Japan's Old Age Crisis and Ours to Come

What happens when people live to be very old and don't have a passel of kids to take care of them?

Netsuke photos from Metropolitan Museum of Art

The days of our years are threescore years and ten; and if by reason of strength they be fourscore years, yet is their strength labour and sorrow; for it is soon cut off, and we fly away. —Psalms 90:10, King James Version

Most of the coverage of Japan’s aging population focuses on the current low birth rate and its implications for the future. In January, prime minister Fumio Kishida told legislators that the country is “on the brink of not being able to maintain social functions” because of its falling birth rate. “In thinking of the sustainability and inclusiveness of our nation’s economy and society, we place child-rearing support as our most important policy,” he said.

But even if the government succeeds in goosing the birth rate, the effects will be felt decades from now. Japan has an immediate problem that dates back to policies adopted in 1948. People over 75 now make up 15 percent of the population, and they don’t have a lot of kids to take care of them. Japan’s postwar baby boom lasted only about two years. By contrast, the U.S. experienced high birth rates from 1946 to 1964.

In 1948, the Diet passed the Eugenic Protection Law. It made abortions legal and cheap, about $10. “Critics assert that it is easier for a woman to avoid an unwanted child in this way than to have her tonsils re­moved,” The New York Times reported in 1964. “One result of the prac­tice has been the virtual elimi­nation of illegitimate births.”

The bill also promoted contraception, establishing “eugenic protec­tion consultation offices” throughout the country. They provided marriage counseling and gave couples “guidance in adequate methods of contraception.” Local governments trained midwives and nurses to encourage family planning. Employers, unions, and nonprofits pushed the idea of smaller families and helped spread information about how to achieve them.

The Times reported:

At the Tokyo Steel Com­pany plant at Kawasaki, near Tokyo, a pilot project was set up among families of the 20,0000 workers. Housewives were given the opportunity to receive family-planning guid­ance as an alternative to such other instruction courses as cookery or household eco­nomics. A leader met with groups of about 10 women and explained not only birth con­trol techniques but ways in which family life would be improved if there were fewer children.

Initially the labor union charged that the program was a plot by management to reduce the outlay for family al­lowances—wage supplements paid to workers according to the number of their children. But the women accepted the courses eagerly and as word spread, enrollment in family­ planning instruction rose to almost 100 per cent. The birth rate among company families dropped markedly, the rate of pregnancies and abortions de­clined and the number of those practicing contraception rose quickly by more than 25 per cent….

Since the eugenic program began, surveys have discov­ered that there has been not only an increasing acceptance of the idea of family limitation but a shift in the reasons given for it. In the immediate post­ war years simple economic factors were dominant. Now, in a more prosperous and com­petitive society in which edu­cation is the key to advance­ment, 43 per cent of mothers say that their chief purpose is to provide better education for a smaller number of children. Twenty-nine per cent mentioned safeguarding of the mother’s health and 9 per cent the desire for a more pleasant life, while only 12 percent mentioned financial strain.

The result of the eugenic program has been that Japan’s birth rate has been cut in half.

Unlike China’s notorious One Child policy, the program wasn’t coercive. But it made smaller families a norm in Japan a generation earlier than in the U.S. The results are a preview of what American baby boomers will face as they get old.

For the first time in human history, large numbers of people are living to advanced ages. A life span of only “three score and ten” is a tragedy for us, not an expectation. (When the mother of my oldest friend died last year at 91, I recalled overhearing a conversation she’d had with my mother after she turned 35, which seemed impossibly old at the time. “Half a lifetime,” she’d said.) Seven percent of the U.S. population is now over 85. In 1950, the number was so low it shows up as zero percent in United Nations figures. The 14 percent of the population over 80 compares to 1 percent in 1950.¹ These numbers will only grow in the coming decades. The oldest baby boomers turn 80 in 2026, the youngest in 2044.

Thanks to the baby boom, today’s very old Americans tend to have multiple children to take care of them. Even for those living on their own or in institutions, eldercare is time-consuming, emotionally draining, and often extremely expensive. There are forms to fill out, bills to pay, errands to run, and health care to arrange—not to mention emotional needs. It’s easier if, like my own parents, the very old have a diversified portfolio of kids, preferably including at least one medical professional, to take care of the things they can’t handle.²

The alternative is what Japan is experiencing: a rapidly growing population of very old people without much family support. In some cases, the unshared burden of taking care of parents simply becomes too much, especially when the parent is a difficult character. In others, middle-age children—including increasing numbers of men—are quitting their jobs to take care of their parents. At the extreme are “lonely deaths,” or kodokushi, when people die alone and go unnoticed for days. (In some cases, the deceased elderly person was not alone but living with a person with dementia.)

As a childless baby boomer, I’m afraid I don’t have a good solution.³ But we’ve been warned.

1. Using ChatGPT, I got a bunch of potentially useful data on the percentage of various national populations over 80 from 1920 to the present. But I can’t be sure the AI isn’t making stuff up and by the time I find the numbers on the cited sources I haven’t saved any time. ChatGPT has an enormous advantage at rummaging through databases but that isn’t any good if I can’t trust it. And it looks like it was wrong.

2. I live a continent away from my parents. My very capable brother who lives in the same town has taken on day-to-day responsibilities. Another brother, who lives across the state and visits several times a month, is an M.D. and talks with medical staff. I mostly handle finances, which can be done at a distance.

3. No, I don’t regret not having kids. You’re reading my work because I didn’t.