Stillbirths

Edward Higgs

The civil registration of births, marriages and deaths had originally been established in England and Wales by the 1836 Registration Act (Registration Act, 1836) for the purposes of underpinning title to property via recording the lines of descent of legal persons. Fears had been expressed that the title to property was uncertain because faults in the parochial registration of baptisms, marriages and burials made it difficult to be sure who had the right to alienate property. The statistical functions of the General Register Office (GRO), the body that administered the registration system, were added to its responsibilities only as something of an afterthought. By accepting the centrality of the recording of property rights in the establishment of the civil registration system in 1836, one can explain some of the features of the statistical data published by the GRO that have puzzled scholars. This includes the failure to register stillbirths until the twentieth century. These 'deficiencies' only appear as such if one assumes that the raison d'etre of the registration system was the generation of data for demographic and medical research. Stillbirths had never been born alive, and therefore could not count as legal persons (Higgs, 2004, 1–44).

On a number of occasions in the nineteenth century medical bodies called upon the GRO to include the recording of stillbirths in the registration process for purposes of improving medical knowledge. However, senior officers of the GRO rejected these requests. William Farr, the GRO's chief medical statistician from 1839 to 1879, had advocated the registration of stillbirths, mainly to prevent infanticide, in the Annual Report published in 1866. However, his superior, George Graham, the Registrar General from 1842 to 1879, blocked the proposal. As the latter explained to the Home Office the following year, he believed that to 'investigate every miscarriage and every abortion and the exact time of conception and the precise period of gestation appears to me an indelicate, indecent, nasty enquiry', and he feared that the inception of such a policy would undermine the willingness of parents to register births at all (Twenty-seventh Annual Report, 191; National Archives, London: HO 45/8044). This was not only the rejection of a particular registration procedure but also of the medical community's authority to determine what should count as a person in the civil registration process. Under the 1874 Births and Deaths Registration Act (37 & 38 Vict., c.88) a stillbirth did not have to be registered but the body could not be buried without a 'written certificate that such child was not born alive' signed by a registered medical practitioner. But this system seems to have been enforced in a lax manner (Macfarlane and Mugford, 46).

Graham's views on registration were seconded by William Ogle, the GRO's Superintendent of Statistics from 1880 to 1893, who argued before the 1893 Select Committee on Death Registration that it would be impossible to define or prove the period of gestation (First and second report of the select committee on death certification, Q 4088). The Select Committee advocated the registration of stillbirths, as had the Royal Sanitary Commission in 1871 (Second report of the Royal Sanitary Commission, Vol. 1, 58). The omission of stillbirths has, of course, important implications for the calculation of infant mortality rates. Graham Mooney calculates, for example, that if one included estimated stillbirths in infant mortality rates in England and Wales in 1890 one would raise the rate from 151 per 1,000 live births to 155. The rate for Norwich at the same date would rise from 181 to 200 (Mooney).

This deficiency was remedied, in part, by the Notification of Births (Extension) Act of 1915. Under this Act the procedure of notifying births to the local medical officer of health, which up to that date had been optional, was made obligatory throughout the country, both in respect of stillbirths as well as live births. The number of notifications so received was published in successive reports of the Chief Medical Officer of the Ministry of Health from 1919 onwards.

The civil registration of stillbirths was only introduced on 1 July 1927 after the passing of the Births and Deaths Registration Act (16 & 17 Geo. 5, c.48) of the previous year. Stillbirths were defined as:

Any child which has issued forth from its mother after the twenty-eighth week of pregnancy and which did not at any time after being completely expelled from its mother breathe or show any signs of life.

Rates of stillbirths by region, and in terms of legitimacy and illegitimacy, were first produced in the Statistical Review of the Registrar General for 1927, published in 1928 (General Register Office, 129–31).

Stillbirths were now being integrated fully into the developing twentieth century medical definitions of infant mortality — the existing distinctions between infant mortality (under 1 year), neonatal mortality (under 4 weeks) and stillbirths, were eventually joined by the concept of perinatal mortality (stillbirths plus neonatal or early neonatal deaths) in the post-Second World War period (Peller, 405–56). The concept of 'life' as understood by the GRO was extended back into the pre-partum period. This greater susceptibility of the GRO to medical definitions of a 'person' might reflect the administrative subordination of the GRO to the Ministry of Health in 1919 (Higgs, 188–201). Modern debates over the status of human foetuses, and the point at which they can be said to have human rights in law, reveal that the definition of a 'person' is still far from straightforward.

REFERENCES

First and second report of the select committee on death certification, BPP 1893–4 XI.

General Register Office, Registrar General's Statistical Review for 1927 (London, 1928).

Edward Higgs, Life, death and statistics: civil registration, censuses and the work of the General Register Office, 1837–1952 (Hatfield, 2004).

Alison Macfarlane and Miranda Mugford, Birth counts. Statistics of pregnancy and childbirth, volume 1, text (London, 2000)

Graham Mooney, 'Still-births and the measurement of urban infant mortality rates c. 1890–1930', Local Population Studies, 53 (1994), 42–52.

National Archives, London: Home Office: Registered Papers: HO 45/8044 REGISTRATION OF BIRTHS, ETC: Registration of still-born children: opposed by registrar general.

S. Peller, 'Mortality, past and future'. Population Studies, 1 (1947–8), 405–56.

Second report of the Royal Sanitary Commission, Vol. 1, BPP 1871 XXXV.

Twenty-seventh Annual Report of the Registrar General (1864), BPP 1866 XIX (3712) [View this document: Twenty-seventh annual report of the registrar-general ]