SINGAPORE — Parents of infants who are stillborn may soon be able to officially register their stillborn child’s name within a year of the delivery, should a Bill introduced in Parliament on Tuesday (Nov 7) to amend the Registration of Births and Deaths Act 2021 be passed. 

The Stillbirths and Births (Miscellaneous Amendments) Bill aims to make official the naming of a stillborn child in recognition that stillbirths can be a “painful experience” for parents, similar to the loss of any child, the Ministry of Home Affairs (MHA) said in a press release.

The ministry added that the official naming of a stillborn child under the proposed legislation for remembrance may help some bereaved parents cope with the loss.

If passed, the Bill will introduce new provisions in the Registration of Births and Deaths Act 2021, which governs the registration of births, deaths and stillbirths.

Parents who wish to register a name for a stillborn child will be able to do so with the Immigration and Checkpoints Authority (ICA) within a year of the delivery. 

Parents may also apply for a commemorative birth certificate that reflects the stillborn child’s name, for remembrance purposes, through ICA’s website, in the time before the new provisions come into force if approved.

The inclusion of the names of stillborn children on official documents was highlighted by a petition started by Ms Mandy Too, whose twins Abigail and Lara were stillborn two years ago. The online petition, which started in April this year, has more than 2,800 signatories so far. 

Ms Too and her husband Aidan Hoy shared their experience in an interview with national news channel CNA last month, on why they wanted their twins’ names included in their stillbirth notification documents issued by the hospital, which referred to their twins each as “stillborn female child”.  

The couple also corresponded with Associate Professor Jamus Lim, Workers’ Party Member of Parliament for Sengkang Group Representation Constituency, who had filed a parliamentary question in September last year asking whether digital birth certificates would allow for the designation of a name for stillborn children.

In a written response to Assoc Prof Lim’s question, Minister for Law and Home Affairs K Shanmugam said at the time that there were two main reasons that stillbirth registration did not provide for the official naming of the stillborn child. 

“First, names of stillborn children, like in abortions, are not required for the Government to administer public policies and programmes.

“Second, it allows the registration process to be fully automated without parents having to take any action. This is to alleviate any administrative burden while they may still be grieving,” he said.  

He added then that to change the stillbirth registration process would require “further process and system changes”, but that MHA would study the feasibility and pros and cons of amending the system during its next review of the policy and process.

In response to TODAY’s queries, MHA said that it had started reviewing the issue in September 2022 and the proposed amendments are a result of the review.

MHA added that the amendment to the definition of stillborn child is planned to come into force in 2024, while the amendment that allows official registration of names for stillborn children will likely take effect at “in about two years’ time”. 

The estimate of two years takes into consideration the enhancements needed for ICA’s systems to allow for the official registration of names, and because ICA has other more pressing system enhancements to make, MHA said.

“In the interim, parents who wish to name their stillborn children can apply for commemorative birth certificates, which will reflect the name of the stillborn child,” it added. 

Pending the legislative amendments and system enhancements, ICA said that it has been issuing commemorative birth certificates since Oct 1 this year to parents of stillborn children.

As of Nov 3, seven commemorative birth certificates have been issued.

REVISING DEFINITION OF A STILLBORN CHILD

Along with the official registration of stillborn children, the drafted Bill will also redefine a stillborn child as one who is delivered after 24 weeks of pregnancy, instead of the definition now that is from 22 weeks, which was aligned with the World Health Organization’s International Classification of Diseases statistical reporting guidelines.

This proposed parameter will then correspond with the cut-off timing for abortions under the Termination of Pregnancy Act 1974, where an abortion is allowed for a baby up to 24 weeks of pregnancy.

Although MHA said that the present 22-week threshold for defining a stillborn child was not meant to indicate foetal viability — which is the gestational age at which a premature live-born baby has at least 50 per cent chance of survival until discharge from hospital — it has received feedback that it can be misinterpreted as such. 

Feedback received by MHA from the medical community indicated that ambiguities in the stillbirth threshold may add pressure on medical practitioners to use “more liberal” treatment for or resuscitation of infants born between 22 and 24 weeks of pregnancy. 

These could potentially result in higher rates of futile attempts at resuscitation and bears the risk of potentially severe neuro-developmental disabilities in infants who survive.

The Ministry of Health (MOH) said that it conducted a review together with local medical experts in 2018 on the survival and morbidity rates of premature babies. 

The survival rate for premature babies born at 24 weeks was found to be about 50 per cent and while it was around 20 per cent for those born at 23 weeks. 

Of the 13 premature babies born at 23 weeks, only six survived to discharge, according to updated data from 2019 to 2020 from two local public hospitals, said MOH.

However, all six who survived suffered from severe problems such as brain haemorrhage and severe chronic lung disease.

“These neonatal conditions often lead to neurodevelopmental disabilities, poor quality of life requiring life-long medical treatment, and a shortened life expectancy,” said MOH.

The proposed Bill raises the threshold to remove any potential confusion regarding foetal viability and to clarify the existing position that an abortion is not counted as a stillbirth especially for parents who face difficult decisions regarding possible medical interventions for their unborn child.

Other miscellaneous changes will be made to the definition of stillborn child in the Income Tax Act 1947 to reflect the amendments to the Registration of Births and Deaths Act 2021 if passed, for the purposes of administering tax benefits.