Article ID: JJAM-2020-0035
To investigate the governance of the Japanese Midwives Association and the challenges it faced based on reviews of agendas proposed at its annual meetings.
Literature review of the Bulletin of Annual Meetings of the Japanese Midwives Association (between 1929 and 1943) and other midwifery journals.
A nation-wide organization of midwives in Japan was founded in 1927 with a view to consolidate the scope of their work and to raise their status. An annual meeting of the Japanese Midwives Association was held in a different prefecture each year hosted by the head of that prefectural association who took over the Association's presidency for one year until the next meeting. In more than half of the prefectures a male medical doctor was the head of the prefectural Midwives Association. A review of bulletins of annual meetings of the Japanese Midwives Association revealed three major points. One is that midwives in the prewar period were eager to establish midwifery by demarcating boundaries between midwives and medical doctors on the one hand and those between midwives and lay birth attendants on the other. This fact is evident in the meeting agendas: requests to revise articles of the Midwife Regulations to allow midwives to give injections in emergency cases; requests for medical doctors not to assist in normal deliveries; and requests banning lay attendants at births. Secondly, emergent public welfare services in the early Showa Period began to have a major impact on midwives' living standards. The increase in institutional deliveries without charge or with limited charge for the urban poor coupled with the introduction of health insurance, negatively influenced the lives of midwives who had been practicing independently. Thirdly, the war with China and the beginning of World War II changed the agendas of the annual meetings of the Japanese Midwives Association. After 1938 requests for preferential allocations of cotton cloth used in deliveries increased due to the shortage and rationing of materials. The government's introduction of community nurses as a new profession to reduce infant mortality gave rise to a renewed question of how to differentiate the scope of midwives work from that of community nurses. Nevertheless, midwives gave unanimous support to the government's involvement in the war and believed they could contribute to the country's war efforts by delivering healthy babies.
Agendas proposed at the annual meetings of the Japanese Midwives Association illustrate that the government was reluctant to approve midwives of a legal status they endeavored to achieve, considering the sensitive relationships involving midwives, medical doctors, and nursing professions. Although the Japanese Midwives Association tried to pass a law which aimed to elevate their status by establishing the scope of midwifery work, the attempt was blocked by the beginning of World War II. A study on challenges facing the Japanese Midwives Association in prewar period gives us a new insight into present day midwives' position in the society.