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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
Tunisia
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Tunisia
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.
Stillbirths are registered in the death register. The provisions on death in the Law No. 1957-3 of 1957 apply to stillbirths. Therefore, registration of stillbirths is compulsory. In practice, many stillbirths go unregistered.
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.
Stillbirths are recorded through the civil registration system in Tunisia and are not reported through the health sector.
Law Source
Informant
Who is the designated primary informant for declaring stillbirths to the civil registrar?
Any parent
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.
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.
Stillbirth is treated like a death. The directors or administrators of the hospital is responsible for reporting in-facilty stillbirths to the registrar under Article 46 of the Law No. 1957-3 of 1957.
However, under Decree No. 99-1043, the MCCD (which is used for stillbirth) is given to the family, with the MCCD portion folded and sealed, to bring to the civil registrar.
Therefore, under the Law No. 1957-3 of 1957 Regulation of Civil Status (Article 46), the health sector is a notifer. However, under the decree, the health sector issues evidence of death; which is what happens in practice.
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.
Stillbirths are treated like deaths. Under Article 44 of the Law No. 1957-3 of 1957, the stillbirth record is "drawn up by the Civil Status Officer of the district where the death [read: stillbirth] took place." However, under Articles 46 and 49, if the stillbirth occurred in a place other than the municipality where the deceased resided, the Civil Status Officer, who drafted the stillbirth record must send a copy of the document to the Civil Status Officer in the jurisdiction where the [parents of the] deceased last resided, who must transcribe the document into the death register in that jurisdiction. Therefore, stillbirths are registered in the place of residence of the parents.
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.
A three day registration timeframe is implied in Circular No. 85 of the Secretary of State for Justice and the Secretary of State for the Interior of December 12, 1965. Law No. 1957-3 of 1957 Regulation of Civil Status, Art. 43, which requires the family to report a death (and therefore stillbirth) within 3 days. In addition, the Law No. 1957-3 of 1957 Regulation of Civil Status, Article 46 requires a hospital administrator or director to notify a death that occurs within 24 hours.
Does the civil register contain a separate register for stillbirths, distinct from birth and death registers?
No
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.
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.
Stillbirths are treated like deaths. Therefore, there are no fees for stillbirth registration. However, there is no provision in law that explicitly addresses fees for stillbirths (or deaths).
