Shirts off! The growing backlash against Japan's topless health checkups in schools

In Japan, the practice of requiring students to strip to the waist during routine health checkups has sparked significant controversy and discomfort among students, parents and educators. A report by The Guardian on September 6, 2024, sheds light on this issue, revealing that many students, some as young as 13, are subjected to health exams where they are asked to remove their shirts and, in some cases, bras. The emotional and psychological toll of these practices is profound. A survey highlighted by The Guardian found that 95.5 per cent of middle school students expressed dissatisfaction with having to undress for health examinations indicating a widespread sentiment of discomfort and embarrassment.

The testimonies of students underscore the distress associated with these exams. One 13-year-old girl recounted feeling exposed and humiliated during her school health checkup, while another described the anxiety of being instructed to lift her top and bra. Such experiences reflect the broader discomfort and trauma that many children face in this context.

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Inconsistencies in policy and practice

The lack of a unified policy on whether students should undress for health checkups has led to a patchwork of practices across Japan. Local education boards, in collaboration with visiting health professionals, determine the procedures for these exams. As a result, practices vary widely: some schools mandate that children, including those in senior high schools, remove their shirts and bras, while others allow students to remain clothed.

The inconsistency in implementation has fuelled frustration among parents and advocacy groups. For example, in some western Japanese cities, high school students are required to be topless during health exams. This variation in practices raises concerns about the adequacy and fairness of the procedures being used.

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Medical association and expert opinions

The Japan Medical Association has defended the practice of topless health checkups, arguing that removing clothing is necessary for a comprehensive examination. However, this stance has been challenged by medical experts who question the necessity of such practices. According to The Guardian, Kentaro Iwata, a professor of infectious diseases at Kobe University Hospital, has voiced scepticism about the medical justification for requiring students to undress. Iwata acknowledged that while removing clothing might slightly improve the clarity of heartbeat sounds, it is not essential for accurate health assessments. His comments reflect a growing concern among healthcare professionals about the balance between medical practices and patient comfort.

Government response and recommendations

In response to the mounting criticism, Japan’s Ministry of Education issued a notice on January 23, 2024, aimed at addressing privacy concerns during school health checkups. A report in The Mainichi said a notice from the ministry advised local education boards to avoid requiring students to undress if it does not compromise the accuracy of the examination. It suggested alternatives such as allowing students to wear gym clothes or use towels to cover their bodies. The notice also recommended measures to ensure privacy and respect during the exams, including conducting separate examinations for boys and girls and using partitions or curtains.

Despite these recommendations, the implementation of these guidelines has been inconsistent across different regions and schools. The discrepancy between the ministry’s recommendations and the actual practices observed in some schools has led to continued criticism and scrutiny.

Inconsistent implementation and continued criticism

The implementation of the Ministry of Education’s guidelines has not been uniform leading to continued issues and complaints. For instance, a report by The Mainichi on June 3, 2024, highlighted a case in Yokohama where students were required to undress from the waist up during health checkups. This situation prompted concerns about privacy and the adequacy of the measures in place to address students’ discomfort. Some students expressed their unease about having to undress, and parents criticised the lack of sensitivity towards their children’s feelings.

The situation in Yokohama points out to the broader issue of inconsistent application of guidelines and the need for more concrete and uniform policies. Despite the education ministry’s efforts to address these concerns, local variations in practices continue to affect students’ experiences.

Similarly, there were shockwaves in India in a 2020 incident in India where female trainee clerks at the Surat Municipal Corporation were allegedly made to stand naked in a group for a medical examination. This incident highlighted significant concerns about privacy and the respectful treatment of individuals during medical procedures.

Calls for reform and consistency

The ongoing controversy over topless health exams in Japanese schools highlights the need for comprehensive reform and consistent application of policies. Experts like Satoshi Kodama, a professor and medical ethics specialist at Kyoto University, have called for more specific guidelines from the education ministry to ensure uniformity across schools and regions, The Mainichi said in a report. Kodama emphasises the importance of science-based evidence and clear communication to address concerns about privacy and respect during health checkups.

The debate has also prompted a broader discussion about the balance between medical practices and respect for personal privacy. As Japan continues to grapple with these issues, it is crucial for policymakers and educational authorities to prioritise the comfort and rights of students while ensuring that health checkups are conducted effectively and respectfully.