September/October 2021

HIM Happenings: Birth Certificates Enter a New Era
By Dava Stewart
For The Record
Vol. 33 No. 5 P. 28

For most people, a birth certificate is one of life’s standard documents, like a Social Security card or a passport. It’s important, but few people give it much thought.

Vital records may seem unrelated to questions of policy, but in the case of birth certificates, state law determines what information is collected and in what manner. State law determines who can be listed on a birth certificate as a parent and under what circumstances. The fact that there are differences state to state can make certain situations far more complicated.

“There are no federal statutes regarding birth certificates,” says Brittany Biggett, an assistant HIM manager at Winnie Palmer Hospital in Orlando, Florida. Part of her job is making sure that new parents understand the rules surrounding how births are registered, including the fact that they are governed by state laws that carry consequences if they are violated.

Many don’t realize that when information is collected in order for a birth certificate to be issued, it’s also used for other purposes. For example, statistics regarding the number of births in a given period come from birth certificate information.

“When you see a statistic about teen pregnancy declining, that information comes from our department,” Biggett says.

Biggett’s team researches the medical records at her facility, calculate how many babies were born there, how many transferred in—Winnie Palmer is one of the largest neonatal ICU facilities in the country—and call the birth parent to confirm the information. Then, they put together a packet and make an in-person visit to the parent(s) to further verify. “Our team gathers the information for an average of about 36 birth certificates per day,” Biggett says.

One of the obvious areas where they take extra care is in getting the baby’s name correct. “We have so many different names and variations of names. You can name a baby anything,” Biggett says.

The information is submitted to the vital statistics office, which issues a Social Security card, and to the local department of health.

Historical Changes to Birth Certificate Forms
As social norms evolve and change, so does the information collected for vital records, including birth certificates. For example, at one time a baby born to an unwed mother was classified as “illegitimate.” In fact, a paper published in 1915 presents the case both for and against “the registration of illegitimate births.” In 2007, about 41% of all births in the United States were to unmarried women, and the number was rising.

Another relatively recent change is labeling fields on the birth certificate “Birth Parent” and “Parent” rather than “Mother” and “Father.” Although that certainly seems like a progressive update, there are still some differences in how heterosexual and same-sex parents are added to their children’s birth certificates.

In some situations, whether or not a person giving birth is married is an important component of the process of registering a birth, even though so many more children are born to unmarried parents than in the past. For some same-sex couples, the process of having both parents’ names on a child’s birth certificate is different than for their heterosexual counterparts.

Biggett notes that many of Florida’s laws related to registering births were updated in the 1990s, around the time it became legal for same-sex couples to marry. The updates didn’t eliminate differences in the state’s process, however. For example, if the person giving birth says that her heterosexual unmarried partner is the father, she can sign the birth certificate. The spouse then has five days to come to the facility and sign. For same-sex couples, the process is different. The biological father goes on the birth certificate and the nonbirthing parent must adopt.

Other states have different processes and regulations, but there are often differences between births to heterosexual and same-sex couples.

Another interesting quirk of Florida law is that if the mother is in a heterosexual marriage, the only name that can be on her child’s birth certificate as the other parent is her legal husband—even if all parties agree that he is not the biological father.

“In some cases,” Biggett says, “the mother says, ‘But I haven’t seen him in 20 years!’ We explain the law and give them the number to the health department so they can find out how to correct the birth certificate. It’s a felony for the hospital, the county, and the parents if this law is violated.”

A Parent Adopts the Child With Her Genetic Material
In 2020, an NBC report spotlighted the gaps in parenting laws that affect same-sex couples. Sara Watson and her spouse Anna Ford had a baby in 2017. Watson’s egg was fertilized using donor sperm and implanted in Ford. When Ford gave birth, Watson was forced to adopt her own child.

The adoption process took eight months, during which time Watson didn’t have any legal parental rights. She couldn’t add her son to her insurance, pick him up from daycare, or make medical decisions about his care. “She and her partner had to get three letters of reference attesting to their ability to be good parents, they had to have a home study, and Rhode Island law required that they put an ad in a newspaper in Massachusetts—where the anonymous sperm donation was from—asking if anyone wanted to claim parental rights of their child,” according to the report.

An Attempt to Make the Process Uniform
The Uniform Law Commission, a group that seeks to provide states with uniform laws to facilitate interstate commerce and simplify things for people who live, work, or travel between multiple states, has drafted the Uniform Parentage Act (UPA). The first UPA, in 1973, provided states with a path to establish a child’s legal parents, regardless of their marital status. All states enacted the original UPA, which was revised in 2002 and 2017.

The most recent revisions took into account surrogacy and other forms of reproductive assistance. They also address same-sex parents and recognize “de facto” parents, defined as a person who provides for a child’s basic needs and cares for them, regardless of relationship. This is a significant change because it offers a legal path for a nonbiological or nonlegal parent to establish legal parental rights.

The most recent version of the UPA has been enacted in six states and introduced in three others.

The Gender Question
For many years—perhaps since birth certificates have been issued—there was never any question whether or not gender should be indicated on the document. It was simply a given that babies were male or female. Now, though, health care experts, psychologists, and many individuals recognize that gender is much more complex and nuanced.

In many states, including Florida, parents can decline to put a gender on the birth certificate. Rather than choosing male or female, they can choose “X.” In such cases, the birth certificate can be changed later for a nominal fee.

In staff meetings, Biggett stresses inclusivity to her team. “I ask them to pay attention to the pronouns that the parents use, and mimic them. We live in a sensitive time, and I want everyone to feel included in the process,” she says, adding that it’s been something of an adjustment for the HIM team, but that they all are making an effort to adapt.

At a special gathering of the House of Delegates in June, the American Medical Association approved the removal of sex designations from public birth certificates.

“Designating sex on birth certificates as male or female, and making that information available on the public portion, perpetuates a view that sex designation is permanent and fails to recognize the medical spectrum of gender identity. This type of categorization system also risks stifling an individual’s self-expression and self-identification and contributes to marginalization and minoritization,” said American Medical Association Chair-Elect Sandra Adamson Fryhofer, MD, in a press release.

Indeed, times are changing. On the surface, the topics of social norms, state regulations, and birth certificates seem disparate and unrelated. However, history and current events tell a different story.

— Dava Stewart is a freelance writer based in Tennessee.