Promotion of Women’s Active Engagement
led by Midwives
Masayo KOBAYASHI
Chief, Midwives Division, Department of Health Promotion Policy,
Japanese Nursing Association (JNA)

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Basic information on midwives in Japan• History
Historically, as early as 1765, the term "midwife" was used todescribe midwives.
By 1868, midwives were recognized as a socially responsible
professionals.
In 1876, specialized midwifery education began.

Basic information on midwives in Japan• Regulation
The duties of midwives in Japan were stipulated as follows by
the Act on Public Health Nurses, Midwives and Nurses
which was established in 1948.

Based on the Act on Public Health Nurses, Midwives and Nurses (established in 1948 and revised in 2018)

Maternal and child health statistics

Care for pregnant and parturient women• The experience of pregnancy and childbirth has importantmeanings for women and their families.
• Midwives are the most appropriate care providers to attend
childbearing women.
• ' The State of the World‘s Midwifery 2021 ’ described t h eimportance of care by ensuring that all pregnant women haveaccess to Midwife-led care, which could prevent maternal andneonatal deaths and stillbirths and save 4.3 million lives annuallyby 2035.
• In Japan, the government is actively promoting Midwife-led careto meet the diverse needs on the women.

The gap of life expectancy and healthy life expectancy
90.00
84.93

85.59

86.30

85.99

86.61

75.00

78.07

72.65

87.45

12 yearsdifference

85.00

80.00

87.14

78.64

72.69

79.55

79.19

73.62

73.36

70.00

69.40

69.47

2001

2004

70.33

70.42

2007

2010

80.21

74.21

71.19

80.98
9 years
difference
74.79

81.41

75.38

72.14

72.68

2016

2019

65.00

2013

Average life expectancy of men

Healthy life expectancy of men

Average life expectancy of women

Healthy life expectancy of women

Source: Compiled based on data from the White Paper on Ageing Society 2022.

Increase in the number of working women(10 thousand)
3,100
2,956

3,000
2,865

2,900

2,813

2,800
2,700

3,005 2,986 3,0022,665 2,664 2,649 2,656 2,654 2,658
2,633 2,654

2,707

2,737

2,764

2,600
2,5002,400
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021(Notes) 1. Compiled from the Labour Force Survey (Basic Tabulation), Ministry of Internal Affairs and Communications
2.The number of employed person in 2011 is a supplementary estimate by the Ministry of Internal Affairs and Communications
3. The White Paper on Gender Equality 2022

Changes in the number of employed womenImpact of women's health challenges on work• Around 40% of female employees have "felt they had to give up something atwork" due to health issues specific to women.
Have you ever felt you had to give up at work due to health issues
specific to women, symptoms that are more common in women(including mental health problems), pregnancy, childbirth ?

No, I have
not had thatexperience.
57.5%

Yes, I haveexperienced
feeling that I
had to give up.

42.5%.

What they felt they had to give up• ‘Working as a full-time employee’ 57.9%• ‘Getting a promotion or a job with more responsibility’
48.0%• ‘Continuing in the desired occupation’ 38.1%• ‘Becoming a manager’ 32.5%• ‘Training, study abroad, postings, etc. to develop theircareers’ 27.1%(multiple answers)

n=2,400

Source: Based on the Survey on the Promotion of Working Women‘s Health 2018.
Ministry of Economy, Trade and Industry.

Health literacy x Work performance whenexperiencing PMS or menstrual symptoms
6.10
6.00
5.90
5.80
5.70
5.60
5.50
5.40

6.003

(n=2000)

5.779

High health literacy

Low health literacy

Presenteeism when experiencing PMS or menstrual symptoms* wassignificantly low among women with high levels of health literacy
compared to those with low levels of health literacy (p<0.01, resultsfrom a covariance analysis).
*Premenstrual Syndrome (PMS) and menstrual symptoms (pain or discomfort during
menstruation, or other related symptoms such as abnormal bleeding).

Health literacy x Work performance whenexperiencing menopausal symptoms or disorders
Performance whenexperiencing menopausal
Symptoms or disorders

Performance when experiencing
PMS or menstrual symptoms

Health Literacy and Job Performance
6.10
6.00
5.90
5.80
5.70
5.60
5.50
5.40(n=318)

5.830
5.439
High health literacy

Low health literacy

Presenteeism when experiencing menopausal symptoms or disorders*
was significantly low among women with high levels of health literacy
compared to those with low levels of health literacy (p<0.01, resultsfrom a covariance analysis).
*”Menopausal symptoms” refers to various the symptoms that may appear during
menopause (including the five years before and after menopause) such as hot flashes,sweating, and so on. These symptoms are not accompanied by other diseases. If thesymptoms are so severe that they impact the woman’s daily life, she may beconsidered to have a menopausal disorder.

※Levels of health literacy were measured by the “Health literacy scale for women of reproductive age” (Kawata et al, 2014). The median score was taken as the cut-off value for classification into
the high or low literacy groups. Results were adjusted for age, education level, number of children, and the presence of underlying diseases.
※Work performance was self rated between 0-10, with 10 begin usual performance.

Source: Based on Survey on Health Promotion and Working Women 2018 (Health and Global Policy Institute)

Activities of midwives

JNA Initiatives【System development】① Conducted a survey to grasp theactual situation
The survey conducted by the JNA in
2022 found that Midwife-led care isprovided in most phases of the firststage to the fourth stage of a normalbirth.

② Dissemination of midwife-led care
• Holding forums*Posters to disseminate midwifery-led care
Prepared as a grant-funded project of the Ministry of
Health, Labour and Welfare.

JNA Initiatives[Strengthening practical abilities]

Dissemination of CLoCMiP®
Improved educational opportunities for midwives
2012
Development of a midwifery clinical ladder that can be shared nationwide, identifying the experiences
required for proficiency in midwifery practice and the tasks to be achieved.
‘Clinical Ladder of Competencies for Midwifery Practice; CLoCMiP®.’
2022
Revised, specifying the stages of proficiency in women‘s health care ability.
*Clearly stated educational methods, content and evaluation of education to reach the attainment
targets for each level.

Midwifery care for all women and their families
System Development

Strengthening PracticalAbilities

Strengthening Policy
Capacity

Developing a system for
midwives to utilize theirexpertiseStrengthening the practiceabilities indicated in the
midwifery competencies

Developing the ability tosummarize issues on mothers,
children and women and to
make political proposals to thenational government, ministries
and competent authorities

Further Professional Development of Midwives