Disparity of Public Postpartum Care Services in Japan: A Nationwide Survey of Providers
Background: Recent changes in Japanese society, such as a declining birth rate and aging population and the trend towards smaller families have had a serious impact on families with babies and children. It was reported in 2006 that the incidence rate of the onset of major depressive episodes during pregnancy and within 3 months of delivery were 5.6% and 5.0% respectively in Japan. Health centers have played a central role in caring for mothers and babies during the postpartum period since the 1960s. This study aimed to identify current public postpartum care services and the associations between them and local demographic factors. Methods: We conducted a cross-sectional study with multiple regression analysis. Primary data were collected using a semistructured original questionnaire sent by mail to 1,742 health centers in December 2012. Data on demographic factors were acquired from a national open data source. Results: The response rate was 45.1% and the valid response rate was 41.6% (725/1,742). Of the 725 respondents, 60 were Public Health Centers and 665 were Municipal Health Centers. In the multivariate analysis, Public Health Centers had statistically significant higher ORs of carrying out the newborn visit, Hello Baby program or both, a home visit from an expert following referral, and providing help with housework (OR=2.66, 95% CI 1.35–5.24, p=0.005; OR=7.52, 95% CI 2.56–22.10, p<0.001; OR=4.30, 95% CI 2.01–9.17, p<0.001). Conclusions: Home visiting services were the main publiclyfunded postpartum care that was provided, while public facilitybased services, suitable for young couples in economic hardship without any family support, were very limited in Japan. From a multivariate analysis, municipalities with a small population and low Financial Capability Index had more difficulty providing services. A comprehensive approach, including financial support by government, would therefore be required to reduce the disparity in public postpartum care services.