The government will soon release its first guidelines on confidential births in response to calls from a hospital and municipality that had been left on their own to grapple with the issue, sources said.

In 2019, Jikei Hospital in Kumamoto introduced a system to allow for confidential births, where women faced with an unplanned pregnancy can consult with hospital staff about giving birth anonymously.

The mother’s name is revealed only to the staff member in charge of the childbirth. This allows the child to learn the identity of his or her mother, in the event they decide in adulthood that they want to know.

A teenager gave birth at Jikei Hospital in December 2021 without divulging her identity to the doctors treating her, becoming the country’s first case of a confidential birth. The hospital has now publicly disclosed five cases in total.

But Japan has no legal provisions for confidential births, presenting challenges for health care workers and local government officials in how to handle a birth report without the mother’s name or guarantee the child’s right to know about his or her parent.

Under the new guidelines, the central government will require hospitals to thoroughly explain the child’s right to know their mother's name to any women who wish to give birth anonymously. Hospitals will also have to follow new rules on managing the mothers’ names and other personal information, according to the sources.

The sources said the government is considering stating in the guidelines that a local mayor can record the child in a family register, even if the mother or the doctor who helped with the delivery fails to file a birth report, as required under the Family Register Law.

The government also plans to assure hospitals in the guidelines that using a pseudonym for the mother in her medical records will not violate the Medical Practitioners Law, according to the sources. The guidelines will also advise local child consultation centers on how to deal with the child after the mother is discharged from a hospital.

Jikei Hospital, the only hospital in Japan that currently has a system for allowing confidential births, and the Kumamoto city government have faced a host of challenges in handling these cases with no precedents to follow.

One early hurdle was how to record the children in a local family register. The city ultimately registered at least one of them under the mayor’s authority without birth reports at the suggestion of the Justice Ministry’s Kumamoto District Legal Affairs Bureau.

Another challenge was how to find someone who can look after the children.

It took more than six months for a local child consultation center in Kumamoto to make arrangements for the first case of a confidential birth using the special adoption system as requested by the mother.

Kumamoto Mayor Kazufumi Onishi said the center was extra careful in the process since they need to keep the mother’s identity secret, adding that officials were faced with a “very tough decision” since they had no guidelines to refer to.

The Jikei Hospital staff in charge of confidential births keeps copies of the mothers’ IDs to guarantee the child’s right to know about his or her parent.

But some experts said a public-sector body should be responsible for retaining the confidential information, while others said there should be procedures set up for allowing the children access to it.

Jikei Hospital modeled its confidential birth system on Germany’s regime, which was legalized in 2014.

“The convenience of women with the urgent need (to give birth anonymously) should come first,” Yasunori Kashiwagi, a professor of education at Chiba Keizai College, said of Japan’s new guidelines on confidential births.

Kashiwagi, who is well-versed in Germany’s program, said the new guidelines should note that the central government takes responsibility for managing personal information provided by the mothers and that only the children can be authorized to access the data.

He added that the guidelines should also outline procedures for the instance where a family court rules on any objections filed by the mothers against letting their children learn their identities before the confidential information is disclosed.

(This article was compiled from reports by Ryuichi Hisanaga and Rina Horikoshi.)