(Bloomberg) -- Tokyo Governor Yuriko Koike vowed to subsidize the cost of epidurals, in her latest effort to entice people to have children, as she seeks to fend off a challenge from a high-profile female opponent in an election next month. 

Koike, who is running for her third term as governor, announced the new policy amid a raft of others on Tuesday, while opposition Constitutional Democratic Party lawmaker Renho Saito also revealed pledges to improve compensation for contract and part-time workers as a way to fight the low fertility rate in the capital of the world’s most elderly country. 

“After having their first child, I hear people say they don’t want to experience that pain again,” Koike told reporters, adding she would work so that women want to have a second or third child. “I want people to see childbirth and raising children as a happiness, not a risk,” she said. 

The campaign is set to start on Thursday, with a record of more than 50 candidates set to run, according to public broadcaster NHK. The others include Shinji Ishimaru, the former mayor of a city in Hiroshima and Toshio Tamogami, a former chief of staff of the Air Self-Defense Force.

Koike’s platform includes expanding free childcare to first-born children. Renho, who generally goes by her given name, emphasized improving conditions for workers to change the tide on the fertility issue, with a pledge to turn contracted government staff into full-time workers. 

“I will implement genuine long-term fertility measures, support young people thoroughly, and expand their life choices,” Renho said. “I will also realize transparent fiscal reforms, where everyone can check the situation.”

Demographic issues gained renewed urgency after data showed the fertility rate, an indication of the average number of children a woman is likely to produce over her lifetime, dropped below 1 in Tokyo last year, while the nationwide figure hit a record low of 1.2. 

Koike has introduced a series of policies aimed at bolstering fertility in the 14-million strong metropolis since she came to office in 2016, with little success. Next to come is a municipal matchmaking app set to be launched this year. The Tokyo government has also been overwhelmed by interest in subsidies for egg-freezing.

Her championing of epidurals — which are rare in Japan — is an eye-catching new tactic. A survey conducted by the health ministry found that the pain-relief method was used in 8.6% of births in the month of September 2020. That compares with 4.6% for the whole of fiscal 2014, according to a separate study from the Japan Association of Obstetricians and Gynecologists. By contrast, about three quarters of births in the US involve epidurals.

Reasons for the low usage of epidurals include cultural beliefs that favor natural childbirth, with pain seen as a necessary part of the process. Japan also has a lack of qualified anesthesiologists, and where hospitals do offer epidurals, they are expensive. 

The average cost of childbirth in Tokyo was around ¥565,092 ($3,584.9) in 2021, according to data from the health ministry, although this is generally offset by subsidies. Epidural use typically adds ¥100,000 to ¥200,000 to the total. 

A victory for Koike in the July 7 vote would likely be a relief for the ruling Liberal Democratic Party, of which she was previously a member. A loss to the opposition — following on from a series of special election defeats — would further underscore Prime Minister Fumio Kishida’s woes after support for his cabinet fell to a fresh low in two media polls at the weekend. 

Koike also promised to improve Tokyo’s resilience against natural disasters. Renho vowed stronger checks on government spending, an issue she pursued as a lawmaker. Renho also called for a halt on a controversial redevelopment project that opponents say threatens to destroy a beloved avenue of ginkgo trees along with historic sports stadiums in central Tokyo. 

--With assistance from Yoshiaki Nohara.

(Updates with pledges from Koike’s rival Renho Saito.)

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