To tackle a baby shortage, Tokyo tries easing the pain of childbirth

So when the time came, she opted for an epidural. Though common in the U.S. and many parts of Europe, the pain-relief procedure is much rarer in Japan, where some believe that women who endure childbirth without pain-relief enjoy closer bonds with their children.

Now, in the hope that it will help nudge up the number of babies being born, the city government in Tokyo has begun rolling out subsidies to help women pay for epidurals and chip away at that stigma. The policy marks another small step in Japan’s battle against a slow-motion demographic crisis of falling births and an aging, shrinking population.

“I was a little shackled by the Japanese custom that you are only a mom if you go through natural birth, so I had my first child without an epidural," Nishimura said. “And I deeply regretted it."

She credits the procedure for her rapid recuperation after the birth of her second child, a boy. “I really want epidural deliveries to become the norm," she said.

Last year, an epidural was used in 13.8% of births in Japan, according to the Japan Association for Obstetricians and Gynecologists. In the U.S., 77% of births involve an epidural, according to Centers for Disease Control and Prevention data from 2022. In France and some European countries, the percentage is more than 80%.

An epidural is an invasive procedure in which an anesthetic is delivered into the body via a catheter inserted into the lower back. In common with some soon-to-be parents in other countries, some expectant moms in Japan are put off by safety fears, an issue amplified by the relative rarity of the procedure there.

“My Japanese friends who choose not to get them are scared of the fact that there is not a lot of information on epidurals. You only know that you are getting injected in the spine and that is scary," said Yuka Hirose, who had her first child in 2015 in Japan without an epidural.

Hirose had her second in 2017 in the U.K., where “people don’t have negative sentiments toward epidurals at all." She chose to have an epidural for that birth and again for the birth of her third child in Japan last year.

A collection of toys on the floor at Nishimura's home in Tokyo.

There were around 686,000 births in Japan in 2024, according to Japanese government figures, down from more than a million a decade earlier. Deaths outnumbered births by more than two to one. With modest immigration, Japan’s population has shrunk by about 4 million since its 2008 peak, to around 124 million.

Features of Japan’s demographic decline are mirrored in other Asian economies and in the West. Fertility rates—the number of babies a woman will have in her lifetime on average—are falling and in many countries have dropped substantially below the 2.1 level needed to keep populations stable without immigration.

In Japan, the rate in 2023 was 1.2. In the U.S., it was just over 1.6. In South Korea, Singapore and China, the rate was one or below.

The global downshift in fertility rates has many causes, demographers say. Some couples are putting off having children until they feel established in their careers. Housing and child care are often expensive, making large families scarcer. Social mores are changing, with childlessness no longer viewed as unusual or undesirable.

In Japan and other countries, governments have offered child-rearing subsidies, tax breaks to families and a host of other benefits in an effort to arrest the fertility decline, all with limited effect.

In the U.S., President Trump has made permanent a child tax credit introduced in his first term and has encouraged Americans to have more babies.

While Tokyo officials are hopeful their epidural subsidy will help encourage more births, they don’t expect it to halt demographic decline in its tracks.

“The causes of the declining birthrate are complex, and we don’t believe that a single measure will solve the problem," said Shiori Wada, who leads the subsidy initiative at the city’s metropolitan government.

The city found through surveys that there were people who wanted epidurals and couldn’t get them, often because of the cost, Wada said. Epidurals aren’t typically covered by health insurance and not all hospitals offer them. Women who want one need to find a private clinic that does, and pay the out-of-pocket expense.

Tokyo has said that from Oct. 1, it will pay up to 100,000 yen, or about $673, toward the cost of an epidural at some 119 healthcare facilities around the capital. A survey conducted by the city put the average cost at about 124,000 yen.

Outside of Tokyo and other big cities, access to epidurals is hampered by a lack of anesthesiologists.

“It is easy to choose a delivery hospital depending on whether you prefer epidurals or not in a big city like Tokyo. In rural areas, like a hospital network in Hokkaido, there are no other options, so people can’t choose," said Mamiko Nakajima, a former midwife who now runs an online counseling service for new and expectant mothers.

But the big reason for Japanese hesitancy around epidurals is cultural, according to moms, midwives and doctors, with a “natural" birth without pain relief viewed by some as an essential rite of passage in motherhood.

“I believe natural is best," said Hisako Saito, a midwife in Tokyo who has delivered more than 800 babies in a 30-year career. She said that the pain of delivery strengthens the bond between mother and baby and that she believes some mothers find it hard to hold or soothe their babies if they had an epidural during birth.

“I think it might be a procedure that isn’t suited to the Japanese people," she said.

Katsuo Terui, chairman of the Japan Society for Obstetric Anesthesia and Perinatology, said he has heard similar views since childhood. He said fathers don’t experience the pain of childbirth, but enjoy strong bonds with their children.

“I don’t feel pain is critically important for forming the mother-child bond," he said.

One Japanese mother, who didn’t want to be named, said she was scolded by her husband for considering an epidural when their baby was almost due in 2021. After the experience of two miscarriages, she ignored his misgivings and had one anyway. The baby was eventually delivered by emergency caesarean section.

By making epidurals more accessible, the Tokyo subsidy should encourage more women to opt for pain relief in childbirth, but it probably won’t have a big effect on the overall number of births, said Keiko Tanabe, an associate professor at Kanagawa University of Human Services and co-founder of the Tobu Mutsuu Café, which provides information about pain relief in childbirth to mothers and midwives.

The bigger hurdle in Japan is that moms still bear the lion’s share of responsibility for child rearing, even after government efforts to nudge dads to do more by promoting paid parental leave and other measures, she said.

“We’re talking about situations where you have to manage everything alone and try to resume your career," she said. “Would you give birth in that situation? No way."

Write to Jason Douglas at jason.douglas@wsj.com and Junko Fukutome at junko.fukutome@wsj.com