Lead
On March 11, 2011, the Great East Japan Earthquake struck. The tsunami that followed destroyed public health centers across the affected coastline, and in some municipalities the master records for the issuance of the boshi techo — the Maternal and Child Health Handbook — were lost entirely. When mothers at evacuation shelters were asked about their children's vaccination histories, some had nothing to show.
This is not history in the sense of being over. In the 2016 Kumamoto Earthquake, public health centers in affected areas lost function, and confirming vaccination and health checkup records for young children became difficult. Japan faces elevated risks of earthquakes, flooding, and typhoons across much of its territory. In many regions, "this might happen someday" is closer to "this could happen at any time."
The question this article addresses is concrete: where and how should a child's health records be kept so they are accessible when they are needed most?
The Maternal and Child Health Handbook — Paper's Strengths and Its Vulnerability
Japan's boshi techo (Maternal and Child Health Handbook) is a singular institution — a single booklet tracking health records from pregnancy through the preschool years, held by the family and shared with healthcare providers at each visit. Nothing quite like it exists as a standard national system in most other countries. Takeuchi and colleagues (2016) reviewed the handbook's history, contents, and value comprehensively, showing that since its introduction in 1947 it has functioned alongside a dramatic decline in infant and child mortality: the rate of deaths occurring in children under one year (infant) and under five years (child) per 1,000 live births [1]. Its core value is precisely that it is a record shared between parents and the healthcare system: the same document travels with the child from prenatal clinic to delivery to the 18-month checkup to the three-year checkup, carrying cumulative history that no single provider would otherwise hold.
But a paper document has physical vulnerabilities. It can be destroyed by flood, fire, or tsunami. A survey conducted in Miyagi Prefecture following the 2011 earthquake recorded the impact of the disaster on maternal and infant health management among women who had recently given birth; administrative records were lost on the institutional side, while individual handbooks held by families paradoxically became the only surviving source of information [2]. The handbook's importance was thrown into relief by the very catastrophe that threatened to eliminate it.
At the same time, mothers who had evacuated reported the opposite problem: "I brought the handbook but the clinic I'm seeing at the evacuation shelter has no context for what's in it," or "I need a replacement copy and cannot get one from my home municipality." Paper's strength — it can be consulted offline without any infrastructure — and its weakness — a single physical object that can be lost or destroyed — are two sides of the same document.
Post-earthquake assessments of maternal and child health following the 2016 Kumamoto Earthquake identified lasting disruption to infant health checkup schedules and vaccination timing: the sequence and age schedule at which immunizations are administered to provide optimal protection as among the persistent problems for affected families [3]. These are not catastrophic failures in isolation, but the accumulated disruption to preventive care for thousands of young children represents a meaningful public health cost.
The boshi techo, in other words, is excellent — and it is not enough on its own.
The Case for Digitization — Designed as Redundancy, Not Replacement
Digitizing the boshi techo entered serious policy discussion in Japan in the 2020s. The Ministry of Health, Labour and Welfare released materials in 2021 examining the direction of digitization [4], and pilot electronic issuance programs have been advancing at the municipal level.
The primary value of digitization is redundancy. Records stored in the cloud can be accessed even when the physical handbook has been destroyed. If data sharing between healthcare facilities follows, a family evacuated to another city could have records available there as well.
But digitization does not reduce risk to zero. In a major disaster, communications infrastructure fails, and charging mobile devices becomes difficult. Cloudless access during extended power outages was not a theoretical concern in 2011 or in Kumamoto — it was the actual situation. Centralizing everything digitally creates a different single point of failure than paper does.
The rational design is paper plus digital as redundancy. Paper is vulnerable to physical destruction but requires no infrastructure to read. Digital is resilient against physical loss but vulnerable to communications failure. Combining them — and distributing copies across multiple locations (device, cloud, printed backup) — is the approach that maximizes access under different failure modes.
Information Sharing Within the Family — Including Non-Technical Members
A second disaster scenario is that the person who holds the information is not present when it is needed. A parent is injured and unconscious at the disaster site. A child has become separated from their caregiver in the chaos of evacuation. In those situations, whether grandparents, relatives, or daycare staff can access a child's medical information may determine the quality of care that child receives.
Japan's Basic Disaster Management Plan, administered by the Cabinet Office, identifies information management and sharing for vulnerable populations — including pregnant women, infants, and young children — as a component of disaster response [5]. But in practice, the mechanisms for that sharing are largely left to individual families as a matter of self-preparedness. What the policy establishes in principle, families have to implement in their own households.
This is where non-technical solutions matter as much as digital ones. A grandparent or relative who is not a smartphone user cannot access a cloud account under stress. A daycare staff member should not need to log into an app to find out whether a child is allergic to penicillin. The relevant information needs to be available in formats that different people in different situations can actually use.
Practically speaking, three measures are widely cited as effective:
- An emergency information card — a small laminated sheet listing the child's name, blood type, allergies, regular physician, and caregiver contact numbers — kept with the child's health insurance card and boshi techo
- Shared account access — ensuring that more than one family member has the credentials to access cloud-stored records, with a password stored somewhere other than the primary caregiver's phone
- Coordination with the regular physician — confirming that health checkup and vaccination records are also held in the medical practice's own system, so that information can be reconstructed even if all personal records are lost
Rethinking What Recording Is For
The purpose of parenting records is not only to make visible the arc of a child's growth. Medical information, vaccination history, allergy documentation, and developmental notes kept in a continuous timeline serve a different function in an emergency: they become the information that allows others to protect the child.
A parenting app like Memori, designed to keep a timeline of photos and health notes accessible across multiple devices and shareable within a family, can function in this context not only as a memory album but as a redundant repository accessible when it matters most. Thinking about your records through the lens of emergency access — alongside the more ordinary lens of nostalgia — changes what it means to keep them well.
"I'm glad I kept that record" is a sentence that usually comes out of ordinary life. But the possibility that it comes out of an urgent situation is also a reason to start keeping records in the first place.
Summary
The history of the boshi techo and the documented experiences of the 2011 earthquake and 2016 Kumamoto Earthquake together illustrate the indispensability and the vulnerability of paper records at the same moment. Digitization offers redundancy along one axis but introduces dependence on communications infrastructure along another.
The conclusion is not "one or the other" but "both, in multiple places." A low-technology solution — the emergency information card — combined with a high-technology solution — cloud-stored records — is the realistic design for information access in a crisis.
Disasters arrive without notice. The design of your records is something you can do today.
References
- Takeuchi J, Sakagami Y, Perez RC. The mother and child health handbook in Japan as a health promotion tool: an overview of its history, contents, use, benefits, and global influence. Glob Pediatr Health. 2016;3:2333794X16649884. doi:10.1177/2333794X16649884. PMID: 27336022
- Yoshii C, Nakamura T, Hori C, et al. Report on maternal anxiety 16 months after the Great East Japan Earthquake disaster: anxiety over radioactivity. Glob J Health Sci. 2014;7(1):52–62. doi:10.5539/gjhs.v7n1p52. PMID: 25363115. PMC: PMC4825496
- Ishii K, Nishi D, Hamazaki K, et al. Prolonged maternal and child health, food and nutrition problems after the Kumamoto Earthquake. Int J Environ Res Public Health. 2021;18(5):2309. doi:10.3390/ijerph18052309. PMID: 33652731. PMC: PMC7956302
- Ministry of Health, Labour and Welfare, Maternal and Child Health Division. Materials on the Maternal and Child Health Handbook and Related Information. 2021. https://www.mhlw.go.jp/content/11908000/000942846.pdf [in Japanese]
- Cabinet Office, Japan. Basic Disaster Management Plan (Revised May 2023). 2023. https://www.bousai.go.jp/taisaku/keikaku/pdf/kihon_basicplan_R05.pdf [in Japanese]