Strictly speaking, stillbirths should be separated from neonatal deaths, while early neonatal deaths are frequently registered as stillbirths, such that stillbirths and early neonatal death within 1 week after birth are included in a single category of perinatal deaths, where the perinatal mortality rate is the number of perinatal deaths after 22 weeks of pregnancy per 1000 total births. Statistics regarding maternal mortality in Japan have been officially

reported since 1899, when pregnant and parturient CHIR-99021 ic50 women in Japan were supported by licensed midwives. At that time, as noted above, the maternal mortality rate was 409.8/100 000 births, with most births occurring in the home. By 2010, some 110 years later, maternal mortality in Japan had decreased to 4.1/100 000 births (reduction rate = 409.8 / 4.1 = 99.95, ∼100) (Fig. 1).[1] The reduction rate of maternal mortality in see more the recent 60 years is 161.2 in 1950 divided

by 4.1 in 2010 equaling 39.3, which is significantly greater than the gradual decline in maternal mortality in the first 50 years between 1899 and 1950, which was 409.8/161.2 with a reduction rate of 2.54.[1] The marked decrease in maternal mortality since 1950 can be attributed to the significant decline in home births and an increase in the number of births in obstetric hospitals or clinics. For example, the non-hospital births rates in 1950, 1960, 1970 and 1980 were 95.4%, 49.9%, 3.9% and 0.5%, respectively. A corresponding increase in the number of hospital births was observed over the same period of time, with rates of hospital births reported to be 4.6%, 50.1%, 96.1%, 99.5% and 99.5%–99.9% in 1950, Urease 1960, 1970, 1980 and 1990–2008, respectively. Consequently, maternal mortality decreased from 161.2 per 100 000 births in 1950, to 117.5, 48.7, 19.5, 8.2,

5.8 and 4.1 in 1960, 1970, 1980, 1990, 2000 and 2010, respectively.[1] In the 60 years from 1950 to 2010, the reduction rate in maternal mortality was 39.3 (161.2/4.1), with a significantly greater reduction in mortality for women giving birth in hospitals (hospitalization rate, >50%) than in those who did not give birth in hospitals (hospitalization rate, <50%) (Table 1). It is likely that improved medical knowledge and appropriate disease management, including obstetric problems, contributed to the effective reduction in maternal deaths for women giving birth in hospitals in Japan. The societal factor that most likely contributed to the improvements in maternal mortality during this time in Japan was the considerable migration after 1950 of young people from rural to urban areas. This was a time of significant industrial development in Japan, with evident external societal changes.