保健医療科学

2019Vol.68 No.1 p.2−7

Topics: Recent topics in public health in Japan 2019

＜ Review ＞
National campaign to promote maternal and child healthin 21st-century Japan: Healthy Parents and Children 21
Eri Osawa 1), Toshiyuki Ojima 2), Yuka Akiyama 3), Zentaro Yamagata 3)
1)

Department of International Health and Collaboration, National Institute of Public Health,
Department of Community Health and Preventive Medicine, Hamamatsu University School of Medicine
3)
Department of Health Sciences, Graduate School Department of Interdisciplinary Research, University of Yamanashi
2)

Abstract
Now Japan is facing new social problems such as an increase in anxiety about child care and child abuse,
psychological problems of parents and children, and child-rearing stress after dramatically improvement of
the health of mothers and children.
To approach such new issues, Healthy Parents and Children 21 revealed maternal and child health initiatives, directions, goals, and indicators for the 21st century in 2001. Since then, many issues related toadolescent health, safe pregnancy and delivery, and child health care have been further improved. Now, thesecond term of Healthy Parents and Children 21 from 2015–2024 aims at improving the lives of parents andchildren by ensuring constant, high-quality maternal and child health services all over Japan, and developing
diverse maternal and child health services that cover various problems of child-rearing.
This paper provides a summary of past maternal and child health policies and an overview of the maternal and child health policy since 2001, especially focusing on the first and second terms of Healthy Parents
and Children 21—Japan’s maternal and child health policy.
keywords: Healthy Parents and Children 21, Maternal and Child Health, Health Policy, Policy Evaluation(accepted for publication, 23rd January 2019)

I．Introduction

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Japan is one of the countries in which the health of mothers and children has dramatically improved. At the beginning of 1900, the infant mortality rate was close to 160, andit reached 3.2 in 2000. Thereafter, owing to advances inhealthcare, it has continued to decrease, and it is now 2.0(Figure 1) [1]. Likewise, the maternal mortality rate wasnearly 400 at the beginning of 1900, but it reduced to 6.3 in2000 and to 3.4 in 2016 (Figure 2) [2]. However, currently
in Japan, the environment surrounding children and theirparents is completely different from that of the past owing
to the declining birthrate, nuclear familization, and urbanization.
This paper presents an overview of maternal and child

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1900 1910 1920 1930 1940 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2016
Infant mortarity rate

Figure 1 Historical Trend of Infant and Neonatal Mortality Rate in Japan

health policy, especially focusing on the first and second
terms of Healthy Parents and Children 21—Japan’s mater-

Corresponding author: Eri Osawa
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
E-mail: osawa.e.aa@niph.go.jp

2

Neonatal mortality rate

J. Natl. Inst. Public Health, 68 (1) : 2019

National campaign to promote maternal and child health in 21st-century Japan: Healthy Parents and Children 21

III．The first term of Healthy Parents andChildren 21 from 2001 to 2014

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Figure 2 Historical trend of Maternal Mortality Ratein Japannal and child health policy since 2000.

II．Maternal and child health policy up to2000
When the Health Center Law and the Maternal and Child
Protection Law were formulated in 1937 and the Ministryof Health and Welfare was established in 1938, maternaland child health measures were implemented under thesystem. In the 1940 s, when health checkups for infants andpregnant and child care book systems (the predecessorsof maternal and child health books) were introduced, various maternal and child health services began to improve,
including those encouraging notifications on pregnancies
and thorough immunization drives. As a result of the abovemeasures, the health of infants was steadily promoted [3,4].
However, few facilities were able to produce safe births
in rural areas. In such areas, “Maternal and Child HealthCenters” were opened by local governments, and safe deliveries became possible for couples [5]. These maternaland child health centers were also places where mothers
could be made aware of maternal and child health issues
such as postpartum care. Because such measures gradually
expanded, the “Maternal and Child Health Law” was finallyenacted in 1965 [3,4].
Even then, with the expansion of infant health examinations, screening tests for diseases, etc. being conducted,
efforts were made to enable the early detection and treatment of diseases, and maternal and child health activities
carried out by volunteers in the area were enriched. In theearly 1980s, major measures for maternal and child healthin Japan were almost completed, and the infant mortality
rate declined steadily [3,4].

By 2000, improvements to the maternal and child healthindices, namely the infant mortality rate and the maternalmortality rate, were maximized. However, on the other
hand, an increase in anxiety regarding child care and childabuse, the psychological problems of parents and children,and child-rearing stress became social problems as a resultof fewer opportunities to learn how to take care of children
owing to the declining birthrate, the progress of nuclear
familization, and urbanization.
To approach such new issues, the Healthy Parents andChildren 21 plan was introduced, including maternal andchild health initiatives, directions, goals, and indicators ofthe 21st century in 2001. It was a national campaign plan
outlining goals to be achieved and it was formulated as oneof the subprograms of “Health Japan 21”—the national
health promotion plan formulated in 1999. It was based on
the basic philosophy of health promotion introduced by theWorld Health Organization in 1986 [6]. At the beginning of
the first term plan in 2001, 61 indicators were included andthe year of achievement was set to 2010. However, basedon a subsequent intermediate evaluation, the achievement
year was set to 2014 and 8 indicators were added [7,8].
There were four agendas with 69 indicators (79 items)
under the first term of Healthy Parents and Children 21(Table 1*). In response to the increased incidence of induced
abortions, sexually transmitted diseases (STDs), drug
abuse, and school dropouts in adolescence becoming serious
social problems, agenda 1 comprised initiatives to strengthen the consultation system for adolescents at school and in
the community along with the dissemination of information
about adolescent health. Agenda 2 was focused on improving quality of life (QOL) through safer pregnancies andchildbirths. Also, it was required to consider support forcouple seeking infertility treatment due to development ofreproductive supplementary medicine. Agenda 3 aimed to
improve and maintain standards of child health and medicalcare. It included the perspective of QOL and the healthy
development of children in society with a low birth rate andageing population. These targets were included to combat
the decline in maternal and child health activities and thechanging conditions of pediatric medical services in thesociety. As mentioned above, anxiety about child care andchild abuse, psychological problems of parents and children,and child-rearing stress had become social problems. Agenda 4 promoted the peaceful development of children’s minds* The electronic data of Table 1 is listed as an online appendix in the "Journal of the National Institute of Public Health". (https://www.niph.
go.jp/journal/data/68-1/table1.pdf)

J. Natl. Inst. Public Health, 68 (1) : 20193

Eri Osawa, Toshiyuki Ojima, Yuka Akiyama, Zentaro Yamagata
and the mitigation of child care anxiety among parents.
A total of 60 items, including morbidity rate of sexuallytransmitted diseases (STDs) in teens (agenda 1), incidenceof postpartum depression (agenda 2), incidence of maternalsmoking during pregnancy and percentage of 3-year-old
children without tooth decay (agenda 3), achieved their target. Although certain improvements were observed under
the first term of Healthy Parents and Children 21, several
challenges remained. The mortality rate owing to suicide inteens and the percentage of very low and low birth weight
infants worsened, and the progress in agenda 4 was relatively slow. A committee formed to conduct the final evaluation revealed that the issues that required further approachwere “Enhancing adolescent health measures”; “Enhancing
perinatal medical services, pediatric emergencies, andchild-home care”; “Strengthening an effective cooperation
system among various maternal and child health services”;“Developing children-friendly communities supporting thepeaceful growth of children”; “Supporting parents who havedifficulties raising their children”; and “Strengthening theprevention of child abuse”[9].

IV．The second term of Healthy Parents andChildren 21 from 2015 to 2024
Based on the challenges revealed in the final evaluationof the first term of Healthy Parents and Children 21 and thediscussion that followed, the second term of Healthy Parents and Children 21 defined “a society where all children
grow well” as the desired goal to be achieved in ten years.
This goal could be realized through the elimination of regional health disparities by ensuring constant, high-quality
maternal and child health services all over Japan and by
developing diverse maternal and child health services thatcover various type of illnesses, disabilities, economic statuses, and other differences [10].
Figure 3 shows the conceptual image of the second termof Healthy Parents and Children 21. As shown in Figure 3
and Table 2**, the second term of Healthy Parents and Children 21 includes five agendas: (1)Seamless healthcare forpregnant women and infants (Fundamental agenda A ), (2)Health initiatives from elementary school age and adolescence to adulthood (Fundamental agenda B), (3) Community-building to ensure the healthy growth and protection

The second term (2015‐2024) of
Healthy Parents and Children 21

A society where all children can grow up healthyChild‐raising and health support

Counseling
Decliningbirth rate

Vaccination

HealthCheck‐Up

Postpartum
depression

Infertility
Low birth‐weightinfantFundamental measure A:
Seamless healthcare for pregnant
women and infants

Prioritizedmeasure 1:
Supporttailored toparents whohhave
difficulties
diffi lti
raising theirchildrenPrioritizedmeasure 2:
Prevention ofchild
h ld abusebfromfpregnancy

SexualHealthPhysical
activity

DentalHealthMentalHealthDiet &
nutrition
education

Smoking&
Drinking

Overweight &underweight

Fundamental measure B:
Health initiatives from elementary
school age and adolescence toadulthood

Fundamental measure C:
Community building to ensure the healthy growthand protection of children

Figure 3 The second term (2015-2024) of Healthy Parents and Children 21 [10]** The electronic data of Table 2 is listed as an online appendix in the "Journal of the National Institute of Public Health". (https://www.niph.
go.jp/journal/data/68-1/table2.pdf)

4

J. Natl. Inst. Public Health, 68 (1) : 2019

National campaign to promote maternal and child health in 21st-century Japan: Healthy Parents and Children 21
of children (Fundamental agenda C), (4)Support tailored toparents who have difficulties raising their children (Prioritized agenda 1) and (5)Prevention of child abuse from pregnancy (Prioritized agenda 2). Fundamental agendas A and B
stem from the challenges of the first term and include newchallenges that need to be addressed in a society with a lowbirth rate and various types of family arrangements. Fundamental agenda C aims to create a conducive environment
to children’s and parents’ health as a foundation for agendas
A and B. Prioritized agenda 1 and 2 was set as an agenda
required to be addressed more intensively. In order to move
initiatives forward, citizens’ understanding and the promotion of collaborative activities among related organizations,both academic and professional, are required [10].
Since Healthy Parents and Children 21 is a national campaign plan, it is widely sustained by various projects andactivities. Some municipalities have reviewed their support
programs for child rearing right from pregnancy to school
age and have launched an improved program nationwide
called Community-based Integrated Care for Householdswith Children (Kosodate Sedai Houkatsu Shien) [11,12].
The system enables municipalities to provide a one-stop
support center for households with children, and it aims tocontinually connect with and support children. The center
functions as a place that connects households with children
to sources of important information and support, such as
the other projects, local residents, nonprofit organizations,and medical institutions. In communities, there are manystations—voluntarily run by local residents—where parents
with children gather and consult experienced people [13,14].
Such projects and activities can help realize the goals of
Healthy Parents and Children 21.
Additionally, since the final evaluation of first term also
recognized that regional disparities existed in the planningand implementation of maternal and child health programs,
the national and local governments were expected to develop a mechanism that enables them to follow measuresaccording to the concept of the Plan-Do-Check-Act (PDCA)
cycle [9,15].
The 52 indicators in the second term plan were organizedaccording to the three layers of “health outcomes,” “healthbehaviors,” and “environment” (Table 2). Indicators areverified based on existing statistical surveys and researchworks by academics. The midterm evaluation will be revealed along with the framework later this year.

V．Conclusion
In Japan, the health of mothers and children has dramatically improved with the modernization of society and thedevelopment of supporting systems. However, health prob-

lems are changing remarkably with the times, as a result of
the increase in new problems such as child care anxiety andchild abuse, parents’ and children’s psychological problems,and child-rearing stress. Knowledge of the challenges Japan
currently faces with respect to maternal and child healthcare and child rearing—and our measures against them—will help us overcome these challenges in a modern society
dealing with issues such as urbanization, a declining birthrate, and nuclear families.
This article is an overview of Healthy Parents and Children 21. As mentioned above, this national campaign planis supported by various projects and activities initiated bycommunities and organizations all over Japan. The readers are advised to refer to other publications for details onthese projects and activities.

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J. Natl. Inst. Public Health, 68 (1) : 2019

National campaign to promote maternal and child health in 21st-century Japan: Healthy Parents and Children 21

21世紀の日本における母子保健推進のための国民運動̶健やか親子21̶

大澤絵里 1)，尾島俊之 2)，秋山有佳 3)，山縣然太朗 3)
1)

国立保健医療科学院

2)

浜松医科大学医学部健康社会医学講座

3)

山梨大学大学院総合研究部医学域社会医学講座

国際協力研究部

抄録
日本では，母子の健康が劇的に改善したが，現在，育児不安や児童虐待，親と子の心の問題，育児ストレスという社会問題に直面している．
そのような新しい問題に取り組むために，健やか親子21は2001年に21世紀の母子保健の活動，方向
性，目標および指標を示した．2001年以降，思春期の健康，安全な妊娠と出産，子供の健康管理に関連する多くの問題が改善した．現在は，健やか親子21第二次（2015〜2024）が展開され，全国各地で一定の質の母子保健サービスの確保，および様々な育児の問題に対応した母子保健サービスを発展させることを通じて，親子の生活の質の向上に取り組んでいる．
本稿では，近代化した社会における母子保健および子育て支援の考察の一助とするために，過去の日本の母子保健政策と現在の対策，特に健やか親子21第 1 次と第 2 次に焦点をあてて，2001年以降の日本の母子保健政策を紹介する．
キーワード：健やか親子21，母子保健，保健政策，政策評価

J. Natl. Inst. Public Health, 68 (1) : 20197