Pregnancy and Childbirth in Japan: Registration, the Mother and Child Handbook, Costs and the ¥500,000 Allowance

Confirming the pregnancy

Pregnancy care in Japan starts at an obstetrics and gynecology clinic (sanfujinka), not with a family doctor. If a home test is positive, book a visit at around five to six weeks of pregnancy (counted from the first day of your last period). The doctor confirms the pregnancy with an ultrasound and estimates the due date. You usually pay for these early visits in full, because a normal pregnancy is not treated as an illness under health insurance. Ask for a note of your estimated due date; you will need it at city hall.

Registering your pregnancy and the Mother and Child Health Handbook

Once the pregnancy is confirmed, submit a pregnancy notification (ninshin todoke) at your ward or city office or its public health center as early as possible. You will receive the Mother and Child Health Handbook (Boshi Kenko Techo), the booklet that records every checkup, the birth, and your child's growth and vaccinations through early childhood. It comes with checkup coupons and information on parenting classes. Bring your residence card. ^[3]

The Children and Families Agency publishes the handbook in ten languages: English, Simplified Chinese, Korean, Vietnamese, Portuguese, Nepali, Tagalog, Indonesian, Spanish and Thai. Many municipalities hand out bilingual copies on request, so ask when you register. ^[2]

Prenatal checkups and coupons

Checkups (ninpu kenshin) follow a standard national schedule: about every four weeks until week 23, every two weeks from week 24 to 35, and weekly from week 36. Municipalities subsidize 14 checkups through the coupons in your handbook. In Tokyo, for example, all 14 are covered at a common rate, while the number of subsidized ultrasounds and other extra tests varies by ward. ^[3] Because the subsidy amounts differ from place to place, expect a modest out-of-pocket payment at some visits. Coupons are issued by your municipality and can generally be used only at contracted clinics, usually within the same prefecture. If you move to another municipality, even within the same prefecture, contact the health division at your new city hall right away: coupons from your old address usually have to be exchanged for new ones, and checkups you pay for before the exchange may not be reimbursed. ^[3]

Since April 2026, the RSV vaccine for pregnant women has been part of Japan's routine immunization program. It is given once, between 28 weeks 0 days and 36 weeks 6 days of pregnancy, and protects the baby against severe RSV infection in the first months of life. How you receive it, and whether you pay anything, depends on your municipality, so ask your maternity clinic or the health division at your city hall before you reach week 28. ^[8]

Where should you give birth?

Decide on a birth facility early, often by around week 20, because popular places fill up. There are three broad types:

• Hospitals (byoin): general or university hospitals with pediatric and emergency care on site; the usual choice for higher-risk pregnancies and the most likely to offer an epidural.
• Maternity clinics (sanka clinic): smaller private facilities run by obstetricians, often with more comfortable rooms and meals, where many uncomplicated births in Japan take place.
• Birth centers (josanin): run by midwives for low-risk natural births without medical pain relief, with a partner hospital for transfer if complications arise.

The Ministry of Health, Labour and Welfare runs a nationwide facility search site, Shussan Navi, where facilities publish their prices, services and whether pain relief is available. ^[1] To find a clinic or hospital where staff speak your language, use our finder at /find and filter by language.

How much does giving birth cost? The ¥500,000 allowance

As of September 2026, a normal delivery is not covered by health insurance, because childbirth is not an illness, so you are billed the facility's own price. Instead, everyone enrolled in Japanese health insurance, including foreign residents on employee insurance or National Health Insurance and their dependents, receives the Childbirth and Childcare Lump-Sum Allowance (shussan ikuji ichijikin) of ¥500,000 per child for births from April 2023 onward. ^[1]

In most cases you never handle the money. Under the direct payment system (chokusetsu shiharai seido) you sign a form at the facility, the insurer pays the ¥500,000 to the facility, and you pay only the difference at discharge. If the bill is lower than the allowance, you can claim the remainder from your insurer. ^[1]

This system is set to change. A revision of the Health Insurance Act promulgated on June 5, 2026 will replace the lump-sum allowance with a benefit that insurers pay directly to the birth facility, so that the standard cost of a normal delivery involves no out-of-pocket payment, together with a flat-rate cash payment to every mother. It will take effect within two years of promulgation, on a date still to be set by Cabinet Order; the amounts have not been set, and facilities may choose to stay under the current allowance for the time being. Until then, the rules above apply. ^[7]

The gap is real but usually modest. According to Ministry figures, the national average cost of a normal delivery was about ¥520,000 in fiscal 2024, roughly ¥20,000 above the allowance. But the range is wide: from around ¥400,000 in Kumamoto to about ¥650,000 in Tokyo, before optional extras such as a private room. ^[4] Budget for more in central Tokyo and at private clinics with hotel-style service. Some municipalities add their own top-up subsidy, so check your ward's website. If a cesarean section or other medical treatment becomes necessary, that part is covered by health insurance in the usual way.

Can you get pain relief? Length of stay and language support

Epidurals (mutsu bunben) are far less common than in many Western countries. They are offered mainly at larger hospitals and some clinics, often only during weekday daytime hours, and typically for an extra charge on top of the standard package. If pain relief matters to you, confirm availability, hours and price when you choose the facility; Shussan Navi shows which facilities offer it. ^[1]

Plan for a longer hospital stay than in many countries: around five days after a vaginal birth and roughly a week after a cesarean. During your stay, midwives teach you how to feed and bathe your baby before you go home.

Language support varies. University hospitals and large city hospitals often have English-speaking obstetricians or interpreter services, while many clinics rely on translation apps. Bringing a Japanese-speaking partner or friend to the first visits and to the birth-plan discussion helps, as does learning the key words in the glossary below.

Maternity leave and benefits

Employees are entitled to maternity leave (sankyu) from six weeks before the due date until eight weeks after the birth, followed by childcare leave (ikukyu), which either parent may take, in principle until the child turns one. If you are covered by employee health insurance such as Kyokai Kenpo and your employer does not pay you during maternity leave, you can claim the Childbirth Allowance (shussan teate-kin): two-thirds of your standard daily wage for up to 42 days before and 56 days after the birth. ^[5] Childcare leave benefits are paid separately through employment insurance: 67% of your wage for the first 180 days of leave and 50% after that. Since April 2025, if both parents each take at least 14 days of childcare leave in the period right after the birth, an additional benefit (出生後休業支援給付金, 13% of the wage) is paid for up to 28 days. That brings the rate to 80%, and because social insurance premiums are waived during the leave and the benefits are not taxed, it is roughly equal to full take-home pay. If your spouse is not employed, or you are a single parent, your own leave is enough to qualify. ^[9] Residents on National Health Insurance, including many self-employed people and students, receive the lump-sum allowance but not the Childbirth Allowance.

After the birth: paperwork deadlines

Two deadlines matter most for foreign parents. The birth registration (shussho todoke) must be filed at the city office within 14 days of the birth, counting the day of birth. The hospital fills out the birth certificate half of the form. If neither parent is a Japanese national, you must then apply for your baby's status of residence at the regional immigration bureau within 30 days of the birth. ^[6] Register the birth with your own country's embassy as well, and add the baby to your health insurance so that medical visits are covered.

Newborn checkups, vaccinations and postpartum care

Once registered, your baby joins Japan's public infant health program. Municipalities provide free health checkups at set ages, typically around three to four months, 18 months and three years, and in many areas at one month and at nine to eleven months. Routine childhood vaccinations such as hepatitis B, rotavirus, pneumococcal, the five-in-one DPT-IPV-Hib vaccine, BCG, measles-rubella, chickenpox and Japanese encephalitis are given free within their scheduled age ranges. ^[6] The coupons come with the handbook or by mail. A public health nurse or midwife usually visits newborns at home in the first months.

If you have little support nearby, ask your ward about postpartum care (sango kea): subsidized overnight stays, day visits or home visits by midwives that cover rest, breastfeeding help and baby care. Many wards also offer home-helper services and multilingual parenting consultations.

Glossary

• 産婦人科 (sanfujinka): obstetrics and gynecology
• 妊娠届 (ninshin todoke): pregnancy notification
• 母子健康手帳 (boshi kenko techo): Mother and Child Health Handbook
• 妊婦健診 (ninpu kenshin): prenatal checkup
• 助産院 (josanin): midwife-run birth center
• 出産育児一時金 (shussan ikuji ichijikin): childbirth lump-sum allowance
• 直接支払制度 (chokusetsu shiharai seido): direct payment system
• 無痛分娩 (mutsu bunben): epidural delivery
• 出生届 (shussho todoke): birth registration
• 産後ケア (sango kea): postpartum care