This month’s article in the series of “Examining Japan’s Welfare Public Assistance System” takes up the issue of poverty observed in the fields of pregnancy and childbirth. This is a report from Kinikyo Sapporo Hospital, Hokkaido.

“I was tired of living. I was so lonely and had no one to consult with. I have thought about killing myself … countless times,” said Ms. A (anonym) in her 30s, who recently gave birth to a child at Kinikyo Sapporo Hospital. She availed herself to the childbirth hospitalization assistance system.
Using the childbirth hospitalization assistance system, expectant mothers with economic difficulties (of households exempt from residence tax or covered by the welfare public assistance system) can give birth to children free of charge or at a very low cost. About half of the childbirths at this hospital are using this system.
Ms. A left home when she was 15 years old. Regarding her case, Dr. Nagashima Kaori of the obstetrics and gynecology department of the hospital said, “Ms. A’s family home was not a place where she was able to feel safe and secure to stay.”
Having no permanent place to live, until shortly before childbirth, she stayed at Internet cafes on a meager income she had earned and saved by working at a bar. When she visited the Sapporo Hospital, she had already started feeling the labor pain. She reached the hospital only because she remembered visiting there as a child.

Many pregnant women suffer from child abuse

Among the users of the hospitalization childbirth assistance system, in addition to those having economic difficulties, “Year by year, we find increasing number of pregnant women suffering from such complex problems as unmarried motherhood, mental illness, developmental disorders or domestic violence from their partners,” said Ms. Isogawa Satoko, the maternity nurse at the hospital.
Dr. Nagashima observed, “In many cases, pregnant women themselves have suffered from child abuse or similar treatment by their parents. In some cases, they are victims of sexual abuse.”
Due to such experience of abuse, not a few women even in adulthood suffer from depression, PTSD (post-traumatic stress disorder) or developmental disorder. Some of them are addicted to drinking or smoking, or repeat slitting their wrists. Lacking the experience of being “embraced by their parents,” they cannot have much trust on others. In many of difficult cases, these women commonly tend to turn their eyes away from others or keep a firm expression.

Not having enough school education

Due to poverty or abuse within family, many of the women quit school education after finishing a junior high school or in the middle of senior high school, which makes the problem even more serious. Mr. Sakurai Toshihiro, a social worker at the hospital said, “It is difficult to find a job if you have finished only a junior high school. They have not received enough education to be able to ‘dream’ about, or believe in having a better future ‘if they work harder.”
Some pregnant women earn their living by working in an adult-entertainment business. “You may wonder why they work in such a business. But if they had a decent job or had enough money, they didn’t have to choose such a job,” said Dr. Nagashima.
Another distinctive feature among them is the “lack of partners.” Many of them get pregnant with a customer at a bar where they work, or with a man they come to know at an Internet cafe. Some men just leave them once they learn about their pregnancy. Some women were forced to be pregnant as the result of domestic violence.
Dr. Nagashima said, “If you only look at the absence of partners, you may just think they are ‘irresponsible.’　But in some cases they were victims of abuse and their mind and body have become separated, or they were not good at measuring an appropriate distance with other people. Or in other cases they were just desperate to keep in contact with someone. Anyone could fall into such a situation if put in their shoes. It is important to accept and understand the pain they have suffered over the years all alone. Blaming them would not lead to any solution.”

Giving priority to their hope for the future

Kinikyo Sapporo Hospital tries to intensify effort to give support to pregnant women having various difficulties. “In the past I used to wonder ‘Why do they want to give birth to babies even if they have no money?’ But as I gradually learned the background of their lives, I have changed my viewpoint. Now I feel more confident in giving necessary support to each case,” Ms. Isogawa said.
In the case of Ms. A, the priority was given to “what she herself wants to do most” in supporting her life.
Ms. A once thought about applying for a welfare public assistance. But when she went to a welfare office, she was turned down on the account of having no fixed place of living. “But this hospital assured me that I would be eligible for the welfare benefit, and I would be able to start my life again. The childbirth at this hospital made me feel safe and comfortable in life. Now I can think positive about my life,” Ms. A said with a bright smile.
After the childbirth at the hospital, she has left her baby to the care of a home for infants. But she wishes to raise her child by herself in the near future. Now she has a permanent residence and works part-time while receiving the welfare benefit. Her hope is to “graduate” from the welfare benefit and live independently with her baby.
Mr. Sakurai stated, “We try to support them until they themselves become bearers of society. Only then they can truly become independent persons.”
The welfare benefit system should not be cut back, but be increased and improved, which would only mark the start of ending the “cycle of poverty.”

(Article by Tada Shigemasa)