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Four years have passed since the city of Kumamoto asked the central government to consider passing a law allowing for confidential births — which allow women to give birth without publicly revealing their identity — but so far there have been few discussions on the issue.

A recent decision by a woman under 20 — who had initially planned to give away her baby after a confidential birth in November but then changed her mind — has shone a spotlight on the question of how to support women with unintended pregnancies and their newborns.

Legality of confidential births

“There needs to be a legal framework in place so that hospitals and local authorities can work without (legal) worries” to help such women and their babies, Takeshi Hasuda, the head of Jikei Hospial in Kumamoto, said at a news conference on Nov. 10 when he announced that the woman had given birth.

In 2007, the hospital installed a baby hatch dubbed the “storks’ cradle,” which allowed women who were unable or unwilling to raise their newborns to entrust them to the hospital anonymously. The hospital started the system in order to cope with increasing cases of mothers abandoning their newborn babies, having first sought reassurance from the central government that such a facility would not be illegal.

By the end of March 2021, a total of 159 babies had been left in the baby hatch — with as many as 60% of them believed to have been born at home without the help of medical professionals, apparently because their mothers were facing difficult life situations including poverty and isolation.

Hoping to help such women give birth in a safe environment, the Kumamoto Municipal Government asked the central government in July 2017 to consider legalizing confidential births. Around the same time, Jikei Hospital announced that it would consider offering such births.

The stances of the hospital and the municipal government differ slightly. For example, the municipal government believes a new law should be established while the hospital wants the central government to allow confidential births by re-interpreting and applying existing legislation in order to expedite the process. But both parties agree that the greater issue cannot be handled by a private hospital and one municipality.

That sentiment is shared by some at the health ministry, although challenges remain.

“We are researching the issue, but it would be difficult for one ministry to make a judgment on whether to introduce the system or not,” one ministry official said.

Information management risks

The confidential birth system under consideration by Jikei Hospital would allow women to bring their child into the world safely at the facility. The women could register under a pseudonym and would only reveal their identity to certain hospital staff.

The hospital’s newborn counseling room would keep the information and the children would be allowed to find out their mother’s true identity once they reach a certain age. But such a system raises the question of how to manage such personal information at the hospital.

Since the facility is also considering allowing anonymous births, in which a mother refuses to disclose her identity even to her child, there will also be the issue of how to guarantee a child’s right to know their biological origins.

The hospital currently follows a system adopted in Germany, where baby hatches first went into operation around 20 years ago. Germany also allowed anonymous births before a wave of criticism emerged, with critics saying the policy strips the right of children to learn information on where they came from. Afterward, the German government established a law that allows confidential births but not anonymous births.

According to the legislation, pregnant women who wish to remain anonymous must reveal their identity, but only to their pregnancy counselor. The information is kept by authorities and when their child turns 16, they are given access to their birth mother’s personal details.

A total of 827 confidential births were reported in Germany between May 2014, when the system started, and February of this year.

Tobias Bauer, an associate professor at Kumamoto University specializing in bioethics who is well-versed in Germany’s situation, said that authorities need to be involved in information management, as private hospitals run the risk of going out of business.

“It’s necessary to protect both the lives of mothers and babies and the children’s right to know their origins,” Bauer said.

There is also the problem of the koseki, Japan’s family registry, and how to register babies whose mothers’ identities have not been disclosed.

According to the Kumamoto Municipal Government, babies who are placed in Jikei Hospital’s baby hatch are treated as abandoned children, so their family register is created at the time of birth using names given to them by the mayor.

If a hospital adopts a confidential birth system and fills in birth registrations for babies but leaves the parents’ section blank — despite knowing the parents’ identity — the hospital could be charged with the crime of submitting false information on official documents. If local authorities do not accept such documentation, then these babies could end up without a family registry, which would cause countless problems — from voting and banking to medical care and education.

Aya Umezawa, an associate professor at Kumamoto University specializing in the civil code and family law, is urging the government to consider creating a new law. Umezawa says it would be difficult to clear the hurdle of family registry issues while operating under existing laws.

Jikei Hospital is the only hospital in Japan that accepts newborns from anonymous mothers. Nearly 70% of such mothers come from outside Kumamoto Prefecture, meaning the hospital is functioning as a shelter for suffering women nationwide.

The hospital has received numerous requests from women who wish to give birth secretly or anonymously, indicating the need for the government to take steps to reach a conclusion on the issue.

This section features topics and issues from the Kyushu region covered by the Nishinippon Shimbun, the largest daily newspaper in Kyushu. The original article was published Nov. 21.

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