Stillbirths and Births (Miscellaneous Amendments) Bill

Order for Second Reading read.

3.47 pm

The Minister of State for Home Affairs (Ms Sun Xueling) (for the Minister for Home Affairs): Mr Deputy Speaker, on behalf of the Minister for Home Affairs, I beg to move, "That the Bill be now read a Second time."

The Registration of Births and Deaths Act 2021, or RBDA, governs the registration of births, deaths and stillbirths in Singapore. This Bill introduces two main amendments in relation to stillbirths.

First, clause 9 of the Bill will introduce new sections in RBDA to allow for the official naming of a stillborn child.

The new section 36A will enable the parents of a stillborn child to apply to the Registrar-General of Births and Deaths, or RG for short, for a name to be entered in the stillbirth register within one year after the stillbirth, should they wish to do so.

Mr Deputy Speaker, Sir, the Ministry of Home Affairs (MHA) has heard the views of bereaved parents. We have heard their deeply felt sentiments that a stillbirth is similar to the loss of any child. For some parents, being able to officially name the child is an important step in the healing process.

I would like to especially thank Ms Mandy Too, who had advocated for a stillborn child's name to be entered in the stillbirth register.

In her correspondence, she shared, "official documentation for stillborn babies would afford them a level of dignity commensurate with the impact they had on those who grieved for them" and that it would mean the world to her and her husband if their daughters' legacy would help future bereaved families. The time her twin girls – Abigail and Lara – spent with us may have been short, but they have left an indelible mark in this journey to help the bereaved parents.

Others had shared their views in an online petition.

"For my sleeping child, WY", said one mum. Another mum said, "Every birth should be recognised, and every baby deserves a name. In 2007, I lost a baby boy at 24 weeks, and it took me 15 years to finally have another baby."

I would also like to mention Ms Felicia Tan, who lost three children and subsequently set up Angel Hearts, a not-for-profit group which creates angel gowns for babies who sadly do not make it home from the hospital. She shared that it is heartbreaking for parents to go shopping for suitable wear for burial as the babies are so tiny that even the smallest baby clothing would simply be too big for them. She said, "Giving the babies a name and clothing them is our way of saying goodbye and remembering them."

Another parent reached out to me for a commemorative certificate as they were preparing for a memorial for their stillborn child.

We hope the amendments to RBDA to allow for the official registration of a name for a stillborn child will go some way to recognise the birth of the child and support the healing process for bereaved parents.

Once clause 9 comes into force, there will be a facility for parents to apply to the RG to register a name for the child, within one year after the stillbirth. Subsequently, the digital stillbirth certificate for the child, which can be downloaded from the My Legacy website, will reflect the child's registered name.

The official naming of stillborn children will require enhancements to the Immigration and Checkpoints Authority's (ICA's) systems. As ICA also has other pressing system enhancements, the enhancement relating to stillbirth naming will take some time. We estimate it to be about two years.

The name for a stillborn child will be subject to requirements laid out in the new section 36B, which mirror the requirements for live births. For instance, the name should not be offensive or obscene.

In the interim, parents who wish to name their stillborn child may apply to ICA for a commemorative birth certificate that reflects the child's name, for remembrance purposes. This can be done through ICA's website.

Currently, "stillborn child" is defined in section 2(1) of RBDA as "a child that issues from the child's mother after the 22nd week of pregnancy and does not show any sign of life at any time after being completely expelled or extracted from the mother." I apologise that this is legal language.

Clause 2 of the Bill amends the definition by raising the threshold from 22 weeks of pregnancy to 24 weeks. To provide context, RBDA was enacted in 1937 with a definition of stillbirths that used a threshold of 28 weeks of pregnancy.

In 2021, when RBDA was repealed and re-enacted, the definition of "stillborn child" was updated to the current threshold of 22 weeks, to align with the World Health Organization's (WHO's) statistical reporting guidelines which recommended using a gestational age of 22 weeks of pregnancy. These guidelines are non-binding on countries and MHA had, in 2021, decided to adopt them for RBDA for consistency with the WHO for the purpose of statistical reporting.

Subsequently, MHA received feedback from our local medical community that the threshold of 22 weeks of pregnancy in RBDA may be misinterpreted to be an indication of foetal viability, which refers to the ability of a foetus to survive outside the womb. Medical practitioners are concerned about this, because local medical and scientific evidence points to 24 weeks of pregnancy as the threshold for foetal viability and not 22 weeks.

Reviews by the Ministry of Health (MOH) in 2018 and 2022 involving local experts concluded that the survival rate for premature babies born at 22 weeks is close to zero, while foetal viability at 24 weeks is about 50%. It is also for this reason that the 24-week threshold is reflected in the Termination of Pregnancy Act 1974, where an abortion is not allowed for a foetus of more than 24 weeks' duration.

Medical practitioners highlighted that if parents mistook the 22-week threshold in RBDA as an indication of foetal viability, there could be confusion for them on the medical interventions for their unborn child.

We have only had one surviving baby born at 22 weeks in Singapore for the last 10 years. The media reported that the child, a baby girl, was born in 2018 and required a slew of life-sustaining treatments and maximum ventilator support. She spent a total of 166 days in the hospital before being discharged. She is a miracle baby who survived despite the odds. Sadly, such cases are extremely rare.

MHA has reviewed the matter with MOH and will amend the threshold in the definition of "stillborn child" in RBDA to 24 weeks of pregnancy. This will align with the cut-off for abortions in the Termination of Pregnancy Act 1974 and remove any potential confusion regarding foetal viability. For absolute clarity, clause 2 of the Bill states the existing position that a stillbirth does not include an aborted foetus.

I would like to assure Members that the amendment to RBDA to raise the threshold to 24 weeks of pregnancy does not imply or indicate any changes to medical guidelines, practices or the standard of care for premature babies born before 24 weeks of pregnancy.

Clauses 10 and 11 of the Bill make similar amendments to the definition of "stillborn child" in the Income Tax Act 1947. Stillborn children are counted in the child order for the purposes of administering tax benefits.

The Bill also makes other amendments, which I will summarise.

Clauses 3 to 8 of the Bill make amendments to RBDA in relation to registration and re-registration of births. These amendments are meant for clarity, with no changes to existing processes.

Clauses 12 to 15 of the Bill make consequential amendments to other Acts, for example, to update the reference to the RBDA 1937, which has been repealed, to the RBDA 2021.

Mr Deputy Speaker, before I conclude, I would like to share that this journey has not been an easy one. The conversations with bereaved parents, medical practitioners and community partners have been wrought with emotion.

Last Friday, as I was settling my younger child to sleep, she suddenly asked if she was a rainbow child. She had watched an episode on "Bluey", an Australian animated series, on baby loss. She reminded me about this rainbow pendant, which was gifted to me by a non-profit organisation, Angel Hearts, last year.

I hope that today's amendments will help bereaved parents in some way and also remind us that as we treasure and honour our babies who have departed, let us also look to the future with hope.

Ms Mandy Too is now a mother to Josie; and Ms Felicia Tan, a mother to Titus. I wish all our parents the very best. Mr Deputy Speaker, Sir, I beg to move.

Question proposed.

Mr Deputy Speaker: Mr Gan Thiam Poh.

3.58 pm

Mr Gan Thiam Poh (Ang Mo Kio): Deputy Speaker, Sir, there are strong reasons to support the Bill to allow bereaved parents to name stillbirth babies, whom they had carried for more than 24 weeks.

I hope that families experiencing this tragic loss can find some solace and closure in naming their babies and as they conduct the necessary rites with these names, laying the babies to rest.

This legislation recognises these babies as beings in their own right – distinguishable from their parents. May the names provide their grieving parents a last chance for them to express their hopes and wishes for their children, gone too soon.

I commend the Ministry for considering and fulfilling the wishes of the affected families. I, therefore, wholeheartedly support this proposed legislation, notwithstanding, there are some pertinent issues for the consideration of the Ministry.

One consideration for parents after a stillbirth is the availability of a wrongful death claim. If a baby's stillbirth was due to wrongful conduct, it is important to recognise the tort claim. The approach may be taken from a legal marker equating foetal life with that of born persons. The claim would be in alignment with the reproductive justice principles. The mother is the parent of the child. She should not be deprived of the choice for a wrongful death claim.

Next, the Ministry may consider mandatory insurance coverage for autopsies after stillbirth. This is consistent with the reproductive justice framework. Firstly, an autopsy allows the parents of the stillbirth child to find out how the child died. It gives a sense of satisfaction that all avenues of investigations have been carried out. Secondly, the autopsy could reveal whether similar problems would affect future children. Thirdly, the information from the autopsy may be used during the counselling for future pregnancies. Fourthly, autopsies enable an improved management approach for future pregnancies. Finally, detection of chronic diseases of the mother would help prevent maternal morbidity or mortality.

The mandatory insurance coverage of autopsies after stillbirth would help the women to reduce the costs of the stillbirth. In addition, the results of autopsies should help to reduce medical costs in future pregnancies, which benefit the women and insurance companies.

Lastly, a tax benefit could be considered to provide practical assistance and support to the parents for the surprising costs of stillbirth, especially helpful for the mothers with lower socioeconomic status. These costs may be higher due to any maternal health complications that contributed to the stillbirth. The parents may incur additional medical costs if they seek mental health treatment. The parents may also face additional costs related to the child's burial and funeral.

Mr Deputy Speaker: Assoc Prof Jamus Lim.

4.02 pm

Assoc Prof Jamus Jerome Lim (Sengkang): Mr Speaker, the proposed amendments embodied in the Stillbirths and Births Bill will alter the status of stillborn children, in the eyes of the law, by vesting official recognition of these children in allowing their names to be registered. Of course, for the parents of such children, they will always be recognised, regardless of the position of the law. But the step that this Bill takes, while seemingly small, will confer enormous dignity to these children, who would otherwise have gone on to live a full life.

While I cannot fully understand how it feels, as a parent, to lose a child in this manner, my family has experienced the misfortune of a stillborn child. As I had previously shared with this House, it was one of the few times that I had seen my father cry – even despite the fact that he was a traditional man. And it left my mother mourning for years after the loss and still leaves a gaping hole in her heart. We had named my brother Jaaron and he would have been 33 years old this year. Had this Bill been in place, we would at least have been able to commemorate him in a formal way and that process would have helped our family find some additional closure.

Of course, those who grieve find succour in myriad ways. For many, ritual and routine take the mind off the immediacy of the loss, and help the soul heal. That is why, all across the world, we observe funerals and wakes, and prayers and rites performed for the deceased. While practices differ – some weep, while others avoid doing so; some are sombre, while others involve singing – the commonality across cultures is that these rituals help with the grieving process.

I believe that, for many parents, being able to register the name of their child on birth certificates is one such ritual. Based on an online petition, this view is also held by more than 2,800 supporters.

It is for this reason – the dignity of recognition that a name confers, which, in turn, helps a mourning family move on from an unspeakable tragedy – that the Workers' Party supports this Bill. It is the right thing to do.

I will offer some additional thoughts on the other stipulations in the Bill. The amendments align the thresholds for what would constitute a stillborn child: the existing Registration of Births and Deaths Act currently sets the threshold at 22 weeks, which was, in turn, an alteration of the original 28 weeks in the original 1937 Act.

Ostensibly, this was to conform with the WHO's statistical reporting guidelines. Based on what I have been able to ascertain, however, the WHO actually recommends – for international comparability – the reporting of late foetal deaths to be at least 28 weeks. This is incongruent with the official MHA explanation.

Nevertheless, the same WHO report as well as the extant scientific evidence, suggests that, in high-income countries, such as ours, most live-born babies will survive even when they are born as early as 25 weeks of gestation, which is closer to the proposed 24-week threshold. For this reason, I agree with the re-alignment, although I would seek some clarification on why the cutoff was even lowered to 22 weeks in the first place.

The Bill, with accompanying collaterals, also does not make clear that the ability to register names for stillborn children applies to all children born in Singapore, regardless of nationality. Presumably, this would be the case, since the birth register is not restricted to only citizens. Nevertheless, it would be useful to verify that this is the case. After all, parental grief is not constrained by their or their stillborn child's national origin.

I wish to close with a more general lesson from this episode. While the Ministry has suggested that it has been looking to refine the laws in this regard since 2022, in response to two separate Parliamentary Questions I filed that year gave little indication that there was any intention to change the law. The first, in May, simply stated that, "birth certificates are not issued to stillbirths" and suggested that MHA would stop at the stage of issuing a "digital stillbirth certificate".

The second, in September that year, stressed the need for, "process and system changes," some of which Minister of State Sun had elaborated on but, likewise, seemed unnecessarily dismissive, bluntly declaring that ICA had "received only one request" for a commemorative birth certificate.

This response prompted my suggestion to Mandy Too and Aidan Hoy, the parents of Abigail and Lara, that if there was a way to demonstrate that birth certificates for stillborns was a matter that had broad support, it may help move the needle in the direction of change. And to their enormous credit, Ms Too and Mr Hoy did the rest: they gathered the signatures and support to advocate for this cause.

I think this episode is a reminder for all of us, that the power to effect change, ultimately, lies within our hands. Representatives like those in this House are often only a conduit for the desires of our people to shape the world that we live in. When ordinary people have the courage to act on their convictions, change happens. That is the power of the people, in a democratic society.

Mr Deputy Speaker: Mr Louis Ng.

4.09 pm

Mr Louis Ng Kok Kwang (Nee Soon): Sir, this Bill proposes amendments that will allow parents of a stillborn child to officially register a name for the child within one year after the stillbirth. This is an empathetic move that gives due acknowledgment to the lived, personal experiences of Singaporeans who have had the misfortune of losing their child. I thank the Government for making these positive changes.

I have two points of clarifications.

My first clarification is on the concern of misinterpretation of the stillborn threshold in the Registration of Births and Deaths Act. Minister of State Sun Xueling had earlier shared the rationale provided for increasing the threshold from the 22nd to 24th week of pregnancy is to address feedback from the medical community on potential misinterpretation of the threshold.

The feedback was that the stillborn threshold may be misinterpreted as an indication of foetal viability. This may confuse parents making difficult decisions about medical interventions for their unborn children.

Additionally, there were concerns expressed that such ambiguities lead to pressure on medical practitioners to use treatment methods that may increase the risk of severe neurodevelopmental disabilities in infants who survive or in higher rates of futile resuscitation attempts.

If there is, in fact, a significant risk of confusion about foetal viability, beyond increasing the threshold, can the Minister of State share if the Government is looking into other steps to ensure that parents have proper information relevant to foetal viability outside the womb?

Increasing the threshold is one way to remove potentially confusing information. But it will not fully solve the problem. It is even more important to ensure that parents have accurate, scientific information to help them make emotionally-charged decisions on foetal viability.

My second set of clarifications is on the naming of the stillborn child. MHA has clarified that pending the new provisions being operationalised, parents who wish to name their stillborn child may apply for a commemorative birth certificate. Can the Minister of State share if parents, whose stillborn are birthed in this transition period before the provisions are operationalised, can apply for their stillborn child to be named once the provisions come into effect?

Can the Minister of State also confirm that steps will be taken to ensure that the application process for entering a name for the stillborn will be sensitively designed and easy for parents to navigate?

Sir, notwithstanding these clarifications, I stand in support of the Bill.

Mr Deputy Speaker: Minister of State.

4.11 pm

Ms Sun Xueling: Mr Deputy Speaker, I thank Members for their support and feedback on this Bill. Please allow me to address the questions and feedback in turn.

Firstly, to Member Jamus Lim's question: yes, stillbirth registration is for all stillbirths in Singapore regardless of nationality.

Mr Louis Ng asked whether parents can officially register a name for stillbirths that occur during the transition period before the provisions are operationalised. Under the new section 36A of the RBDA, parents with stillbirths registered in Singapore may apply for their stillborn child to be officially named when the provisions are operationalised, as long as the application to name the child is made within a year after the stillbirth. This time limit also applies to parents who have had stillborn children before the legal provisions are operationalised.

I would also like to assure Mr Ng that ICA will ensure that the application process is sensitively designed and easy to navigate.

Mr Ng also asked about the steps that the Government is taking to ensure that parents have accurate, scientific information on foetal viability outside the womb. When parents are faced with the prospect of delivery before the infant is at full term, they will be counselled by their doctors. This includes information on the infant's chances of survival and risk of severe complications, and takes into account the specifics of the case, such as any medical conditions the mother may have. Such counselling will help parents to come to an informed decision about the appropriate course of medical intervention.

Mr Gan Thiam Poh asked about tortious claims and expressed concern that a mother should not be deprived of an opportunity to file a wrongful death claim if the stillbirth was due to tortious conduct. We would like to assure the Member that these amendments are not intended to and do not affect any existing legal rights or claims, including tortious claims, that a mother may have in relation to her stillborn child.

Mr Gan also asked the Government to consider mandatory insurance coverage for autopsies after stillbirths. Autopsy, or post-mortem examination, is not routinely offered for stillbirths and the decision on an autopsy of a stillborn child is a personal decision by the parent. As this is a personal decision by the parent, parents may seek their own options to cover the cost.

Mr Gan Thiam Poh also asked about the practical assistance and support that could be provided to parents to cover the costs associated with the stillbirth. We recognise that we need to support parents of stillborns. Our public maternity hospitals provide support for these parents. Parents may also be referred to a medical social worker, nurse or mental health team for emotional and practical support, such as advice on financial assistance and counselling during the bereavement process.

In the Government's desire to support families and employees, there is also continuous engagement with employers and employees to look at how leave benefits can support better work-life situations, better productivity in the workplace and better overall well-being for employees.

I would like to end off my speech by saying that MHA has heard the views of Ms Mandy Too and all the other bereaved parents who had signed the petition and who have shared their views with MHA.

When MHA and the Government look into reviews, we do not look at it cursorily. And when we say we will study something, we will commit to it and study it carefully before committing to policy and legislative changes. As you would know, by October 2023, our systems were in place to start issuance of commemorative birth certificates. And the first certificates were issued to Ms Mandy Too's twin daughters.

We were also careful with publicity as we do not want to make it look like it was compulsory and different parents may also address infant loss differently.

To date, 51 commemorative birth certificates have been issued and like I mentioned, there have been parents who have reached out over email, over the phone, to ask for overnight issuance of commemorative birth certificates. When ICA and MHA undertake to look into policy change and effect legislative change, we make sure that we tackle all the nuts and bolts so that when we decide to go ahead with these changes, we are able to meet the needs of bereaved parents. With that, Mr Deputy Speaker, I beg to move.

Question put, and agreed to.

Bill accordingly read a Second time and committed to a Committee of the whole House.

The House immediately resolved itself into a Committee on the Bill. – [Ms Sun Xueling.]

Bill considered in Committee.

[Deputy Speaker (Mr Christopher de Souza) in the Chair]

The Chairman: The citation year "2023" will be changed to "2024", as indicated in the Order Paper Supplement.

Clauses 1 to 16 inclusive ordered to stand part of the Bill.

Bill reported without amendment; read a Third time and passed.

Mr Deputy Speaker: Leader.