From handbooks to platforms: Japan's maternal and child health services in the digital era.

The World Health Organization promotes universal health coverage and advocates digital initiatives. Japan has followed suit by pursuing the maternal and child health (MCH) system digitalisation. For decades, Japan has utilised a paper-based MCH handbook, credited with helping to maintain low perinatal mortality rates. However, such paper-based systems - both in Japan and abroad - often struggle with fragmented oversight, limited updates, and difficulty adapting to new technologies, thus fuelling demands for digital transformation. In this commentary, we describe Japan's ongoing transition to digital MCH services and the complexities of modernising a long-established paper handbook, including the need to maintain user confidence, ensure data security, and reconcile diverse stakeholder interests. Japan's experiences, reflecting both advantages and challenges, offer a cautionary yet instructive model for countries that digitise paper-based MCH frameworks.