I move: "That the Bill be now read a Second Time."
The purpose of this Bill is to provide for offical registration of stillbirths. There are more than 300 stillbirths each year in Ireland, or about six in every 1,000 births. A stillbirth can have a very powerful impact on the lives of the parents involved. It is an event which can create great loneliness and shock. There is ample testimony of the trauma and sense of loss which parents can experience following a stillbirth. In some cases, parents can experience long term suffering as a result of the stillbirth.
One of the significant developments in psychology in recent years has been recognition of the need to grieve as part of the healing process. Research evidence is accumulating which concludes that an important facet of the process of coming to terms with, or adapting to, any loss involves recognition and acknowledgement of the person who has died. This acknowledgement facilitates appropriate grieving after the loss. It is associated with more positive adaptation to the loss and far better long term psychological outcomes.
The parents of stillborn children here receive no official recognition of the existence of their stillborn child. There is some form of civil registration of stillbirths in most, if not all, other European Union countries. In Ireland, there have been calls from many quarters for the establishment of a stillbirths register. Bereaved parents, and in particular the Irish Stillbirth and Neonatal Death Society, ISANDS, has been campaigning on this issue for some time. The Second Commission on the Status of Women also recommended that a stillbirths register be established.
The establishment of a stillbirths register, as proposed in the Bill, will not only bring this country into line with other European Union countries but, more importantly, will provide tangible evidence for parents of the existence of their stillborn child. The register will thus serve as a focus for the memories of bereaved parents and help them to come to terms with their loss.
My approach to this Bill has been shaped by two considerations. On the one hand, the rationale for stillbirths registration is essentially therapeutic. Stillbirths registration is primarily intended to comfort grieving parents rather than to serve an evidential or statistical purpose. Statistics on stillbirths are already compiled by the Central Statistics Office and by the Department of Health. Given its therapeutic rationale, the stillbirths registration system should not be unduly bureaucratic or impose additional burdens on bereaved parents. On the other hand, if an official register is to be created, some procedural formality is necessary to ensure the accuracy of the information recorded. The Bill aims to combine sensitivity to the needs of bereaved parents with the formality appropriate to a part of the civil registration system.
I have given considerable thought to the definition of a stillbirth to be included in the Bill. A stillborn child is a child born dead but viable outside the womb. There is, however, no universally accepted medical definition of what constitutes viability. In some countries the demarcation between a miscarriage and a stillbirth is based on gestational age. The gestational age used was typically 28 weeks, but because of advances in medical care this has been reducing. Twenty-four weeks is now the threshold for stillbirths registration in the UK. Other countries base their definition on the weight of the child, 500 grammes being the normal weight used.
A case can be made for either criterion. Weight is regarded as more definitive than gestational age, which can be difficult to assess. Weight is also the World Health Organisation's preferred criterion. On the other hand, gestational age reflects parents' expectations about the outcome of pregnancy more accurately than weight, which is typically unknown. My view is that since the main reason for establishing a register is to comfort grieving parents, the definition of a stillbirth in the Bill should be as wide as possible, consistent with accepted medical norms. I have therefore provided in section 1 that the Bill will apply to a child which is born dead and which either weighs a minimum of 500 grammes or has a minimum gestational age of 24 weeks.
I would emphasise that the Bill is about registration of stillbirths and that the registration of miscarriages is not within its scope. There is an acknowledged difference between a stillbirth, which is a child born dead but viable outside the womb, and a miscarriage, where the pregnancy ends before viability is reached. The registration systems in other European Union countries draw a line between a stillbirth, which is registrable, and a miscarriage, which is not. While I recognise that a miscarriage can be a source of distress and disappointment to the parents involved, this Bill is dealing with the question of stillbirths registration.
Section 3 of the Bill provides for the registration of stillbirths within the existing organisational framework for registration of births, deaths and marriages. In other words, responsibility for the registration of stillbirths would be assumed by the Registrar-General, superintendent-registrars and the 300 local registrars. A stillbirth will therefore be registered at local level as is a birth or death.
As the stillbirths register is an official one and as certificates will be provided to parents, it is important the information held on the register be accurate. I have therefore provided in section 5 that where the parents of the stillborn child are not married to each other, the procedural formalities for recording the father's name on the register will be the same as for a live birth. These procedures are set out in section 7 of the Births and Deaths Registration Act (Ireland), 1880, as amended by section 49 of the Status of Children Act, 1987.
Section 6 of the Bill provides that registration will be compulsory in the case of stillbirths which occur on or after the commencement of this Bill. Compulsory registration of stillbirths is the norm in other jurisdictions. By making registration compulsory I believe that we assert the offical character and status of the register and thereby reinforce the reality of the stillborn child, particularly as perceived from the parents' point of view. I recognise, however, that it would not be appropriate to add to the grief of the parents by imposing a duty on them to inform the registrar of a stillbirth or by pursuing them for failure to do so. Section 6 provides an option for the parents to inform the registrar of the stillbirth if they wish. If the parents do not choose to inform the local registrar themselves within a specified period, then the duty to inform the registrar will fall to the relevant hospital or, where no hospital is involved, to the relevant medical practitioner. This procedure will ensure that registration is comprehensive.
I am also making provision, in section 7, for retrospective registration of stillbirths. A stillbirth which occurred at any time before the commencement of the Bill may be registered at the request of either parent and subject to the production of satisfactory supporting documentation. This degree of retrospection is unusual in legislation but I am conscious of the fact that the suffering of bereaved parents of stillborn children can last for a long time, even for decades. In the absence of retrospection this Bill would come too late for many people. I believe that a compassionate approach requires that we facilitate those who want official recognition of past stillbirths. Such retrospective registration will, of course, be entirely voluntary as it would be neither practical nor desirable to make registration of past stillbirths compulsory.
Section 8 deals with stillbirths registers. Information held on these registers will not be accessible to the public. This differs from the position in relation to birth and death certificates, where any member of the public is entitled to search indexes of registers and is entitled to obtain any certificate simply by paying the required fee. In the case of stillbirths no public interest would be served by having the information on the registers open to the public and, given the relatively small number of stillbirths each year, an openly accessible register could be seen as an invasion of the privacy of the person concerned. The registers of stillbirths here, like those in the UK and Northern Ireland, will be private.
A certificate of a stillbirth will be available to the parents of the stillborn child, either at registration, if the parents choose to notify the registrar themselves, or subsequently, subject to verification of the parents' identity. Stillbirth certificates will otherwise be made available only at the discretion of the Registrar-General. The fee will be the same as for a birth certificate. The format of the stillbirth certificate, which is detailed in the Schedule to the Bill, will resemble that of a birth certificate but will include information on the weight and gestational age of the the child together with information on both the mother's and the father's occupation and other personal details in line with the recommendations of the Second Commission on the Status of Women. This format will be the same for all stillbirths regardless of when they occurred.
I hope that this Bill will be received positively in the House. The campaign for a register of stillbirths has been in train for some considerable time. I am very pleased to be able to introduce this measure and I look forward to constructive contributions to the debate.