Japan to eliminate out-of-pocket childbirth costs in bid to tackle falling birthrate

Japan’s Health Ministry is preparing to make childbirth essentially free for families by bringing normal deliveries under the public medical insurance system, in what officials describe as a major reform to address the country’s demographic crisis.

The policy, endorsed by a panel of experts on 14 May, is expected to come into force as early as April next year. It would standardise fees nationwide and ensure that parents no longer face direct out-of-pocket payments for a normal birth.

At present, childbirth is not insured in Japan because it is not regarded as a medical treatment in the same category as illnesses or injuries. Caesarean sections, which involve surgery, are the main exception.

What the reform covers

Under the proposed changes, the cost of normal deliveries will be covered in full through public insurance. However, epidurals — which are used to manage labour pain — will remain outside the scheme, meaning families would still have to pay for those services if requested.

Currently, hospitals and clinics can set their own charges for childbirth, leading to significant regional price differences. The average cost for a normal delivery in the first half of fiscal 2024 stood at around 518,000 yen (S$4,600), according to the Health Ministry.

The government already provides a lump-sum childbirth benefit of 500,000 yen (S$4,400) per baby, but rising delivery fees often mean families still face additional expenses.

If the reform is implemented, medical institutions will be required to apply a standardised nationwide fee, designed to reduce disparities and remove financial unpredictability.

Concerns from obstetricians

While the reform has been broadly welcomed by policymakers and the public, some obstetricians have raised concerns that it could create financial pressure for medical facilities.

If hospitals are required to adopt lower, standardised fees under the insurance framework, critics argue that their revenue could fall, potentially affecting service quality or investment in maternity care.

Healthcare experts suggest that further measures may be needed to ensure medical institutions remain adequately supported as the system transitions.

A response to record-low fertility

The urgency behind the policy shift stems from Japan’s rapidly shrinking population and persistently low birthrate.

Preliminary government data shows that only 720,988 babies were born in 2024, the lowest number since records began. This represents a 5 per cent decline from 2023.

The total fertility rate (TFR) — the average number of children a woman is expected to have in her lifetime — fell to 1.20 in 2023, down from 1.26 the year before. This marks the eighth consecutive annual decline and the lowest figure ever recorded in Japan.

Demographers warn that without significant policy interventions, Japan’s population will continue to contract at an accelerating pace, with wide-ranging implications for the economy, labour force, and social support systems.

Regional comparison: Singapore’s experience

The challenges Japan faces are not unique. Singapore, another country grappling with low fertility, also recorded a TFR below replacement level.

According to the Ministry of Health, Singapore’s TFR stood at 0.97 in both 2023 and 2024, marking the second consecutive year it has remained below 1.

Despite this, resident births rose slightly from 30,500 in 2023 to 30,800 in 2024.

Childbirth costs in Singapore vary widely depending on hospital type and ward class. At public hospitals, a complicated vaginal delivery can cost as little as S$1,491 in a Ward C setting, compared to S$6,795 in a Ward A ward.

Private hospitals are significantly more expensive, with average bills for vaginal deliveries reaching S$11,129 and some exceeding S$13,000.

Caesarean sections carry higher costs due to surgical and recovery requirements. In public hospitals, a Ward A procedure starts at about S$8,700, while private hospitals charge from S$12,000 for a two-bedded room.

These figures illustrate the scale of financial burden that families may face in the absence of comprehensive insurance coverage for childbirth — a gap Japan now seeks to address.

Wider policy implications

Japan’s move to eliminate out-of-pocket childbirth costs is seen as one of several strategies to reduce barriers to parenthood.

In recent years, the government has also expanded childcare subsidies, promoted flexible working arrangements, and introduced housing incentives for young families.

However, experts caution that financial support alone may not reverse the downward trend in fertility. Broader social and cultural shifts, such as work-life balance, gender equality in caregiving, and economic stability, play crucial roles in family planning decisions.

Nonetheless, eliminating direct delivery costs is expected to send a strong signal of support for parents and prospective parents.

Next steps

The Health Ministry is expected to finalise the reform details over the coming months. If approved, the new framework would begin in April 2026, aligning with the start of Japan’s fiscal year.

Further consultations with medical institutions and local governments are expected, particularly to address concerns over implementation costs and hospital revenue models.