The premises are as spick-and-span as any health centre. But unusually for somewhere full of newborn
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Kaori Ichikawa, who heads the Association for Antenatal and Postnatal Care Promotion in Tokyo, says that Japan is slowly realizing that it needs to do more to support women after they give birth. A few years ago the government improved the postnatal care it offers. That was prompted by a fall in the number of births and a rise in reported cases of child abuse. Now, she says，the focus is on the women themselves. Alarm grew this year，when it was revealed that suicide was the leading cause of death among pregnant women and new mothers in 2015 and 2016.
Japan is not alone in waking up to the inadequacy of care in early motherhood -- “thefourth trimester”，as it is sometimes called. Women are suffering, but feel that they have to act as if everything is fine, says Sarah Verbiest，a public-health expert in North Carolina who runs a research project on the fourth trimester. The system in America, as elsewhere, she says, tends to focus on the health and well-being of the baby, rather than that of the mother. The needs are glaring. Some 10%15% of women in America and around a quarter in Brazil are reckoned to suffer from postpartum depression. The physical toll of giving birth is less well studied, but some 90% of women may tear their pelvic-floor muscle during birth, and 6% of them suffer a serious injury, according to Britain's Royal College of Obstetricians and Gynaecologists.
The growing focus on postpartum care is in part a consequence of good news: childbirthitself is safer than it has ever been. From 1990 to 2015 the number of maternal deaths around the world fell by almost half, to 216 per 100,000 women, thanks in large part to women delivering their babies in proper medical facilities. Nearly all of these deaths (99%) are in developing countries. However，this article focuses on the rich world，where, with the notable exception of America, maternal mortality has fallen.
A second reason for the new attention being paid to care for new mothers is that women,including famous ones, have been speaking out about their unhappy experiences. Serena Williams, a tennis player, has written of the “funk” of postnatal depression. Keira Knightley, an actor, wrote about her experience of childbirth:<6Hide. Hide our pain, our bodies splitting, our breasts leaking, our hormones raging.” Ali Wong, a comedian，delighted and shocked Netflix fans by yelling about women’s “demolished-ass bodies” and her horror at finding out that new mums who advised her to steal nappies from hospital meant not for the baby but for herself.
The importance of the postnatal adjustment has been implicitly recognized in traditionalrest periods such as China’s zuoyuezi (“sitting the month”) when new mothers follow timeworn practices such as refraining from washing their hair or consuming cold drinks, or la cuarentena, a 40-day rest，observed in Mexico and other Hispanic countries.
Yet this is poorly reflected in modem health systems, which tend to offer plenty of check-ups during pregnancy, but very few after it. It is usual for women in countries including America and Britain to receive just one visit from a health worker when their babies are six weeks old. American federal law does not even oblige employers to give women paid time off work.
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