GESTIÓN EN SALUD PÚBLICA: BioEdge: Will IVF turn around Japan’s declining population?

domingo, 10 de junio de 2018

BioEdge: Will IVF turn around Japan’s declining population?

BioEdge: Will IVF turn around Japan’s declining population?

Bioedge

Will IVF turn around Japan’s declining population?

by Michael Cook | 9 Jun 2018 |

Five percent of Japanese babies are due to IVF – one of the highest rates in the world. Still, according to The Economist, “No country resorts to IVF more than Japan—or has less success”.

Japan’s population is less than half of the US, but it has a third more fertility clinics.

Fewer than 10% of IVF treatments succeed, says Yoshimasa Asada, a fertility specialist, and the proportion is falling. “We have the world’s highest IVF numbers and the lowest success rate,” he told The Economist. “It’s an embarrassment.”

Many factors are at play. Japan’s unique social standards play a role. Both men and women work punishing hours; women marry late; few have babies out of wedlock. About 40% of women who undergo IVF do so in their 40s, twice as many as in Britain or France.

The woes of IVF treatment have to be seen against the crisis of an ageing society. The number of Japanese babies born each year fell below 1 million for the first time in 2016. The total fertility rate was 1.44, far below replacement level, and far from the goal of 1.8 by 2026 set by Prime Minister Shinzo Abe. This already assumes that Japan’s population will decline by one-fifth, from 127 million to 100 million by 2060.

The government offers subsidies for IVF, although it is not available under the public health system. The IVF industry is trying to sell the idea that a better-run IVF system could arrest population decline. The head of a Danish company which sells IVF products told The Economist that “with better guidelines and more financial aid Japan could produce an extra 300,000 babies a year. That is roughly the number by which deaths currently outstrip births”.

Sunday, June 10, 2018

The deaths this week of fashion designer Kate Spade and celebrity chef Anthony Bourdain (see below) focused the media once again on explanations for America’s rising suicide rates. The short answer is: nobody knows. The more nuanced long answer is: nobody knows for sure. But something is driving it. Here are a few paragraphs from the New York Times which suggest that suicide is becoming culturally more acceptable:

The rise of suicide turns a dark mirror on modern American society: its racing, fractured culture; its flimsy mental health system; and the desperation of so many individual souls, hidden behind the waves of smiling social media photos and cute emoticons.

Some experts fear that suicide is simply becoming more acceptable. “It’s a hard idea to test, but it’s possible that a cultural script may be developing among some segments of our population,” said Julie Phillips, a sociologist at Rutgers.

Prohibitions are apparently loosening in some quarters, she said. Particularly among younger people, Dr. Phillips said, “We are seeing somewhat more tolerant attitudes toward suicide.”

In surveys, younger respondents are more likely than older ones “to believe we have the right to die under certain circumstances, like incurable disease, bankruptcy, or being tired of living,” she said.

If this is the case, why, O why, is there a movement for assisted suicide? Yes, it’s hard to prove, but it makes sense: if assisted suicide is a triumph of compassion and autonomy, how can unassisted suicide possibly be a tragedy?