In a major overhaul of maternal -health policy, Japan’s government has proposed that childbirth costs be fully covered under public health insurance, eliminating out-of-pocket expenses for expectant mothers.
Current system: allowance insufficient for rising costs
Until now, normal childbirth in Japan was not covered by national health insurance. Instead, the government provided a lump-sum “childbirth allowance” (birth grant) to help families. That allowance began in 1994 at ¥300,000, and was raised over time most recently to ¥500,000 in 2023.
But maternity-hospital costs have risen steadily. In fiscal 2024, the average cost of childbirth nationwide reached ¥519,805 already surpassing the lump-sum grant.
In major cities such as Tokyo, actual childbirth costs can be even higher (around ¥650,000), while in less expensive regions such as Kumamoto Prefecture they may be lower (around ¥400,000), reflecting large regional disparities.
Hence, many parents still bear significant out-of-pocket expenses, a disincentive at a time when the country is grappling with declining birth rates and an aging population.
What the new plan proposes
Under the planned reform, childbirth (normal delivery) would be treated like other medical procedures covered under the public health insurance scheme. The government would set a uniform nationwide fee per delivery and medical institutions would be reimbursed directly under this scheme.
At the same time, the existing lump-sum childbirth allowance would be abolished, since the costs would now be covered directly.
The coverage would, however, have boundaries:
- Standard medical costs for a normal delivery would be covered.
- Services typically considered “extras” such as postpartum special meals, celebratory meals, cosmetic or esthetic treatments offered by hospitals, or other optional add-ons would not be covered under insurance. Patients wanting such extras would need to pay out of pocket.
- For deliveries already covered under current insurance e.g. caesarean sections coverage will remain unchanged (cost-share at 30 percent, as before).
Because some medical institutions may need time to prepare for the transition, the plan may roll out in phases starting first at hospitals or clinics that have the required staff and equipment to provide safe maternal care.
Why now: tackling cost burden and demographic decline
The decision to switch from a lump-sum grant to full insurance coverage is motivated by multiple factors:
- The rising cost of childbirth has increased the financial burden on parents. As noted, in many cases the lump-sum grant falls short.
- The discrepancy in costs across regions has produced inequality: families in expensive urban centers pay far more than those in rural or less expensive prefectures.
- Most importantly, the government aims to address Japan’s ongoing population decline. The nation recorded its lowest number of births on record in recent years declining birth rates pose serious challenges for social security funding and long-term economic stability.
An expert panel had earlier recommended designing a system to make standard childbirth expenses free of charge by around fiscal 2026.
By reducing financial barriers to childbirth, the government hopes more couples will feel encouraged to have children.
Implementation timeline and next steps
The health ministry plans to present the proposal to the medical insurance subcommittee of the Social Security Council the body that advises the health minister.
If approved, the government aims to submit legislation in the next ordinary parliamentary session. The earliest full coverage could begin is fiscal 2027 or later.
In the interim, the government and health authorities are expected to work out the details such as setting the uniform delivery fee, defining “standard childbirth costs,” and establishing which services remain self-paid.
Reactions and concerns
The reform has been welcomed by many who see it as a long-overdue step to reduce inequality, relieve financial stress on growing families, and support population growth.
However, some experts and healthcare providers caution that a uniform fee might not account for the full range of childbirth-related medical needs especially in urban hospitals where operating costs are higher. There are concerns that medical institutions, especially smaller clinics, may find it financially difficult to continue offering delivery services under a capped insurance reimbursement, which could affect availability of care in some regions.
Moreover, optional but often expected postpartum services like private rooms, extra meals, or “luxury” treatments will remain uncovered, meaning some families might still need to pay extra if they opt for comfort or convenience beyond the basic delivery.
Overall, the proposed switch to full public health-insurance coverage for childbirth is perhaps the biggest change to Japan’s childbirth support system in decades. If implemented, it promises to significantly ease the financial burden on new parents especially those for whom the current lump-sum grant is insufficient and may serve as an important step in the government’s broader strategy to address its demographic and population-decline challenges.
Originally written by: Japan Times
Links: https://www.japantimes.co.jp/news/2025/12/04/japan/society/childbirth-costs-full-coverage/
