Boshi techo: Japan's mother and child health handbook
If you are pregnant in Japan, one of the first official steps you will take is registering your pregnancy with your local municipal government. At that point, you are handed a small booklet that will follow you from your first antenatal appointment all the way through your child's school entry. That booklet is the boshi techo, formally known as the Boshi Kenko Techo, which translates as the Mother and Child Health Handbook. It is issued free of charge to every pregnant woman in Japan and serves as a single, portable record spanning two distinct phases of life: the mother's health during pregnancy, and the child's health from birth onward. Understanding what the boshi techo is, what it contains, and how to use it will help you navigate antenatal care and your child's early health appointments with confidence.
How and when to obtain the boshi techo
The boshi techo is issued by your local municipality, meaning the city hall, ward office, or town office covering your area of residence. You receive it when you formally register your pregnancy with that office, and there is no charge for the booklet itself. Registration is a separate step from seeing a doctor or midwife; it is an administrative process with the local government, and it is a prerequisite for receiving the boshi techo. Most women in Japan register during the first trimester, typically after receiving confirmation from a clinic or hospital that the pregnancy is progressing well. Registering early is worthwhile, since the boshi techo is intended to accompany you to every antenatal appointment and the sooner you have it, the more complete your record will be from the start.
When you visit your municipal office to register, you will usually need to bring identification and proof of your address. The staff will complete a registration form and issue the boshi techo on the spot. Some offices also provide pregnancy coupon books at the same time, which can be used to offset the cost of antenatal check-ups, since Japan's national health insurance does not fully cover routine antenatal visits in the way some other countries' systems do. It is worth checking what your municipality offers when you go to register, as the support available varies somewhat from one area to another.
What the boshi techo records during pregnancy
During the pregnancy phase, the boshi techo functions as a running record of every antenatal appointment. Each time you attend a check-up, your healthcare provider fills in the relevant section of the booklet. The entries cover the core measurements taken at most antenatal visits: your weight and any changes since the previous visit, blood pressure readings, and the results of the urine dipstick test that checks for protein and glucose. These three checks are repeated at virtually every appointment precisely because the trends they reveal over time are clinically meaningful. A gradual rise in blood pressure or the appearance of protein in the urine, for example, can be early indicators of conditions such as pre-eclampsia that require monitoring and, if necessary, intervention.
Beyond the routine measurements, the boshi techo also provides space for blood test results. Early in pregnancy, blood tests establish your blood group and rhesus factor, check for anaemia, and screen for certain infections. Later tests may include a glucose challenge to screen for gestational diabetes. Ultrasound scan findings are recorded in the booklet as well, including measurements of the baby's growth and any relevant observations made during scanning. There is also provision for recording relevant medical or obstetric history, which is particularly useful if you change clinics or move to a different area during pregnancy, since a new provider can review your full history simply by reading the booklet rather than having to request records from a previous clinic. At the time of delivery, the details of the birth itself are entered into the boshi techo, completing the pregnancy section and beginning the transition to the child's record.
What the boshi techo records after birth
From birth onward, the boshi techo shifts focus from the mother to the child, becoming a continuing health record for the baby and young child. Japan has a structured schedule of developmental check-ups organised by the municipality and by healthcare providers, and the boshi techo is used to document the results of each one. The check-ups typically take place at 1 month, 3 months, 6 months, 9 to 10 months, and 18 months, with further assessments at 3 years and at school entry, though the precise schedule can vary slightly by municipality.
At each developmental check-up, the healthcare professional assesses the child's physical and developmental progress across a range of areas and records their findings in the boshi techo. Growth charts are a central feature of the postnatal section: weight, height, and head circumference are plotted at each visit, allowing anyone reviewing the record to see at a glance how the child's growth has progressed over time and whether it falls within the expected range for their age. Dental health is also assessed and recorded as the child grows, reflecting the importance placed on oral health within Japan's preventive care framework.
Vaccination records are another major component of the postnatal section. Japan operates a national immunisation programme covering a range of diseases, and each vaccination the child receives is entered into the boshi techo. This makes the booklet the authoritative record of the child's immunisation history. When a family moves, switches paediatricians, or when the child starts school and a health record is required, the boshi techo provides a complete and verified account of every vaccine administered, removing any ambiguity about which doses have been given and when.
Significance and international influence
The defining feature of the boshi techo system is that the record travels with the family. In many healthcare systems, a patient's records are held by the clinic or hospital and must be requested and transferred whenever the patient moves or changes provider. That process takes time and can result in gaps or delays. The boshi techo solves this problem by design: because the mother, and later the child, holds the physical document, it is available immediately at any appointment with any provider, anywhere in Japan. This is especially valuable for families who relocate, which is common in Japan given the frequency of job-related moves.
The boshi techo system was introduced in Japan in 1948 and is widely credited with contributing to the country's exceptionally low infant mortality rate, which is among the lowest in the world. By ensuring that consistent, high-quality health information is recorded and accessible throughout the critical early years of a child's life, the system supports timely detection of problems, consistent vaccination coverage, and a clear record for safeguarding purposes. The model has attracted international attention and has inspired similar programmes in other countries, particularly in Southeast Asia, where adaptations of the concept have been implemented in several nations. The longevity of the system and the outcomes associated with it have led health systems researchers and policymakers to study it as an example of how placing records with the family rather than with institutions can improve continuity of care at a population level.
Using the boshi techo as an international resident
For families living in Japan on a non-citizen basis, the boshi techo system applies in the same way as for Japanese nationals: any pregnant person registered as a resident is entitled to receive the booklet from their municipal office when they register their pregnancy. The administrative process is the same regardless of nationality. However, the booklet itself is printed primarily in Japanese, which can present a practical challenge if you are not a Japanese reader.
Some municipalities with significant international populations have responded to this by producing versions of the boshi techo in English or other languages, or by providing bilingual supplementary inserts that explain the structure and contents of the booklet. It is worth asking at your local municipal office when you go to register your pregnancy, since availability varies considerably depending on where you live. In some areas, local international community groups or non-profit organisations produce unofficial English translation guides that can be used alongside the standard Japanese booklet to help parents understand each section and what to expect at check-ups. Online communities for international residents in Japan can be a useful source of information about what resources are available in specific cities or regions, and some hospitals and clinics serving international patients also offer support in navigating the boshi techo system.
Frequently asked questions
What is the boshi techo?
The boshi techo (mother and child health handbook) is a free official health booklet issued to all pregnant women in Japan by their local municipal government. It records the mother's health throughout pregnancy and then the child's health from birth through school entry, covering developmental check-ups, vaccinations, growth charts, and dental assessments. Because the booklet travels with the family rather than staying at a clinic, it provides continuity of care even when families move or change healthcare providers.
When and where do I get the boshi techo?
You collect the boshi techo from your local municipal office (city hall, ward office, or town office) when you register your pregnancy. There is no charge. Most women register during the first trimester, and registration is required to receive the boshi techo.
What records does the boshi techo contain?
During pregnancy the boshi techo records antenatal appointment findings including weight, blood pressure, urine results, blood test results, and ultrasound scan findings. Delivery details are recorded at birth. After birth it becomes the child's health record, covering developmental check-ups at 1 month, 3 months, 6 months, 9 to 10 months, and 18 months, as well as vaccination records, growth charts, and dental health assessments.
Is the boshi techo available in English?
Some municipalities with significant foreign populations issue the boshi techo in English or other languages, or provide bilingual inserts. It is worth asking at your local municipal office when you register your pregnancy. Some community groups also provide unofficial English translation guides for international residents.
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