The Ministry of Health, Labor and Welfare has proposed a system under which delivery costs would be standardized nationwide and made free of charge, eliminating out-of-pocket payments. The aim is to correct the large regional disparities in childbirth costs and to reduce the financial burden on families raising children.

At present, the average cost of a normal delivery is approximately ¥648,000 in Tokyo, while in Kumamoto Prefecture it is about ¥404,000, resulting in a regional gap exceeding ¥200,000. Since the lump-sum childbirth and childcare allowance is generally fixed at ¥500,000, these cost differences have affected pregnant women’s out-of-pocket expenses and their choice of delivery location.

Under the proposed system, delivery costs would be covered by public health insurance and made free of charge. This is expected to improve cost transparency and eliminate regional inequities. However, amid a declining number of deliveries and a shrinking number of obstetric care providers, there are concerns that inappropriate fee setting could worsen the financial conditions of medical institutions and even lead to their withdrawal from obstetric services. In particular, how to incorporate appropriate consideration for facilities that accept high-risk pregnancies and those that support regional healthcare systems will be a critical issue in system design.

NPMI believes that while free childbirth is a positive step as a measure against the declining birthrate, it also represents an opportunity to reassess the structure and division of roles within obstetric care. Going forward, there will be a need for the consolidation of obstetric functions, the advancement of perinatal care systems, and the development of seamless support mechanisms from pregnancy through the postpartum period. Designing a system that balances policy objectives with the sustainability of frontline healthcare providers will shape the future of Japan’s childbirth environment.

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【Glossary: Perinatal Care】

Perinatal care refers to an integrated medical system that supports pregnant women from management after 22 weeks of gestation through delivery and the neonatal period. It targets a phase in which both mothers and fetuses/newborns are at higher risk, with the aim of ensuring safe childbirth and protecting the life and health of newborns.

In Japan, role sharing and medical collaboration centered on Comprehensive Perinatal Maternal and Child Medical Centers and Regional Perinatal Maternal and Child Medical Centers have been promoted to address high-risk pregnancies and deliveries. However, shortages of obstetricians and midwives, as well as declining numbers of deliveries, have made it difficult to maintain perinatal care systems in some regions.

In discussions on making childbirth free of charge, it is important not only to reduce delivery costs but also to determine how perinatal care systems can be maintained and strengthened in a sustainable manner. In particular, the structure of regional collaboration—including medical institutions that accept high-risk pregnancies and emergency transport systems—has become a major point of debate in system design.

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