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Tuesday, July 27, 2010
MATERNAL AND CHILD HEALTH HANDBOOK
The mother-child health log
Long-standing fixture finds favor abroad, used as evidence here
By MIZUHO AOKI
Boshi Kenko Techo (Maternal and Child Health Handbooks) have been around since shortly after the war as part of government efforts to curb infant mortality and offer basic parental guidance and record-keeping for mothers.
In part because of Japan's experience and assistance, other parts of the world are also giving such guidebooks a look.
And at home, they are playing pivotal roles in lawsuits filed by more than 400 people with hepatitis B who blame the government for causing their infections via shared needles in mass vaccination drives.
Discussions are under way for the handbooks, which include vaccination records, to be used as a certificate to apply for government compensation because they can demonstrate if a mother or offspring may have been exposed during group vaccinations between 1948 and 1988.
Those who don't have the handbooks, or have lost track of them, including about 60 percent of the plaintiffs in the suits, may face the arduous task of proving they were similarly affected.
The handbooks are given to women when they register a pregnancy with their local municipality. The booklets come with 14 supplementary tickets for health checks.
Following are basic questions and answers about Maternal and Child Health Handbooks:
What role do the handbooks play?
The booklets are given to pregnant women to keep track of their and their offspring's health situation. They are used to monitor the health and growth of both mother and child before and after delivery, usually until the child reaches elementary school age.
The first half of the roughly 100-page booklet provides space for doctors, nurses and mothers to record the health conditions of moms and infants after periodic physical examinations and at childbirth, and log records of vaccinations. The booklets also serve as de facto birth certificates.
The latter half of the booklet provides information for mothers, including about pregnancy, delivery and parenting.
Experts say the handbook is useful for mothers to understand the growth of their children as well as to keep their own records, which can provide a ready reference for any doctor.
When should a woman register a pregnancy?
The government recommends that woman register by the 11th week of pregnancy so they can get medical support and necessary information as early as possible. Although the Maternal and Child Health Act calls for pregnancies to be registered, there is no deadline.
What is the history behind the handbooks?
Maternal and Child Health Handbooks trace their roots to 1942, when the wartime government was encouraging childbirths. Two years earlier the infant mortality rate was 90.0 per 1,000 births and the maternal mortality rate around 200 per 100,000 births, according to the health ministry.
The ministry issued maternity handbooks in 1942 and initiated the pregnancy registration system.
Japan became the first country to establish the system.
The initial maternal handbook, called Ninsanpu Techo, was a single paper folded into four panels with blank sections to record the health of an expectant mother until childbirth and basic information about pregnancy, according to the Japanese Society for International Nursing Newsletter published in 2006.
Pregnant women with the guide could receive special rations of food and sanitation items, including cotton, gauze and soap.
How long was the Ninsanpu Techo in use?
The small booklet gave way to the Boshi Techo in 1948, which was aimed at providing better health guidance to both mother and child.
Initially 20 pages long, the booklet was the first to combine the health records of both mother and child from pregnancy to when the child turns 6, according to the Health and Development Service.
With the enforcement of the Maternal and Child Health Act in 1966, the present Maternal and Child Health Handbook was issued with more comprehensive information.
Where do the booklets come from?
Municipalities issue the books. The content in the first 49 pages is determined by the Health, Labour and Welfare Ministry, the latter part is left in the hands of local governments to decide what information to include.
Municipalities also determine the design and size of their local booklets.
Some use popular cartoon characters, including Mickey Mouse, Doraemon or Miffy, on the covers.
The recent interest by fathers in participation in child-rearing has led some municipalities to issue a Paternal counterpart, Fushi Techo.
What do the paternal handbooks include?
Those issued by the Tokyo Metropolitan Government include advice from other fathers and mothers, a psychological test to find out what kind of dad a reader may be, an explanation about the physical changes a pregnant woman undergoes, the development of an infant and other basic information.
Are the handbooks given only to Japanese people?
No. All women who reside in Japan, regardless of nationality or status of residence, receive the booklet upon registering a pregnancy, according to the health ministry.
Are there Maternal and Child Health Handbooks in other languages?
Bilingual booklets are available in eight other languages.
Availability, however, depends on each municipality, with more usually available where many foreigners reside.
For example, Yokohama, which had more than 70,000 registered foreign residents as of 2008, issues Maternal and Child Health Handbooks in English, Korean, Spanish, Portuguese and Vietnamese, according to city officials. They are free upon request.
If the bilingual handbook is not available, it can be purchased from the Mother's and Children's Health and Welfare Association, which makes and sells them in English, Korean, Chinese, Thai, Tagalog, Portuguese, Indonesian and Spanish. Each handbook costs ¥787.
Do other countries issue similar booklets?
Yes. Although the exact number is not known, many countries have adopted or are preparing to adopt similar systems, according to the Health and Development Service.
The Japan International Cooperation Agency, UNICEF and other nonprofit organizations have been involved in creating maternity handbooks for regions with high infant mortality rates.
In 1993, JICA helped establish Indonesia's maternal and child health handbook. It is used nationwide today. JICA also helped in developing and expanding the use of such handbooks in the Palestinian territories, the Philippines and Madagascar.