Background: In Japan, although the number of females who continue to work after marriage has recently increased, the proportion of those working while parenting their infants is still not clearly increasing, indicating that it is still difficult for them to continue working after delivery. The present study aimed to clarify factors influencing females’ continuation of work, using data obtained by continuously following up the same subjects and focusing on occupation changes, family environments, and the type of employment after pregnancy or delivery. Methods: Based on the results of the questionnaire survey, which was conducted involving 164 participants at 4 universities, as part of the Japan Environment and Children’s Pilot Study (JECS Pilot Study) led by the Ministry of Environment and the National Institute for Environmental Studies, the occupational status was compared between the detection of pregnancy (weeks 0 to 7) and 1 year after delivery. Results: <Non-regular employees> compared with <regular employees> changed their occupations significantly more frequently (OR = 5.07, 95% CI = 2.57–10.01, P < 0.001). Furthermore, on examining <non-regular employees> in detail, occupation changes were particularly marked among <part-time and short-term contract employees> (OR = 12.48, 95% CI = 4.43–35.15, P < 0.001). This tendency was especially shown among <<those engaged in specialized or technical work> > (OR = 10.36, 95% CI = 1.59–67.38, P = 0.014) and < <those engaged in clerical work or management> > (OR = 15.15, 95% CI = 2.55–90.17, P = 0.003). Conclusions: Analysis revealed that the type of employment, rather than the category of occupation, was associated with the continuation of work after pregnancy or delivery more closely, as <non-regular employees> compared with <regular employees> continued to work less frequently. Furthermore, on comparison of the category of occupation among <regular employees>, <<those engaged in specialized or technical work> > and < <those engaged in clerical work or management> > were shown to be more likely to continue to be engaged in the same occupation after pregnancy or delivery. These differences may be related to availability of the child-care leave program and other support resources, therefore, it may be important to establish social systems that enable all females, to use these support resources if they wish, and actively work, while delivering and parenting their children. Keywords: Occupation changes, After pregnancy/delivery, Employment, Mother * Correspondence: firstname.lastname@example.org Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Suga et al. BMC Women's Health (2018) 18:86 Page 2 of 11 Background degree of the depression is decreasing yearly, the White With the promotion of their social participation, a large Paper on the National Lifestyle 2006  explains this by number of females are engaged in occupations today, increased numbers of unmarried individuals and couples and the number of those who continue to work after without a child/children, suggesting that increases in the marriage is increasing in Japan. In the Status of Working proportion of females working while parenting their in- Women 2016 , the size of the female labor force was fants have been limited. The necessity of promoting fe- estimated at 28,830,000, and females accounted for males’ participation in the labor force in consideration 43.4% of the total working-age population in 2016. How- of their deliveries is particularly high in Japan compared ever, various problems closely related to women’s psy- with other countries, and this issue has been examined chological, physical health, or social situation may in a number of studies. Higuchi et al.  compared the interrupt the continuity of work or career path. Espe- female employment rate among Japan, the United States, cially, marriage and childbirth are significant life events and Great Britain, and reported that the rate among for women. In the traditional Japanese culture, women those without a spouse was the highest in Japan, never- work until marriage, and afterward, they are expected to theless the rate after delivery was the lowest, indicating take on the responsibility of maintaining the home, usu- that the influences of marriage and delivery preventing ally at the expense of their work outside the home. An them from continuing to work are the most marked. awareness survey of the Japanese woman’s career in the Takeishi  noted that, despite various approaches to area 2015  revealed that 44.2% of those surveyed held support females to continue to work while parenting the traditional idea that the wife should maintain the their children since the enforcement of the Equal Em- house. In addition, 62.0% of the respondents confirmed ployment Opportunity Law, their career patterns have that the wife should be in the house when the children not markedly changed, as the proportion of those who are young. The Fifteenth Japanese National Fertility continue to work after delivery has remained at 15%. Survey, 2015  found that almost all women who con- Furthermore, Imada  compared multiple cohorts vary- tinued to work after having children received help from ing in age, and reported that a large number of females their mothers (children’s grandmothers) or they used resigned from work even in young cohorts. More re- some kind of institution or facility for child care. In cently, the Fifteenth Japanese National Fertility Survey, other words, the lack of these supports may affects the 2015  found that the rate of continuing work after the continuation of work more frequently. Women may birth of the first child was 38.3% in 2010–2014, and this have inadequate access to daycare or nursery options, increased by ~ 10% in 2005–2009. However, this survey and they may be criticized by surrounding people, such also found that 46.9% of the women who worked before as grandparents and co-workers who disagree with their childbirth retired from work after the birth of their first choice to work, leading them to experience both psycho- child, and this group made up 33.9% of the total female logical stress and physical stress. Depression following population (http://www.ipss.go.jp/ps-doukou/j/doukou15/ pregnancy and childbirth is also a common component NFS15_report4.pdf, p.52, Fig. II-4-6) . of the stress experienced by young mothers. However, Based on the Vital Statistics 2014 , the total fertility the rising costs of day-to-day expenses and education for rate, indicating the number of children delivered by a sin- a growing family also exert economic pressure. A survey gle female throughout her life, is limited to 1.42. In Japan’s on the re-employment of women after child rearing in aging society with a declining fertility rate, increasing both 2008  found that the most common and direct reason the female labor force participation and fertility rates is an for women to resume work after child rearing was “eco- urgent issue; however, these findings indicate that females nomic necessity,” which was reported by 39.7% of the still face difficulty in continuing to work after delivery. In participants. Similarly, in the 2015 survey , 52.1% of order to address this, it may be important to clarify and the women responded with the same answer. Evidently, resolve factors associated with such difficulty. Although women wanting to quit their job may not be able to do various factors are likely to be associated, the majority of so easily. previous studies were short-term using specific existing In this regard, the female labor force participation rate panel data or those obtained through Internet-based inter- showed an M-shaped curve, with 2 peaks in their twen- views, for instance, a comprehensive study on challenges ties and fifties and a depression in their thirties. This in supporting females to work while parenting . tendency is particularly marked in Japan compared with Furthermore, the number of those in which data were other countries. According to an age-based classification directly and continuously collected from the same sub- in the White Paper on Gender Equality 2015 , such a jects, focusing on multiple factors, has been limited. depression in the female labor force participation rate in Considering such a situation, the present study aimed the thirties is the second most marked in Japan on a glo- to clarify factors influencing females’ continuation of bal comparison, following South Korea. Although the work, using data obtained by continuously following up Suga et al. BMC Women's Health (2018) 18:86 Page 3 of 11 the same subjects and focusing on occupation changes, factors on children’s health and development using a com- family environments, and the type of employment after bination of surveys and biological samples. The JECS Pilot pregnancy or delivery. Study confirms the feasibility of the content and method of the JECS . Methods Japan environment and Children’s pilot study (JECS pilot The Study’s sample study) design The study subjects were a part of the JECS pilot study, The Japan Environment and Children’s Pilot Study (JECS and the final sample for the present study was 164 (Fig. 1). Pilot Study) is an epidemiological birth cohort study The participants were adult females in their twenties to conducted by the Ministry of Environment and the forties, who continued to work after pregnancy. National Institute for Environmental Studies, at 4 Mother’s age, partner’s presence, number of children, universities (Jichi Medical University, the University mother’s education, and household income were ob- of Occupational and Environmental Health Japan, tained using the questionnaires at the first trimester and Kyushu University, and Kumamoto University), since the second to third trimester of pregnancy. These ques- 2008. Pregnant women were recruited from cooperating tionnaires included questions about basic information gynecological clinics between February 2009 and March such as age and family composition, lifestyle factors such 2010.The way of the agreement was received by a docu- as conditions during pregnancy, and environment such ment after informed consent. All participants were resi- as residential status; the utilized data were extracted dents of the target area (Honshu 1 area and Kyushu 3 from these. The occupation-related data was obtained areas where the university is located). The pilot study in- from the questionnaire at 1.5 years after delivery. This cluded 453 women and their children, and they were questionnaire included an occupational status section. followed until their children were 13 years old. Two times of mother’s occupational statuses, the detec- Biological samples (e.g., blood, urine, and hair) were tion of pregnancy (weeks 0 to 7) and 1 year after deliv- collected in cooperating recruited gynecology clinics ery, were asked in the occupational status section, twice during pregnancy and at the regular check-up for because women generally returned to work after their their children in the first month. Questionnaire surveys 1-year child-care leave . The occupational status sec- were administered at the first, second, and third trimes- tion included the following information: occupational ters, and every six months following the birth of the classification code, type of employment, number of child, beginning with the first month. The questionnaire working days per week, presence or absence of shifts or is written in Japanese and is self-administered. They were night shift, and presence of maternity leave or child-care mailed to the subjects’ houses, and completed question- leave. The rate of returned completed the questionnaires naires were returned by mail. A single detailed survey ex- at the first trimester and second to third trimester of amined child development, home environment, etc. The pregnancy was 76.8%, and the rate for the completed oc- JECS aimed to examine the effects of environmental cupational status section was 88.7%. Fig. 1 The process selecting participants Suga et al. BMC Women's Health (2018) 18:86 Page 4 of 11 Analysis method The participants were classified based on the category Their occupations were classified using the major cate- of occupation before pregnancy for comparison between gories defined in the Japanese Standard Classification the detection of pregnancy (weeks 0 to 7) and 1 year of Occupations 2009 , and the occupational classifi- after delivery to examine their tendencies in relation to cation codes were selected and filled out by the partici- the continuation of work. pants. These codes were categorized from 1 to 6, according When focusing on factors possibly influencing the to the relevant occupations category based on the Japanese continuation of work, the presence of a spouse/partner Standard Classification of Industries . Furthermore, em- or number of children was not associated with occupa- ployees satisfying the following 3 points were classified as tion changes. On the other hand, the participants with a <regular employees>: “there is no fixed period of labor child/children, compared with those without them, contract,”“the prescribed working time is full time,”“direct changed their occupations significantly less frequently. employment.” All others were classified as <non-regular This tendency was more marked among those with a employees>. These classifications were made based on the larger number of children. On comparison based on guidelines of The Vision of the Preferred Way of the type of employment, <non-regular employees> Working 2012 . compared with <regular employees> changed their oc- The category of occupation was compared between cupations significantly more frequently (OR = 5.07, 95% the detection of pregnancy (weeks 0 to 7) and 1 year CI = 2.57–10.01, P < 0.001) (Table 2). There was no sig- after delivery to classify the participants who continued nificant difference between mother’s education and to be engaged in the same occupation as an “unchanged household income. group” and those who resigned from work or changed Tables 3 and 4 present the findings of the analyses their occupations as a “changed group”. We categorized conducted by adjusting for mothers’ age and number of the mother’s age as “20’s”, “30’s”,or “40’s” and number of children, which exhibited significant differences in the children as “0”, “1”, “2”,or “3 or over”, and used them as findings presented in Table 2.Table 3 shows that the categorical variables. Educational level was assessed relationship between change in occupation and type of using the following categories: junior high school, high employment. Furthermore, on examining <non-regular school, colleges of technology, professional training col- employees> in detail, occupation changes were particu- leges, junior college, university, and graduate school. larly marked among <part-time and short-term contract Household income was assessed using the following employees> (OR = 12.48, 95% CI = 4.43–35.15, P < 0.001). A categories: < 2 million yen; 2.0–3.9 million yen, 4.0–5.9 similar tendency was also observed among a non-significant million yen, 6.0–7.9 million yen; 8.0–9.9 million yen; number of <temporarily-dispatched employees>. In con- 10.0–11.9 million yen; 12.0–14.9 million yen, 15.0–19.9 trast, <those who are self-employed> showed a tendency million yen, and ≥ 20 million yen. For the analysis, the to continue to work without changing their occupations 164 participants with all the basic information and oc- (Table 3). cupation data were set as the population. Table 4 shows to clarify whether or not the cate- The relationship between an occupation change 1 year gory of occupation influences such differences in the after delivery and the type of employment was examined continuation of work between <regular employees> by performing multivariate logistic regression analysis, and < non-regular employees>, the 2 types of employ- adjusting for the mother’s age and number of children. ment were compared based on the category of occu- All analyses were performed using STATA Version 14 pation. The above-mentioned tendency, <non-regular (Stata Corporation, College Station, TX, USA), and all employees> compared with <regular employees> changed p-values presented are two-sided (α = 0.05). their occupations, was particularly marked among <<those engaged in specialized or technical work> > (OR = 10.36, Results 95% CI = 1.59–67.38, P = 0.014) and < <those engaged in Table 1 shows basic information regarding the partici- clerical work or management> > (OR = 15.15, 95% CI = pants. The absence of a spouse/partner was rare among 2.55–90.17, P = 0.003). Among <regular employees> en- them, and the proportion of those without a spouse was gaged in these categories, the proportion of those who limited to 1.8%. The number of children excluding the continued to work compared with those who did not was child born during this study was 0 in 48.2% and 1 or higher. In contrast, the proportion of <non-regular em- more in 51.8%. Regarding education, the rate of high ployees> who continued to work was low, revealing more school, professional training colleges, and University marked differences between the 2 types of employment in were large, at 20% or more. For household income, the these categories compared with others (Table 4). category of 2.0–3.9 million yen had the highest propor- While <regular employees> compared with <non-regular tion (34.1%), followed by 4.0–5.9 million yen (26.2%) employees> were shown to continue to be engaged in the (Table 1). same occupation more frequently after pregnancy, the Suga et al. BMC Women's Health (2018) 18:86 Page 5 of 11 Table 1 Characteristics of the study participants All participants Those engaged in Those engaged Those engaged Those engaged in Those engaged in Those engaged specialized or in clerical work or in sales service industry, manufacturing, in unclassifiable technical work management security, forwarding, agriculture, forestry, businesses or cleaning, packaging, or fisheries students or other business (N = 164) (N = 43) (N = 55) (N =17) (N = 35) (N =7) (N =7) N% N % N % N % N % N % N % Mother’s age* 43 55 17 35 7 7 20’s 50 30.5 8 18.6 12 21.8 10 58.8 16 45.7 2 28.6 2 28.6 30’s 108 65.9 33 76.7 40 72.7 7 41.2 19 54.3 5 71.4 4 57.1 40’s 6 3.7 2 4.7 3 5.5 0 0.0 0 0.0 0 0.0 1 14.3 Partner’s presence) Yes 161 98.2 43 100.0 55 100.0 17 100.0 32 91.4 7 100.0 7 100.0 No 3 1.8 0 0.0 0 0.0 0 0.0 3 8.6 0 0.0 0 0.0 Number of children**) 0 79 48.2 24 55.8 20 36.4 7 41.2 20 57.1 5 71.4 3 42.9 1 53 32.3 13 30.2 23 41.8 6 35.3 9 25.7 0 0.0 2 28.6 2 22 13.4 5 11.6 8 14.5 3 17.6 5 14.3 0 0.0 1 14.3 3 or over 10 6.1 1 2.3 4 7.3 1 5.9 1 2.9 2 28.6 1 14.3 Mother’s education Junior high school 4 2.4 0 0.0 1 1.8 1 5.9 2 5.7 0 0.0 0 0.0 High school 42 25.6 1 2.3 12 21.8 9 52.9 14 40.0 3 42.9 3 42.9 Colleges of Technology 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Professional training 45 27.4 21 48.8 9 16.4 3 17.6 10 28.6 1 14.3 1 14.3 colleges Junior college 29 17.7 6 14.0 13 23.6 2 11.8 5 14.3 1 14.3 2 28.6 University 40 24.4 12 27.9 19 34.5 2 11.8 4 11.4 2 28.6 1 14.3 Graduate school 4 2.4 3 7.0 1 1.8 0 0.0 0 0.0 0 0.0 0 0.0 Household income < 2 million yen 5 3.0 0 0.0 0 0.0 1 5.9 3 8.6 1 14.3 0 0.0 2.0–3.9 million yen 56 34.1 10 23.3 15 27.3 9 52.9 15 42.9 3 42.9 4 57.1 4.0–5.9 million yen 43 26.2 11 25.6 14 25.5 4 23.5 11 31.4 1 14.3 2 28.6 6.0–7.9 million yen 28 17.1 11 25.6 10 18.2 2 11.8 4 11.4 1 14.3 0 0.0 Suga et al. BMC Women's Health (2018) 18:86 Page 6 of 11 Table 1 Characteristics of the study participants (Continued) All participants Those engaged in Those engaged Those engaged Those engaged in Those engaged in Those engaged specialized or in clerical work or in sales service industry, manufacturing, in unclassifiable technical work management security, forwarding, agriculture, forestry, businesses or cleaning, packaging, or fisheries students or other business (N = 164) (N = 43) (N = 55) (N =17) (N = 35) (N =7) (N =7) N% N % N % N % N % N % N % 8.0–9.9 million yen 20 12.2 8 18.6 9 16.4 1 5.9 1 2.9 1 14.3 0 0.0 10.0–11.9 million yen 8 4.9 2 4.7 4 7.3 0 0.0 1 2.9 0 0.0 1 14.3 12.0–14.9 million yen 2 1.2 0 0.0 2 3.6 0 0.0 0 0.0 0 0.0 0 0.0 15.0–19.9 million yen 2 1.2 1 2.3 1 1.8 0 0.0 0 0.0 0 0.0 0 0.0 ≥ 20 million yen 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 *We categorized the mother’s age as “20’s”, “30’s”, “40’s”, and used it as a categorical variable **We categorized the number of children as “0”, “1”, “2”,or “3 or over”, and used it as a categorical variable A common-law marriage is included in the partner’s presence Any child born during this study was not included in the number of children Suga et al. BMC Women's Health (2018) 18:86 Page 7 of 11 Table 2 The relation between the continuation of work and each factor (N = 164) Comparison between 0 and 7 weeks of pregnancy and 1 year after childbearing a b All No change Change OR 95% CI P-value Mother’s age 20’s 50 22 28 1.00 30’s 108 56 52 0.73 0.37–1.43 0.359 40’s 6 3 3 0.79 0.14–4.28 0.78 Partner’s presence Yes 161 79 82 1.00 No 3 2 1 0.39 0.03–4.48 0.447 Number of children 0 79 28 51 1.00 1 53 29 24 0.46 0.22–0.95 0.035 2 22 16 6 0.21 0.07–0.61 0.004 3 or over 10 8 2 0.14 0.03–0.72 0.019 Type of employment Regular employee 91 60 31 1.00 Non-regular employee 73 21 52 5.07 2.57–10.01 < 0.001 Mother’s education Junior high school 4 2 2 1.00 High school 42 18 24 1.27 0.16–9.95 0.821 Colleges of Technology 0 0 0 Professional training colleges 45 27 18 0.65 0.08–5.10 0.686 Junior college 29 16 13 0.86 0.11–7.05 0.891 University 40 15 25 1.74 0.22–13.79 0.599 Graduate school 4 3 1 0.43 0.02–9.05 0.59 Household income < 2 million yen 5 2 3 1.00 2.0–3.9 million yen 56 19 37 1.33 0.20–8.65 0.768 4.0–5.9 million yen 43 25 18 0.51 0.08–3.37 0.481 6.0–7.9 million yen 28 17 11 0.46 0.07–3.26 0.438 8.0–9.9 million yen 20 12 8 0.48 0.06–3.65 0.481 10–11.9 million yen, 8 4 4 0.73 0.07–7.21 0.791 12–14.9 million yen 2 1 1 0.78 0.03–21.94 0.884 15–19.9 million yen 2 1 1 0.81 0.03–23.16 0.9 ≥ 20 million yen 0 0 0 Retired or changed occupation The mother’s age was always included in the models as covariates. influence of the category of occupation on the ten- In contrast, <non-regular employees> did not show dency of <regular employees> to continue to work significant differences among different categories of oc- remained unclear. Therefore, <<those engaged in spe- cupation; in all categories, the number of those who cialized or technical work> > and the other category changed their occupations compared with those who of occupation were compared, revealing that occupa- continued to be engaged in the same occupation after tion changes were the most frequent among <<those pregnancy weeks 0 to 7 was higher. engaged in sales> > (OR = 10.34, 95% CI = 1.07–100.35, P = 0.044), followed by <<those engaged in clerical Discussion work or management> > (OR = 2.89, 95% CI = 0.92–9.08, To clarify factors preventing a large number of females P =0.069) (data not shown). from continuing to work and leading them to resign or Suga et al. BMC Women's Health (2018) 18:86 Page 8 of 11 Table 3 The relation between a change in occupation and the type of employment Comparison 0-7 weeks of pregnancy and 1 year after childbearing a b All No change Change OR 95% CI P-value Regular employee 91 60 31 1.00 Non-regular employee Temporarily dispatched employees 12 1 11 25.04 2.90–215.93 0.003 Part-time or short-term contract employees 44 9 35 12.48 4.43–35.15 < 0.001 Those who are self-employed 16 11 5 1.61 0.45–5.80 0.463 Others (contract employees) 1 0 1 –– – Retired or changed occupation The mother’s age and number of children were always included in the models as covariates change their occupations after pregnancy or delivery as to the type of employment, and the study may have sig- a major life event, the present study focused on the cat- nificance in this respect. egories of occupation before and after delivery. On com- In a previous study conducted in 2008 , focusing parison between <regular employees> and < non-regular on the influences of the type of employment, the propor- employees>, the proportion of those who continued to tion of females who resigned from work during their first work was lower among the latter. Among <regular em- pregnancies was 29.6% among <regular employees>, while ployees>, <<those engaged in specialized or technical the value was markedly higher among <non-regular em- work> > and < <those engaged in clerical work or man- ployees>, at 48.3%. Regarding differences in the likelihood agement> > were shown to be more likely to continue to of continuing to work among different categories of occu- be engaged in the same occupation after pregnancy. The pation, Takeishi (2009) et al. reported that <<those en- present study is significant in that, unlike previous stud- gaged in specialized or technical work> > accounted for ies, the present study collected the data directly and was 43.5% of all those who continued to work, followed by not based on secondary data. The use of data directly <<those engaged in clerical work>> . collected from subjects facilitated the clarification of as- The tendency of <regular employees> to continue sociated factors while relating the category of occupation to work may be associated with more stable work Table 4 The relation between a change in occupation and the type of employment classified by occupation Major categories defined in Comparison 0-7 weeks of pregnancy and 1 year the Japanese Standard Classification after childbearing of Occupations a b All No change Change OR 95% CI P-value Those engaged in specialized or technical work B 43 29 14 Regular employee 35 27 8 1.00 Non-regular employee 8 2 6 10.36 1.59–67.38 0.014 Those engaged in clerical work or management A, C 55 26 29 Regular employee 34 21 13 1.00 Non-regular employee 21 5 16 15.15 2.55–90.17 0.003 Those engaged in sales D 17 6 11 Regular employee 5 2 3 1.00 Non-regular employee 12 4 8 2.54 0.10–62.32 0.567 Those engaged in service, security industry, E, F, K 35 14 21 forwarding, cleaning, packaging, or other business Regular employee 15 9 6 1.00 Non-regular employee 20 5 15 9.87 1.24–78.38 0.030 Those engaged in manufacturing, agriculture, G, H 7 3 4 forestry, or fisheries Regular employee 2 1 1 1.00 Non-regular employee 5 2 3 1.80 0.02–141.05 0.791 Retired or changed occupation The mother’s age and number of children were always included in the models as covariates Suga et al. BMC Women's Health (2018) 18:86 Page 9 of 11 environments for them compared with <non-regular survey on the employment structure  in Japan re- employees>, including the term of employment and salar- vealed that both high education and income affected the ies, in addition to the availability of the child-care leave continuity of women’s work. However, this tendency was program as a major system to support females to work not observed in the present study. while parenting. Limited-term contract workers, such as To explain the high likelihood of <<those engaged in <non-regular employees>, had previously been excluded specialized or technical work> > and < <those engaged in from the scope of the child-care leave program until the clerical work or management> > continuing the same Revised Child Care and Family Care Leave Law was category of occupation after pregnancy or delivery, occu- enacted in April 2005 to enable them to use this system if pation selection trends among females after graduation they meet certain requirements. However, as shown in a from university should be examined. According to the research report (2012) , the rate of child-care leave Status of Working Women 2013 , the proportion of program use by <non-regular employees> remained at <<those engaged in specialized or technical work> > after 11.5, and 60.0% of them resigned from work despite law graduation was the highest, at 36.6%, followed by enactment in 2005, while these values of <regular em- <<those engaged in clerical work>>, at 31.9%. Based on ployees> were 60.8 and 32.4%, respectively, suggesting a this, females with higher occupational awareness levels close association of the availability of the child-care leave may be more likely to select these categories of occupa- program with the difference in the continuation of work tion to advance their career, and maintain them even between them. after delivery to meet their wishes. On the other hand, it should be noted that the pro- Shigeno et al.  noted that the actual functioning gram is not available for all <regular employees>. Ac- of support systems influences females’ behaviors related cording to the White Paper on the National Lifestyle to their first deliveries, as the probability of workers, (2006) , more than 40% of the <regular employees> excluding <<those engaged in independent business>>, who continued to work without using the program men- delivering the first child is reduced by half or more if tioned “workplace atmospheres” or “work situations” as the child-care leave program is unavailable. In short, reasons for avoiding using it. This indicates that a large not only to encourage females to continue to work, but number of females working as <regular employees> ex- also to increase the fertility rate, the establishment of perience psychological and physical stress due to the dif- systems that enable all females, regardless of whether ficulty in obtaining co-workers’ understanding regarding regular or non-regular employees, to use the child-care availing the child-care leave program, and therefore, they leave program if they wish by stabilizing working condi- are forced to resign or change their occupation. tions for <non-regular employees> and promoting an Other factors influencing the continuation of work understanding of the necessity of using such programs may include: the presence of a spouse/partner and num- in the workplace may be an important challenge. ber of children. Regarding the former, Higuchi et al.  In a study by Imada et al. , the effect on the con- reported that the proportion of employed wives was tinuation of work was the most favorable when 3 sup- higher in multi- compared with 2-generation family port resources were simultaneously used: the child-care households. In other words, support from the family leave program, nursery school services, and support may reduce the physical stress experienced by women, from relatives. To resolve the actual situation in which it and they may continue to work. However, in the present is only possible for females working as <regular em- study, significant differences were not observed at this ployees> engaged in limited categories of occupation to point, as the absence of a spouse/partner was rare continue to work, combined support approaches are in- among the participants, indicating the necessity of ana- dispensable. Through these approaches, it may be im- lysis involving an increased number of subjects. Further- portant to establish social systems that enable females to more, regarding the number of children, the tendency to select lifestyles they desire, and actively work while de- continue to work was more marked among those with a livering and parenting their children. larger number of children. Sato et al.  similarly re- ported that both <regular employees> and < limited-term Limitations contract employees> with a child/children, compared There are several limitations in the present study. First, with those without them, continued to work more fre- this study used a comparatively small sample size, which quently, and the proportion of such individuals was as leads to broad confidence intervals. Therefore, there is a high as 45.6% among those with 2 or more children. possibility that it does not provide precise estimates. It is This confirms that the presence of a large number of necessary to analyze a larger number of participants and children is not necessarily a negative factor for females to improve the reliability of data. In the future, we plan to work. In addition, other factors related to the individ- to investigate the same through the nationwide “The ual are related to the reason for occupation changes. A Japan Environment and Children’s Study.” Second, the Suga et al. BMC Women's Health (2018) 18:86 Page 10 of 11 present analyses did not include the mothers’ individual Availability of data and materials The data that support the findings of this study are available from the Eco-child factors in detail, such as psychological, physical, and so- study Investigation Committee and the Japanese government, but restrictions cial factors. Specifically, we did not pay attention to the apply to the availability of these data, which were used under license for the individual diseases related to physical stress, and there- current study and so are not publicly available. Data are available, however, from the authors upon reasonable request and with permission of the fore, we could not confirm their influence. We also plan Eco-child study Investigation Committee and the Japanese government. to consider this issue in the nationwide survey. Third, the possibility of a selection bias might not be negated. Authors’ contributions RS and MT1 designed the study and directed its implementation. TK2 helped This pilot study did not use an established study supervise the field activities. RS, MT1, ES, MT2, AS, SA, SM, MS, MO, NM, YB, method, and it involved many complicated investiga- MH, KK, HM, and TK1 performed the field activities, collected data and made tions. Therefore, the participants included in the pilot study design. RS, MT1, RT, MT2 and TK2 designed the study’s analytic strategy. MT1 helped overall strategies, especially in preparing the Methods and Discussion study may have been more cooperative and highly con- sections of the text. All authors read and approved the final manuscript. scious. Furthermore, as the study employed a self-report questionnaire, the way people respond to questions may Ethics approval and consent to participate have differed across participants. In addition, this study Written informed concent was obtained from all participants. Approval was given by the review boards of the University of Occupational includes several participants whose responses to one or and the Environmental Health, Japan (08–91) on February 25th, 2011. more of the questions are missing. Participants may not have responded because they did not wish to offer nega- Competing interests The authors declare that they have no competing interests. tive responses. There is a possibility of a selection bias by excluding participants who did not respond intentionally. Fourth, since a self-reported questionnaire was used, it is Publisher’sNote Springer Nature remains neutral with regard to jurisdictional claims in impossible to totally escape the possibility of social published maps and institutional affiliations. desirability bias. However, because the JECS Pilot Study included a face-to-face survey and the use of official docu- Author details Regional Centre for Japan Environment & Children’s Pilot Study, University ments, it is assumed that the presence of social desirability of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, bias was unlikely. Yahata-nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan. Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan. Department of Obstetrics and Gynecology, School Conclusions of Medicine, University of Occupational and Environmental Health, Japan, Based on these results, the type of employment such as 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan. Fukuoka Institute of Occupational Health, 1-11-27, Nanokawa, Minami-ku, <regular employees> and < non-regular employees>, ra- Fukuoka-shi, Fukuoka 815-0081, Japan. Department of Pediatrics, School of ther than the category of occupation, may be associated Medicine, University of Occupational and Environmental Health, Japan, 1-1, with the continuation of work after pregnancy or Iseigaoka, Yahata-nishi-ku, Kitakyushu-shi, Fukuoka 807-8555, Japan. Regional Centre for Japan Environment & Children’s Pilot Study, Kyushu University, delivery more closely. The existing literature suggested a 3-1-1, Maidashi, Higashi-ku, Fukuoka-shi, Fukuoka 812-8582, Japan. Regional close association of the availability of the child-care leave Centre for Japan Environment & Children’s Pilot Study, Kumamoto University, program with the difference in the continuation of work 1-1-1, Honjo, Chuo-ku, Kumamoto-shi, Kumamoto 860-8556, Japan. Department of Environmental and Preventive Medicine, School of Medicine, between them. Therefore, it may be important to estab- Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi 329-0498, lish social systems that enable all females, regardless of Japan. Department of Obstetrics and Gynecology, School of Medicine, Jichi the type of employees, to use the child-care leave pro- Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan. Regional Centre for Japan Environment & Children’s Pilot Study, Jichi gram and other support resources if they wish, and ac- Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan. tively work they desire, while delivering and parenting Osaka Centre for Cancer and Cardiovascular Disease Prevention, 1-3-2, their children. Nakamichi, Higashinari-ku, Osaka-shi, Osaka 537-0025, Japan. Received: 16 June 2016 Accepted: 22 May 2018 Acknowledgements The authors would like to thank Akiko Shinagawa, Yumi Tanaka, and all the staff of Regional Centre for Japan Environment & Children’s Pilot Study for conducting References the survey and helping with data totalization. The authors would also like to 1. Ministry of Health, Labour and Welfare: Status of Working Women 2016. thank David Jonathan Askew for teaching and proofreading English. 2017; http://www.mhlw.go.jp/bunya/koyoukintou/josei-jitsujo/dl/16b.pdf. 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Published: Jun 5, 2018
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