This chapter introduces Japan’s alternative care system. With nearly 45,000 children in alternative care, Japan has the lowest rate of children entering care of any OECD country. The majority of these children are placed into institutional care (residential care), rather than family-based foster care or adoption. Institutions are also used for babies and infants, despite this contradicting globally accepted best practice.

After introducing the alternative care system and the function of the different institutions, the chapter next tracks the history of alternative care in Japan, which has seen limited change post World War II. There have been efforts over the last ten years to reform policy and practice, including promoting foster care. Efforts to promote foster care have had limited success, with the decentralisation of power leaving local authorities implementing policy very differently.

The chapter closes by examining how the budgetary structure of central and local government inhibit policy change. Local authorities have ‘diminished capacity’, having become dependent on private providers, which further stabilises the system.