Challenges in providing maternity care in remote areas and islands for primary care physicians in Japan: a qualitative study

Abstract

BackgroundMaintaining a maternity care system is one of the biggest issues in Japan due to the decreasing number of obstetricians, especially in remote areas and islands. The aim of this qualitative study was to explore the challenges in women’s health and maternity care in remote areas and islands for primary care physicians and obstetricians in order to provide an insight necessary to develop a better health care system.MethodsWe conducted semi-structured interviews with 13 primary care physicians and 4 obstetricians practicing maternity care at clinics/hospitals in remote areas and islands across Japan. Interview data were analyzed, using the modified Grounded Theory Approach, to elucidate the challenges primary care physicians faced in their practice.ResultsPrimary care physicians who engaged in maternity care recognized the following challenges: low awareness of primary care, lack of training opportunities, unclear goal of the training, lack of certification system, lack of consultation system, and lack of obstetricians to offer support. These six challenges along with the specialty’s factors such as sudden changes of patients’ condition were considered to result to the provider’s hesitation and anxiety to engage in the practice.ConclusionsThis study found six environmental/systemic factors and three specialty’s factors as the main challenges for primary care physicians in providing maternity care in remote areas and islands for primary care physicians in Japan. Increasing the awareness of primary care and developing a maternity care training program to certify primary care physicians may enable more primary care physicians to engage in and provide women’s health and maternity care in remote areas and islands.

Family Medicine Implementation to Maternal and Child Health in Rural Japan: A Narrative Review

“…Rural family physicians in Japan need more training opportunities for MCH to compensate for the scarcity of consultations by obstetricians. Developing maternity care training programs for family physicians can enable them to engage in MCH in rural areas [19].…”

“…Enhanced primary care education about MCH can empower women with the knowledge and skills to better manage their health and pregnancies, leading to healthier outcomes for both mother and child. For the practical education of women, rural medical professionals should be motivated more about MCH to sustain rural communities and improve the younger generation's motivation for having children [19].…”

“…Strengthening MCH in rural areas contributes to the health system's overall resilience, enabling it to better respond to various challenges, including demographic changes and epidemics. The number of family physicians in rural areas has increased gradually, so for resilience in rural healthcare, the functions of family physicians in MCH should be facilitated and expanded [19].…”

“…Enhancing community awareness about MCH, including the importance of vaccinations and traditional health practices, can foster a more health-conscious and supportive community. By applying quality improvement methods to address specific challenges, such as the shortage of rural obstetricians, the weakening of social and cultural support systems, and issues around vaccination and primary care education, we can create a more robust, efficient, and effective health system that better serves the needs of all its members [19].…”

Building primary care in Japan: Literature review

“…The scope of clinical practice of Japanese primary care physicians is varied according to areas and available facilities. For instance, although obstetricians usually provide maternity care including routine prenatal checkups in Japan, some primary care physicians perform obstetrics and gynecology procedures in rural areas . In terms of a certified family physician, 23.6% of physician provides antenatal and postnatal care .…”