Monday, May 09, 2011

The Cost of Giving Birth in Japan

I hope this doesn't excite my family too much, but recently I've been looking into the logistics of childbirth in Japan. Hence the forthcoming post on maternity leave (see next week).

It seems that the Japanese process typically involves a 6+ day stay in hospital for mother and baby, during which time you learn about aftercare for your newborn etc. Understandably, this isn't a cheap period of your life. Luckily, provided you're paying the shakai hoken (social health insurance) you can expect to get the vast majority of that money back, if not more.

In fact, even if you don't stay the full time, or even don't go to hospital at all and find your own midwife, you'll still get that money (approx. 420,000yen depending on your area).

For more, here's an extract from a recent article in the Japan Times:
Expected costs of childbirth in Japan
A 2009 health ministry-funded survey of 2,886 hospitals and clinics showed that the average cost of delivery was ¥423,957 nationally, and ¥459,260 in the Kanto region. The cheapest area in which to give birth was the Kyushu- Okinawa region, where the average cost was ¥393,671.The average length of stay was 6.28 days nationally. Prices are higher if you choose a single room, give birth at night or on a weekend and ask for an epidural.Women covered by the public health insurance scheme can get up to ¥420,000 of their costs subsidized by the government.Costs of prenatal visits to doctors and midwives also vary, but many municipal governments issue vouchers for free prenatal screenings at hospitals, clinics and midwife-led birth centers.

  • If you decide to do a home or private birth, you may need to find a midwife. A good place to start on that route is the Midwives Association of Japan (most of the important stuff is in Japanese).
  • Beware that the regular Japanese birthing process may be culturally different from what you may expect. If  you have "special" requests, such as the father being allowed in the room during birth, no painkillers, sleeping in the same room as the baby in hospital etc, you will have to find a doctor/hospital that is okay with those.
  • A great community site to help you with the raising, matriculation, health care etc of your child in Japan is Japan With Kids.
  • A useful personal account of having twins in Japan can be found on this website.
  • I came across this excellent article from the Alien Times, which I've pasted in full here just in case it ever vanishes:
  • Pregnancy and Giving Birth in Japan

    Author:Anna Hamakoji, Issue: November 2001April 2007 Topic: Children
    Going through pregnancy and giving birth is difficult enough in one's own country, so going through that in a foreign country makes it all that much more difficult. The following is a brief description of what you need to do and what to expect if you are having a baby here in Japan.
    Once a doctor has confirmed your pregnancy, you must register your pregnancy at your nearest health center.
    Take your Alien Registration (AR) Card and fill out a form with your name and address, giving the name of the doctor and the name and address of the medical institution he or she is affiliated with. (You can also ask the clinic/hospital to give you a "certificate of pregnancy" to give to the health center). The center will give you a Mother-Child Book (boshi techo), in which will be recorded the course of your pregnancy and the birth, as well as your baby's growth and immunization records. Be sure to take it to each prenatal visit and, of course, to the birth. You can choose to have bilingual copies. Tsukuba City has the following: English/Japanese, Korean/Japanese, Chinese/Japanese, Tai/Japanese, Portuguese/Japanese and Tagalog/Japanese
    Included in the "boshi techo" is a packet containing local information and immunization schedules. Also included are two coupons that are for health check ups, one in early and one in late pregnancy. There is also a form that will give you a Y1300 reduction on the HIV test (required for all pregnant women).
    After registering your pregnancy, you will need to think about what kind of birth you want or need and where and how you are going to have it. In choosing the place of birth, you will need some idea of what kind of birth you want/need considering your physical condition, Japanese language ability, financial situation, etc. In Japan, fathers are not always permitted at the birth. At some facilities, fathers are allowed only into the labor room, but not the delivery room. At others he can only wait in the waiting room. Some places though, encourage fathers to participate and sometimes, if you have communication problems, they might even allow you to bring a friend who can interpret and assist you. Always ask for such information. Developing realistic expectations and making adequate preparations will help you to have a safe and satisfying experience.
    For foreigners in Tsukuba, there are several places to choose from. I will here only comment on the ones I know personally. There might be others that are good as well. If you have any information please write to the Alien Times.
    The most popular clinic is probably the Shoji Clinic in Yatabe. Dr Shoji and his wife, who is the pediatrician, have lived in the U.S. and both speak English well. Dr. Shoji and his staff are used to foreigners and they always try their best to accommodate each person's special needs. The name is Shoji Sanfujinka Clinic and is located at Yatabe 1562 (Tel: 029-836-0405). It is closed on Mondays, Thursdays, and the 1st, 3rd & 5th Sunday and national holidays. On Mondays there is a female doctor available (as of March 2007), Dr. Saito.
    Then there are two hospitals that are seeing a lot of foreign women -- Tsukuba Gakuen Hospital and Tsukuba University Hospital.
    Gakuen hospital is popular maybe because there are several female doctors to go to for checkups. Dr. Sato and Dr. Kawasaki are especially popular because they speak English. Dr. Sato sees patients on Tuesdays and Wednesdays.Dr. Kawasaki on Monday mornings and Thursdays. You cannot know, however, whether they will be available at the time of your delivery. If not, you will just have to do with the doctor who is on duty. Husbands are allowed into the delivery room if they have attended birth classes at the hospital. Tsukuba Gakuen Hospital is located at Kami Yokoba 2573-1 (Tel: 029-836-1355). For appointments call the appointment center 836-6688
    Tsukuba University Hospital is often the place to go to if you are in need of special care or if there are complications during your pregnancy. It is also the cheapest of all hospitals, although the cost difference between clinics and hospital isn't that much. The total cost depends on your situation, the time of delivery (night & weekend are more expensive than "office hours") how many days you stay after delivery, whether it is a private room or not, etc. The university hospital has several doctors that can speak various levels of English, they also have female doctors and if you ask for it they will try their best to make sure you are examined by a female doctor. You can however not request one to be at your birth, but most days there is usually a female doctor on duty. Husbands are not allowed into the delivery room. Tsukuba University Hospital is located at Amakubo 2-1-2. You need to call 029-853-3570 for an appointment (or go to the appointment counter between 8:30am and 11am.)
    Another option is a midwife clinic. There is one in Ina City (about 20 min. from Tsukuba) that accepts foreigners. It is called Baby Healthy Mirai and its address is Ina-Machi, Minami Ohta 500-1 (Tel: 0297-58-3708). It is closed on Fridays. This is a perfect place for someone wanting an "at home birth" atmosphere.
    Typically, a prenatal visit costs between Y3,500 and Y10,000 depending on the place and how many tests are performed. At some facilities, ultra sound is routine and included in the fee. Other places might do them only once or twice and charge extra. Other tests, such as amniocentesis, can raise the fee as well. The average cost of a normal delivery and a 5-7 day stay is currently Y350,000-Y450,000.
    For the pregnant foreigner, it can be advantageous to join the National Health Insurance scheme. It provides some special benefits for pregnant women. Depending on your taxable income, you may qualify for this help. For a couple with no kids, the income limit is Y4,010,000/year. For each additional dependent, add Y300,000.
    Some of the most common benefits are free medical care for pregnant women and assistance for childbirth expenses given to the woman after the birth. You need to apply for this aid at the city office.
    So what do you need to do after the baby has come? First, before the birth, you should contact your embassy and find out the procedure for obtaining a passport for the baby. After the birth, the hospital will give you a birth certificate. The left side of the document will already have been filled in by the hospital and you need to fill-in the right side and submit it to the city office. The document has to be written in Japanese and the person at the city office is forbidden to do it for you so you need to find someone who can help you write it.
    Take this document, both parent's passports and alien registration cards, the Mother-Child book and go to the Sakura branch of the City office. Your child will be registered and an alien registration card will be issued.
    If you have National Health Insurance, you also need to enter your child's name on to the insurance card, and depending on your income, you can apply for "marufuku," which is free medical care for infants.
    You can also apply for the "bunben hiyo haraimodoshi" which is the assistance for child birth expenses. Bring your bankbook with you (not just your cash card (ATM card)) and if you use a "hanko" seal, don't forget to bring that too.
    There is also child benefit called "jidouteate" for low income families. It is Y5000 per month, (Y10,000 per month from the 3rd child.) Ask at the child welfare counter.
    All of these procedures can be done in one visit to the city office if you bring all the necessary documents. The city office, however, will not give you any official copies of the birth certificate on the same day that you apply for it. For some reason you have to wait at least one day. An official copy of the birth certificate costs Y400. Remember to ask your embassy how many they require.
    The hospital may also, at your request, write a document in English stating that "Ms xxx had a baby girl on month/day". This document has no legal meaning in Japan and the father's name is not included, so make sure you get official copies of the Japanese version since that is the only legal document concerning your child's birth.
    You have to apply for a visa (residence permission) within 30 days of the birth. To avoid any penalties, you have to apply within 30 days whether you have got the child's passport or not. If you have applied for a passport but haven't got it yet, bring the document showing that you have applied with you to the immigration office. You also need to bring your child's Japanese birth certificate and alien registration card for child, mother, and father. And a "certificate of alien registration" where all family members are included is recommended. After you have been to Mito you need to go back to the Sakura branch again and they will write the new information on your child's alien registration card.
    After all of this, you are finished with the "paper work" and can concentrate on the parenting, but that is another story. Good Luck!!


  1. If you have a full-time job and Shakai-Hoken which you should then giving birth in Japan should be fairly straightforward. Depending on your Shakai-Hoken you may have to pay either upfront or not at all..If you do pay upfront you will get it all back anyways, it`s just a bit of a burdon to have between 400'000円-550'000円 Japanese yen before the birth happens. There is also some paperwork but if you work for a reputable company they will help you out with filling out forms. This is because japanese forms are considerably detailed and require small kanji writing ability to complete the forms correctly. It`s easy to muck them up.

    Also new mothers should expect to stay in a hospital for 5 to 7 days. The aftercare is quite good in Japan. In addition if your japanese is good enough it should be even better.

  2. Thanks Benjamin, that's good information.