Issuance of Subsidies for Promotion of Regional Countermeasures against Declining Birth for Fiscal Year 2019], https://www8.cao.go.jp/shoushi/ shoushika/meeting/koufukin/h31/pdf/tousho/31youkou.pdf (last visited May 10, 2019), archived at https://perma.cc/GVZ6-YMUX.
 For example, 産前・産後の日常生活のお世話 [Daily Life Support Before and After Child Birth], Suginami City, http://www.city.suginami.tokyo.jp/kosodate/ouenken/service/oya/osewa/index.html (last visited May 10, 2019), https://perma.cc/2435-DZG2.
Last Updated: 11/13/2019