The purpose of this Bill is to provide for official registration of stillbirths. There are over 300 stillbirths each year in Ireland. A stillbirth can be a very traumatic event for the parents involved. When a child is stillborn, parents can be left devastated and grieving. Bereaved parents can experience a strong sense of loss and, indeed, some parents experience long term suffering as a result of the stillbirth.
The process of grieving after a bereavement has received considerable research attention in the last decade or so. 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. Such validation is not available at present to the parents of stillborn children who receive no official recognition of the existence of their stillborn child. The establishment of a stillbirths register, as proposed in the Bill, would provide tangible evidence of the existence of stillborn children and so serve as a focus for the memories of bereaved parents.
There is some form of civil registration of stillbirths in most, if not all, other European Union countries. In this country, 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, have been campaigning on this issue for some time. The establishment of a stillbirths register was among the recommendations of the Second Commission on the Status of Women.
My approach to this Bill has been shaped by two considerations. On 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.
One of the first questions which had to be considered in drawing up the Bill was how to define a stillbirth. A stillborn child is a child born dead but viable outside the womb. There is, however, no universally accepted 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 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 2 that the Act will apply to a child who is born dead and who either weighs a minimum of 500 grammes or has a minimum gestational age of 24 weeks.
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, superintendant-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 correct. 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 (Ireland) Act, 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 legislation. Compulsory registration of stillbirths is the norm in other jurisdictions. By making registration compulsory, I believe that we assert the official 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 do 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 is 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. 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 purely 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 privacy of the persons concerned. The register 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 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.
I hope this Bill will be welcomed by all sides of the House. This is a measure which has been sought for some considerable time and I am very pleased to be able to introduce it. I look forward to positive contributions to the debate.