It's time for honest birth certificates

Birth certificates are permanent legal documents. They should be accurate, complete and truthful. They aren't. 

It was probably 2007 when I first started thinking about birth certificates. There was a conference in Nanaimo, BC, called "Nobody's Child, Everybody's Children" about donor conception, and I was doing interviews for a CBC Ideas documentary. That's where I met Laura Shanner, a bioethicist then at the University of Alberta in Edmonton. She told me birth certificates needed to change. And she didn't mince her words. "This legal document is written as a lie," she said. 

Since that time, some reform has taken place on the birth certificate front. The province of Ontario, where I live, made some significant changes in 2016 as part of the All Families Are Equal Act. The law made birth registration fairly uncomplicated for families with up to four legal parents, for instance. (Families with more parents have to register differently.) It made it straightforward for any parent to self-identify as simply "parent," while leaving the options of "mother" and "father" open to those who prefer those terms. It formally recognized that some families are created through assisted reproduction and addressed some longstanding inconsistencies in the law towards those families. I applaud all these changes. 

But the reform did not go far enough. It did not make these official documents as accurate or as honest as we need them to be.

Accurate, complete and truthful

When a child is born, the state likes to know about it. Every birth is recorded, by law, along with information deemed relevant to the event. 

In Ontario, parents registering a birth have to fill out a "Statement of Live Birth" within 30 days of a child's arrival. They are informed right off the top that this is a "permanent legal record" and that "it is an offence to wilfully make a false statement." Anyone who does so could be fined up to $50,000 or put in prison for two years. 

A fair whack of information is requested on this form. There are details about the gestation itself, for instance. How long was it in weeks? Was it a twin, triplet or other multiple pregnancy, and if so, did this specific infant come out first, second, third, or...? The name and sex of the child, its precise weight, and the address at which it issued into the world all have to be supplied. 

Then there are all the questions about the person who gave birth. Age, marital status, address, all the names this person has ever had, number of previous live births and stillbirths — it's all there. 

To be clear: the state is not shy about asking questions and compelling answers. 

Except, that is, when it comes to births through assisted reproduction. 

There are at least two compelling reasons for collecting vital statistics like these. One is so that we can analyze and understand trends in our own population. Why else would we need to officially record the age and previous pregnancies of a person giving birth? Another is so that there are accurate records of important events for the people who are the subjects of those events. By forgoing accurate collection of information in cases of assisted reproduction we have neither. 

I would have expected that a state that counts stillbirths and shared wombs would be a state that would want to know more about surrogacy. Here is an opportunity to learn, statistically, more about the practice and about the province's surrogates. How old are they? How many previous children did they give birth to? Do they tend to be single, married, common law, divorced or widowed? What part of the province do they live in and do they live near to or far from the people they are helping? How many surrogate births were there in the province this year?

It would also be a chance to learn more about surrogate pregnancies. Does their duration tend to be shorter? Are birth weights similar? Are surrogates more likely to carry multiples? 

But no. When the person giving birth is a surrogate, not only is she not identified as a surrogate on the Statement of Live Birth, she is not identified at all. Suddenly there's no need for a birth history or a duration of pregnancy. It's almost as though the pregnancy itself did not happen, only the birth.

This type of willing oversight is not only bad for statistics, it's harmful to people born through these technologies. 

What Laura Shanner proposed way back when, and what I stand by today, is an expanded birth certificate that captures all the relevant information unambiguously. Assisted reproduction is a fact, not something to be ashamed of and hidden. We need more lines, with clear categories. 

There is the person who provided the egg and the person who provided the sperm. (Sometimes, intentionally, more than one person provided sperm.) There may be a person who provided mitochondria. These people should be identified — by name, ideally, or at least by donor number. There is the person who gestated the pregnancy. That person, too, should be identified, and all the details collected regarding other pregnancies should be collected for this one as well. Why wouldn't they be?

Then there are the legal parents. Their names may appear elsewhere in other categories, or they may not. What is uncontested is that they are the only parents, and the ones who will be raising this child.

People conceived through donor egg, sperm or embryo, or gestated with the help of a surrogate, deserve to have the "permanent legal record" of their existence be accurate, complete and honest. Just as they should not wonder whether the place of their birth was falsified or omitted, they should not have to wonder who gave birth to them or who their progenitors are. Facts about their origins known to the people filling out the forms should not be deliberately withheld from an official document whose purpose it is to record these facts. There should be no deliberate falsehoods or omissions. 

None of the details in the Statement of Live Birth (also called the long form birth certificate) are available to Joe Public. But, importantly, all of them are available to the person born from this arrangement. As Shanner said years ago, "I can't find any ethical justification for keeping that secret from the person to whom it matters the most."


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