title: [Specified expectant mother, Child Welfare Act, and community cooperation: the role of psychiatrists].
abstract: In 2009, the amended provisions of Article 6 of the Child Welfare Act defined "Specified Expectant Mother" (Tokutei-ninpu) as an expectant mother with the need for potential support in nurturing her baby before its delivery. This term was subsequently supplemented with relevant notices and manuals of the Ministry of Health, Labor, and Welfare; it then became a new target of the community network built for the prevention of child abuse. The two notices issued on November 30, 2012 are of great significance. One notice indicates that pregnant females should be screened for psychiatric disorders as well as some other risk factors by officers of their municipalities as a precaution against child abuse. The other states that in the context of Article 5 of the Child Abuse Prevention Law, medical service workers are immunized from sanctions if they divulge privileged information about a "Specified Expectant Mother" with the potential risk for child abuse to municipalities without patient approval. As a result of the latter notice, medical staff must judge whether the privacy of a parent or health of an unborn child with potential risk is more worthy of protection. However, the official criteria for judging the potential for child abuse and those who fall into the category of "Specified Expectant Mother" have yet to be specified. Fetal abuse, as defined by Condon in 1986, serves as a suitable surrogate marker for possible harmful actions that would justify public community cooperation without patient approval. Parenting capacity has rarely been discussed in the field of child abuse and neglect in Japan. The capacity is a legal requirement for custody. Considering the capacity of a "Specified Expectant Mother" to prevent child abuse and neglect, health care workers supporting pregnant women with psychiatric disorders or intellectual disabilities should deliberate, first, their capacities to appreciate their situations and, then, their parenting capacities. A custody substitution system for children of incompetent parents is clearly indicated for minors in the Civil Code (Article 833 and 867); however, it ignores psychiatric disorders and intellectual disabilities. The rights of children, which are lost in this omission, must be guaranteed by competent persons, usually by child guardians. Contributions of psychiatrists are essential for applying legal protections. Without these contributions, their rights are voided of all substance. Advocacy for such pregnant females requires wide and precise knowledge of relevant laws and ethics.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Ishikawa
mesh_terms: D002648:Child; D002649:Child Abuse / Q000517:prevention & control* / Q000523:psychology; D002669:Child Welfare / Q000523:psychology*; D002675:Child, Preschool; D019058:Community Networks; D005260:Female; D006801:Humans; D007564:Japan; D009035:Mothers / Q000523:psychology*; D011247:Pregnancy; D024382:Professional Role; D011570:Psychiatry