Japan's institutionalised children
Masami Noguchi* resembles a typical Japanese schoolgirl. She happily lists music, origami and badminton as her hobbies and curry rice as her favourite food.
But the 17-year-old stands out from most of her peers in one respect - she is one of thousands of Japanese children who have spent years living in institutions.
Masami was put into care at the age of three, after her abusive grandfather stabbed her mother, marking the start of nine years living in the challenging confines of a state-run institution.
"They had very strict rules," she said. "I could never bring my school friends there. I couldn't go out freely even if I had pocket money and wanted to buy something."
"The staff were very strict. I always had to obey the older children. Younger kids were bullied, including me. The staff beat the kids if they broke the rules. There was strong competition for food and the smaller kids often lost out."
Today, Masami clearly counts herself as one of the lucky ones. Four and a half years ago, she was removed from the institution and placed in foster care - enabling her to enjoy the normality and security of family life for the first time in nearly a decade.
"Now I have my own room. There is nobody to bully me anymore," she said.
"In the institution, I never knew what was going to happen in the next moment so I never felt secure. Here, it's very peaceful and safe."
Masami is all too aware that she is in a minority. Nearly 90% of 39,000 children in care last year were living in government-run institutions rather than with families, Human Rights Watch said in a report released earlier this year.
The rate is the highest among industrialised nations, the report warned, with as few as one in 10 children eventually moving to a family environment through fostering or adoption.
As a result, tens of thousands of Japanese children live in understaffed institutions, often enduring cramped conditions, bullying, violence and social stigma as a result.
A key cause for concern are the thousands of infants who are living in institutions, more than 3,000 children last year, despite the United Nations' Alternative Care Guidelines calling for under-threes in care to be placed in family-based settings.
Describing the situation in Japan as "heartbreaking", Japanese director at Human Rights Watch Kanae Doi said the government was prioritising a care policy heavily dependent on institutions over the rights of children to a family life.
"It is because bureaucratic priorities trump children's rights," she said.
"The financial interests of existing childcare institutions that get government subsidies based on the number of resident children make any meaningful reform very difficult.
"Based on this reality, Japan's child guidance centres often defer to the preference of biological parents to place the child in an institution rather than with a foster family, or they seek to avoid time-consuming and often sensitive adoption or foster care arrangements."
The potential impact of living in an institution, rather than with a family, has been well-documented with effects including poor physical health, developmental delays and long-lasting psychological damage.
Kevin Browne, a professor of Forensic Psychology and Child Health at Nottingham University, said in the Human Rights Watch report entitled, "Without Dreams" that "even apparently 'good quality' institutional care can have a detrimental effect on children's ability to form relationships throughout life".
Also cited in the report was Toshiyuki Abe, now 19, who recalled being brutally bullied as a young schoolboy in an institution.
"I was beaten by a baseball bat, hit in the face. The older guys would just hit me if they were having a bad day," he recalled.
The 119-page report called for a major reform of the Japanese care system, including the closure of all infant-care institutions and the priority of adoption or fostering over institutionalisation.
In response, Japan's Ministry of Health, Labour and Welfare said it was taking active steps to increase the rate of family-based care for children removed from their parents.
"In the current situation, 90% of children are staying in welfare facilities while 10% are with foster parents at a family home," a spokesman said.
"Our aim for the next few decades is to balance their distribution so that roughly a third of them will be staying with foster parents in family homes, group homes and welfare facilities - all of them on a small scale - respectively."
Until then, Masami - one of three foster children living with a family in Machida, western Tokyo - appears destined to remain a minority in Japan.
"In Japan, there seems to be an unconscious feeling that orphans should be in institutions," said Mika Hobbs, 48, her foster mother.
"There is a strong sense of 'blood ties' and the idea of taking another person's child does not seem natural to Japanese people."
Highlighting the benefits of being in a family context, she added: "[Outside institutions], they can be complete individuals."
"They are engaged in school activities, sports, local activities. We can see them expand before our eyes. But they still feel some stigma about having been in an institution."
*Name changed to protect identity