SINGAPORE: Parents of stillborn children could soon choose to register names for them if proposed amendments to a law are passed.
“This is in recognition that stillbirths are similar to the loss of any child, which can be a painful experience for parents, and the official naming of a stillborn child may help some bereaved parents,” the Ministry of Home Affairs (MHA) said in a media release on Tuesday (Nov 7) when the proposed amendments were introduced in parliament.
The Registration of Births and Deaths Act was last amended in 2021.
Under the proposed changes, a stillborn child would be defined as one after 24 weeks of pregnancy, up from the current 22 weeks.
COMMEMORATIVE CERTIFICATES FOR NOW
While parents of stillborn babies get digital stillbirth certificates currently, the children’s names are not listed.
MHA said that before the proposed changes are implemented, parents may apply for a commemorative birth certificate with their stillborn child’s name for remembrance purposes, via the Immigration and Checkpoints Authority (ICA).
That was what Ms Mandy Too and Mr Aidan Hoy did as highlighted in a CNA report in October.
Desperate for some official recognition of the names of her stillborn twins – Abigail and Lara – Ms Too started an online petition in April which garnered about 2,800 signatures.
In early October, the couple received an email from ICA informing them that they could apply for a commemorative birth certificate for the twins.
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The authority told CNA that it started issuing commemorative birth certificates to parents of stillborn children on Oct 1.
Although the certificates are issued by ICA and bear the names of the stillborn children, it is not an official, legal document.
In a written reply to a parliamentary question from Associate Professor Jamus Lim (WP-Sengkang) in September 2022, Minister for Home Affairs and Law K Shanmugam noted that the names of stillborn children are not required for the government to administer public policies.
The registration process was also designed to be fully automated without parents having to take any action, to alleviate any administrative burden while they may still be grieving, he said then.
At the time, ICA had only received one request to register the names of their stillborn children so far, Mr Shanmugam added.
In response to CNA’s queries about whether Ms Too and Mr Hoy’s petition prompted the proposed amendments, MHA said they were the result of a review started in September 2022.
Changes to ICA’s systems to enable the official registration of names for stillborn children may be ready in about two years, the ministry added.
This is because the authority has other “more pressing system enhancements” to make, said MHA.
As of Nov 3, the government has issued seven commemorative birth certificates.
DEFINITION OF STILLBORN CHILDREN
Explaining the decision to potentially amend the definition of a stillborn child to after 24 weeks of pregnancy, MHA said this is to align with what is set out in the Termination of Pregnancy Act, which states that an abortion after 24 weeks of pregnancy is only allowed in the case of medical exigencies.
There has also been feedback from the medical community that the current 22-week threshold for what is considered a stillborn child – set in law in 2021 to align with the World Health Organization’s reporting guidelines – may be misinterpreted as an indication of fetal viability, or the ability of a human fetus to survive outside the uterus.
This may cause confusion for parents facing “important and difficult decisions” about medical interventions for their unborn child, MHA said in its press release.
It added that the medical community is also concerned that such ambiguities may lead to pressure on doctors to use more liberal treatment for infants born between 22 and 24 weeks of pregnancy, or resuscitation.
This could, in turn, result in potentially severe neurodevelopmental disabilities in infants who survive, and higher rates of futile attempts at resuscitation, MHA said.
The Bill therefore amends the threshold in the definition of a stillborn child to after 24 weeks of pregnancy.
“This will remove any confusion regarding fetal viability,” MHA said.
“Additionally, the Bill will make clear the existing position that abortion is not considered a stillbirth.”
MHA said in response to CNA’s queries that the amendment to the definition is planned for 2024.
The Ministry of Health also responded to media queries on the matter, noting that the threshold of at least 24 weeks of pregnancy is based on scientific evidence in the local context.
A 2018 review by MOH and local experts showed that the survival rate for premature babies born at 24 weeks was about 50 per cent, compared to 20 per cent for those born at 23 weeks.
Data from 2019 to 2020 from two local public hospitals also showed that out of 13 premature babies born at 23 weeks, six survived until they were discharged.
But all six of them suffered from severe problems such as chronic lung disease, brain haemorrhage and retinopathy of prematurity, which is a disease where abnormal blood vessels grow in the retina.
“These neonatal conditions often lead to neurodevelopmental disabilities, poor quality of life requiring lifelong medical treatment, and a shortened life expectancy,” said the Health Ministry.
With the newly proposed laws, there will be no changes to existing clinical practices, and active neonatal resuscitation is recommended at 24 weeks and beyond, MOH added.
“When faced with the prospect of delivering a fetus between 22 and 24 weeks, clinicians explain the chances of survival and risks of severe complications to the parents, before coming to a decision.”