Ms. Naoko Kato
Manager, Child Rearing Support, Child Rearing Support Department, Public Health and Welfare Bureau of Kobe

Ms. Naoko Kato explained how health care can be provided to mothers and children through maintaining both records of those needing support and networks of information dissemination. These can serve as countermeasures to the effects of a natural disaster, by creating a community that is both informed and capable of providing healthcare to its citizens.

With a Total Fertility Rate (TFR) of 1.15, Kobe, as the rest of Japan, is heading towards a predicted ‘Super Ageing Society’. A lack of family support and the economic burdens of child rearing mean that many women are hesitating to have children. 

To support the development of the next generation, Kobe City is incorporating national government policies, such as the 2005 ‘Plan 21 for the Healthy Growth of Children’ aiming to support the balance of work with parenting, educating, monitoring and supporting families.

In Kobe, all expectant mothers are interviewed at ward offices, to provide support and ascertain who is in need of healthcare/ home visits, and who would especially be at risk in a disaster. Healthcare is then administered by collaboration between ward offices and health agencies/ organizations. When interviewed, mothers are made to feel at ease and free to return anytime. They are issued a ‘maternal and child health handbook’, for use as a healthcare and child-rearing guide and a record of all medical information pertaining to both mother and child. A disaster situation can greatly impact a mother’s physical and mental health, and many are newly administered or transfer clinics. The handbooks can guide the mothers on what steps to take for their own wellbeing and that of their child, and provide vital details for any health workers as to the mother and child’s condition.

An expectant mother is interviewed at her local ward office

Despite high survival rates in Japan, babies are increasingly born underweight because of women smoking or dieting during pregnancy. Nutrition education and check-ups are offered in public places like kindergartens and local halls, and the national government ‘Hi Baby’ project dispatches nurses to the families of all newborns, to listen to their concerns, and provide supportive information and care. Records of premature births at medical institutions are also used to provide support to families. All the while, important links are being formed between mother and community, preventing isolation and creating a better environment for the nurturing of newborns.

Urbanization, as well as social advancements and the nuclear family, mean that women have fewer people to consult on child care at a time when they are most likely to be mentally and physically unstable, perhaps suffering from isolation, child-rearing neurosis, anxiety, or even postnatal depression. This can be detected, for example, by using the Edinburgh Postnatal Depression Scale. As well as ongoing support at the highly accessible ward offices and medical and health institutions in Kobe, work is also undertaken with schools to gather further information on infants and younger children, and clarify who is at risk of child abuse or in need of prompt support. Then childcare or housekeeping assistance is administered through health centers, and the potential abuse of children is prevented, through a community-wide ‘childcare support network’.

Fathers’ participation in child rearing is promoted through city-sponsored classes on pregnancy and caring for newborns, held at weekends and holidays. Local halls and nursery schools also hold lectures and group events to provide support and exchange networks for mothers.

After the earthquake in Kobe, community based volunteerism flourished when the limited outreach of a city administration was realized. Now, 191 locally formed Disaster Prevention and Welfare Communities provide citizens with advice on health and safety and accident prevention. The highest cause of child deaths in Japan is accidents, which 80% of mothers admit would have been preventable with more attention to safety measures. Citizens are taught the dangers of burns, ingestion and other domestic accidents, given safety information to prepare against earthquakes, such as positioning furniture safely, and taught to keep flammables away from cooking stoves and lock bathroom doors from the outside if water is stored overnight.

Citizens’ paramedic license courses are offered too, with training on practical first aid, CPR (Cardiopulmonary Resuscitation), and AED (Automated External Defibrillator), which is the most effective life saving measure for cardiac respiratory arrest.

Amongst youths in Japan, abortion, drug abuse, suicide and cases of sexually transmitted diseases (STDs) are increasing, and mental issues (eg. psychosomatic), truancy and social withdrawal are also becoming social problems.

To tackle this, peer and professional counseling programs are offered at health centers and schools, to identify problem roots, and to increase awareness, self esteem, independence and mutual respect among young people, encouraging reconciliation within the family.

Elementary and Junior high students learn to interact with babies, and lectures and booklets on reproductive health are issued to high school and university students as well as citizens.

To prepare a community for a natural disaster, it is necessary to take steps in normal time, such as:

• understanding local conditions and latent healthcare needs;
• keeping updated lists of people who would need special medical care, and each jurisdiction’s facilities and human resources (government, NPOs, volunteer groups, medical and welfare workers);
• creating and utilizing networks for organizations to decide roles and leaders in a disaster situation;
• confirming a channel of communication to disseminate disaster information; and
• creating and promoting regional disaster prevention communities to disseminate information on disaster preparedness.
  

In times of actual disaster, certain factors enable effective provision of medical and health care:

• flexible services to respond to changeable conditions and requirements;
• consideration of impacts on water, food, hygiene, sewage, waste infrastructure and utility services;
• provision of both physical and counseling care services, and evacuation centers offering protection and privacy;
• special care for senior and physically or mentally disabled citizens; and
• partnerships among healthcare and medical personnel, and promotion of team-based activities.
  

Over the course of time, steps should be taken to create new relations in communities which cannot be maintained, coordinate administration services to local communities and create systems for disseminating information to every corner of the community.