The current status of and measures against maternal suicide in Japan

Rapid progress in perinatal care in recent decades has led to a dramatic decline in perinatal, neonatal, and maternal mortality (excluding suicides), and achieved remarkable improvements in obstetrical outcomes in Japan. However, while maternal mortality had been on a continuous and steady decline up until 2007 (3.1/100,000 total births), the rate has been fluctuating since then (e.g., 2.7/100,000 in 2014, 3.4/100,000 in 2016). This is likely attributed to a variety of factors that have emerged in the past 20 years due to changes in the environment and social situation surrounding women, such as later marriage and rise in maternal age. In Western countries, “late maternal deaths” occurring between 42 days and one year after delivery are considered to be just as important as “maternal deaths,” i.e., deaths during pregnancy or within 42 days of termination of pregnancy. In particular, suicides attributable to psychiatric disorders have become a serious issue among women less than one year postpartum. However, in Japan, the actual number of deaths by suicide is unknown, since neither death certificates nor postmortem certificates include information on pregnancy and delivery. Despite the fact that the total number of suicide deaths in Japan is known, whether such deaths are associated with perinatal mental issues or not is unclear, and thus, no measures have been taken. Untreated perinatal depression and psychiatric disorders not only cause issues such as suicide, but are also related to pediatric developmental and mental disorders, neglect, and/or child abuse due to impaired nurturing ability. Suicide rates among pregnant and parturient women in Osaka, Tokyo, and Mie are much higher than those of the UK, the US, and Sweden. There is an urgent need to establish a regional support system that facilitates interactions among the obstetrical, pediatric, psychiatric field, and local administrations for monitoring and supporting mothers and infants, as well as a system that allows families, schools, and society to support young people, in order to realize improved preconception health care.