Legal rules and practices of registration and burial of stillbirths in 19th and 20th century Netherlands

Perinatal mortality rates have been widely used and misused as indicators of social advancement, public health, and the quality of maternal and antenatal care1. They figure prominently in international comparisons or to evaluate the progress achieved over time within a specific country and have become a matter of national prestige or shame (Gourbin, Masuy-Stroobant, 1995; Richardus, Graafmans, Verloove-Vanhorick, Mackenbach, 1998). The construction of these figures is very dependent on precise legal definitions of the concerned vital events, on variations in local practices of declaration and on systems of health care and registration. Stillbirths are an important component of perinatal mortality. To do justice to the historical evolution of the term, we here define stillbirths as both fetuses being born dead and children born alive but dying before a birth certificate was issued. Since the introduction of civil registration, many European countries “have grappled with the issues of how to define and record stillbirths” (Gourdon, Rollet, 2009). The way in which legislators, municipal functionaries, physicians, statisticians, and religious authorities in the various countries have dealt with stillbirths in the past might yield important information on the usefulness of statistical data on perinatal death in the past. It might also be helpful in informing us about the way in which a society’s opinion on a question such as “When does life begin?” has evolved. To shed light on the long-term changes in the way legal, statistical and medical authorities constructed the category of “stillbirth”, one can make use of official documents containing information on the registration and handling of the birth, the death and burial procedures for stillbirths. Laws, by-laws, administrative regulations, and church laws express the opinions of jurists, representatives and state officials on what constitutes a stillbirth; they define whether and how the medical profession had to determine whether a live birth and death had occurred and how it should then be registered; what information on these infants was considered relevant for statistical analysis; and how local authorities should handle the burial. These official documents can also lend insight into collective images and how they were confirmed or disputed, as well as illuminate the fine line between what was considered socially acceptable and what was considered objectionable. These sources also shed some light on the ways in which families handled stillbirths. For more recent periods, such information has been gathered from interviews with elderly parents whose child had died during pregnancy or shortly after delivery, and from interviews with retired professionals in the funerary industry, as well as medical doctors or parents themselves who directly dealt with pregnancy loss; but this method of data-gathering could not go further back in time than the mid-1950s (Avis, 2014; Faro, 2015; Peelen, 2011). Our intention is to present an overview for the Netherlands for stillbirths occurring in the nineteenth and the first part of the twentieth centuries. Our study starts around 1810, because until the moment the Dutch Republic was annexed by France, the absence of a powerful central authority meant there was no uniform system of civil registration. Rules for the registration of vital events also varied widely due to the religious diversity of the country (Van der Woude, 1980). The studies cited above did a fine job of covering changes in the attitude toward stillbirths in the more recent period (1970-present), so that period will be treated only very briefly here. 1. The official WHO-definition of perinatal mortality includes two components: stillbirths (babies born with no signs of life at or after 28 weeks’ gestation) and early neonatal deaths (babies dying 0-6 days after birth).