A new survey has revealed that 30 percent of university hospitals admitted patients after a multifetal reduction. The Yomiuri Shimbun conducted this survey among 72 hospitals across Japan. At least 42 pregnant women received care following such procedures since 2020. Consequently, this procedure lacks a clear legal status in Japan. Experts are now calling for urgent guidelines and rules to be established. The procedure involves injecting a drug into a fetus to stop its heart. Doctors perform multifetal reduction to reduce risks for both mother and unborn children.
Multifetal pregnancies can lead to premature births and hypertensive disorders. Therefore, a multifetal reduction aims to mitigate these serious health risks. However, ethical concerns surround choosing which fetuses get to live. Few medical institutions publicly disclose that they perform multifetal reduction procedures. The University of Osaka announced Japan’s first clinical study on the procedure in summer 2025. The university also unveiled a plan for a new joint clinical study with multiple institutions. The Yomiuri survey ran in November 2025 across 90 hospitals. Seventy-two hospitals replied to the questionnaire about multifetal pregnancies and reductions.
The University of Osaka was the only hospital reporting that it performed multifetal reduction between January 2020 and October 2025. Nevertheless, 27 hospitals across 17 prefectures admitted pregnant women who had received the procedure elsewhere. Interviews with these hospitals revealed at least 42 such patients. One facility that performs multifetal reduction is Suwa Maternity Clinic in Nagano Prefecture. That clinic became the first institution in Japan to report performing the procedure in 1986. Local medical institutions offering fertility treatments also perform these surgeries. During the same period, six hospitals referred at least nine pregnant women to other facilities for the procedure.
When asked about participating in the University of Osaka’s planned clinical study, eight hospitals said yes. Another 23 hospitals said they were considering joining the study. Yukiko Saito, associate professor at Kitasato University and bioethics expert, offered her perspective. Multifetal reduction is by no means rare, she stated. The survey has revealed that doctors treating pregnant women need to respond to this reality. She emphasized the importance of ensuring transparency around such procedures. She called for promptly establishing guidelines and rules for safe procedures benefiting both mothers and babies.
Looking ahead, the proposed clinical study may provide much-needed data on multifetal reduction outcomes. The lack of legal clarity leaves doctors and patients in a difficult position. Ethical debates will likely continue as more institutions consider participating. However, the survey demonstrates that multifetal reduction occurs across Japan despite limited public disclosure. The University of Osaka’s leadership may encourage other hospitals to come forward. Standardized protocols could help address both medical and ethical concerns. For now, patients seeking multifetal reduction must navigate an unregulated landscape. Experts urge the government to act quickly on this sensitive issue. The health ministry has not yet announced any formal response to the survey findings.
