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May 24/31, 2000

Where Should Women Deliver Babies in Japan?

Author Affiliations

Author Affiliations: Departments of Health Policy and Management (Dr Ikegami) and Obstetrics and Gynecology (Dr Yoshimura), Keio University School of Medicine, Tokyo, Japan.

JAMA. 2000;283(20):2712-2714. doi:10.1001/jama.283.20.2712

Maternal mortality is rare in Japan, with only 7.1 maternal deaths per 100,000 live births in 1998.1 However, this rate is relatively high when compared with the infant mortality rate (3.6 per 1000), which is the lowest in the world.1 In their article in this issue of THE JOURNAL, Nagaya et al2 exhaustively examine the causes of these maternal deaths and conclude that more than a third could have been prevented if the women had been treated in a hospital with better staffing of obstetric and anesthesia services and better laboratory facilities. Based on their findings, they recommend that all deliveries should occur at designated regional medical facilities and be attended by more than 1 physician. Many maternal deaths result from emergency conditions that are difficult to predict. Consequently, to decrease maternal deaths, it may be necessary to do what the authors have advocated. The Japanese government took tentative steps in this direction in 1995 by establishing grants to regional medical centers for expanding their maternal and child care units.3

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