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Disclaimer / Limitations
This country’s legal measures were reviewed by our legal staff in consultation with in-country lawyers and/or CRVS legal experts. All efforts were made to ensure the accuracy of the legal analysis, however, if you consider there to be any discrepancies or if there have been changes in the law of the country since our staff last updated the legal analysis, we welcome any additional information or insights. Please contact us via this form.
Stillbirth Reporting
South Africa
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South Africa
Stillbirth Reporting
Reporting System
Reporting System
Compulsory Coverage
Is stillbirth registration available and compulsory for all stillbirths occurring within the country's jurisdiction?
Compulsory for all stillbirths
Recommended Practice based on International Guidelines
Tracking stillbirths and other fetal deaths is important for statistical and public health planning purposes. Official recognition that the fetal death occurred can have significance for families and can help to facilitate cremation and burial if the family desires. If stillbirths are recorded via the civil registration system, the law should require that all stillbirths that occur in the country are registered.
Stillbirth registration is compulsory for all stillbirths occurring within the country's jurisdiction. The Births and Deaths Registration Act uses mandatory language ('shall') for both pathways: a medical practitioner who was present at a stillbirth 'shall issue a prescribed certificate' (Section 18(1)), and where no medical practitioner was present, any person who was present at the stillbirth 'shall make a prescribed declaration' (Section 18(2)).
The obligation applies universally regardless of citizenship or nationality. Section 2 of the Act provides that its provisions apply to all South African citizens and to all persons who sojourn permanently or temporarily in the Republic. This means the stillbirth reporting obligation extends to all persons within South Africa, including refugees, asylum seekers, migrants, and stateless persons. The obligation covers both in-facility and community stillbirths.
Does the law mandate reporting of all stillbirths through the health sector?
Not permitted
Recommended Practice based on International Guidelines
Tracking stillbirths and other fetal deaths is important for statistical and public health planning. If stillbirths are tracked through the health sector, the law (or guidelines and SOPs) should require the health sector to report fetal deaths to the central health ministry. For in-facility stillbirths, reporting responsibility should fall on the head of the health facility or attending medical professional. For community stillbirths, reporting responsibility is place on the birth attendant, who may be required to report the ministry of health directly, or may report through a local health facility.
The law does not mandate reporting of stillbirths through a separate health-sector pathway to the Ministry of Health. The medical practitioner's role under Section 18(1) of the Births and Deaths Registration Act is to issue the prescribed certificate (Form DHA-1663), which is then received by a Department of Home Affairs official designated under Section 4. This function is part of the civil registration pathway, not a separate health-sector reporting obligation.
In practice, Statistics South Africa's perinatal statistics (publication P0309.4) are derived from DHA-1663 forms collected from the Department of Home Affairs, not from a separate Ministry of Health reporting system. The health sector's role is embedded within the civil registration process.
Who is the designated primary informant for declaring stillbirths to the civil registrar?
Other
Recommended Practice based on International Guidelines
UN guidelines provide that, in priority order of preference, the informant for a fetal death is the same as for a live birth: first, the head of the health facility (for a fetal death that occurred in a health facility) or the birth attendant (for a fetal death that occurred outside a health facility with a birth attendant); second, the mother; third, the father; fourth the nearest relative of the mother; and fifth, any other adult person having knowledge of the facts.
The Births and Deaths Registration Act does not clearly address the informant responsible for declaring stillbirths to the civil registrar. For stillbirths that occur under medical supervision, the medical practitioner is responsible for issuing the notice of stillbirth/medical certificate of stillbirth (Act, Section 18(1), Regulation 24(1)). While the Act does not explicitly state whether the Notice/MCCD is given to the parents or submitted directly to the registrar, in practice, the Notice/MCCD is given to the parents, who submit it to the registrar for purposes of stillbirth registration. If no medical professional was present at the stillbirth, the law is clear that "any person who was present at the still-birth" is responsible for declaring the stillbirth to the registrar.
What is the role of the health sector in stillbirth registration?
Issuing of evidence of stillbirth
Recommended Practice based on International Guidelines
UN guidelines provide that the head of the health facility is the preferred informant for stillbirths. Where the stillbirths are registered via the civil registration system this should be specified in the law. As with live births, some countries require the health sector to notify information about stillbirths even where the designated informant is the mother and/or father. Where the mother and/or father is the primary informant, the health sector would usually be required under the law to provide a notice of some sort as evidence of the stillbirth for the purposes of registration.
The health sector completes Form DHA-1663, which is the Notice of Stillbirth and medical certificate of cause of death. The medical practitioner provides this form to the parent or other informant, who then submits this form to the local registrar in order to declare the stillbirth.
Recommended Practice based on International Guidelines
If fetal deaths are reported through the civil registration system, the health facility, birth attendant or other informant should report a fetal death to the registration office in the location where the fetal death occurred, or at any location where access is available to the registration system, if the system is sufficiently networked. Where registration is required at the place of residence of the mother, this may reduce the rates of registration.
The Births and Deaths Registration Act does not specify a particular place at which a stillbirth notice must be given. Section 18(3) requires the certificate or declaration to be submitted to 'a person contemplated in section 4', which refers to Department of Home Affairs officials at registration offices. No geographic restriction on the place of reporting was identified in the instruments reviewed. The 2014 Regulations do not contain a specific 'place of reporting' provision for stillbirths.
What is the reporting period for stillbirth registrations specified under the law?
3 days
Recommended Practice based on International Guidelines
The time frame for reporting a fetal death is usually the same as that for a death. There should, however, be a procedure for late and delayed reporting pending a medical-legal decision if the fetal death status is unclear or disputed.
The 2014 Regulations prescribe a reporting period of 72 hours from the occurrence of the stillbirth. Regulation 24(1) provides: 'A notice of stillbirth must be given within 72 hours, in terms of section 18(1) of the Act, on Form DHA-1663'. This refers specifically to reporting of stillbirth by the health section. Regulation 24(2), which applies to reporting of a stillbirth in cases where no medical practitioner was present, does not contain a time limit for reporting.
No provision for late or delayed stillbirth registration was identified in the instruments reviewed.
Does the civil register contain a separate register for stillbirths, distinct from birth and death registers?
Unclear
Recommended Practice based on International Guidelines
Stillbirth should be registered in a separate fetal death (or stillbirth) register. UN guidelines indicate that stillbirths should not be registered in the birth register or the death register, as they do not establish a legal identity, retire a legal identity or affect civil status. Including stillbirths in those registers can also make it harder to disaggregate the data for statistical purposes. Instead it is recommended that a separate register of stillbirths is established. However, some countries with digital systems do include stillbirths in the register of births, with a a notation that the event is a stillbirth to allow for disaggregation.
Under the Births and Deaths Registration Act, Section 5, the Director-General is the custodian of birth and death records. Notably, this Section does not state that the Director-General is the custodian of stillbirth records. After a stillbirth notice is submitted to the local registrar under Section 18 of the Act, the form (DHA-1663 or DHA-6), is forward by the Department of Home Affairs to the statistics agency for use in generating vital statistics. Thus, the details provided are used for statistical purposes only and are not stored in a stillbirth register.
Recommended Practice based on International Guidelines
No fee should be charged for the timely registration of a live birth, marriage, divorce, fetal death or death
To encourage registration, the legislation should clearly state that registration of a birth, fetal death and death within the time period prescribed by the law is free of charge.
No provision addressing fees for stillbirth registration or reporting was identified in the Births and Deaths Registration Act, the 2014 Regulations, or any other instrument reviewed. The absence of a fee provision should be interpreted as no fee being charged for stillbirth reporting.
