Prior to 2001, states did not recognize stillborn babies with birth certificates due to the lack of statutory language in each state.
Since then, with the grassroots help of grieving families and the MISSing Angels’ legislative initiatives nationwide, 43 states now have a Certificate of Birth Resulting in Stillbirth or a Certificate of Stillbirth.
Dr. Joanne Cacciatore helped spearhead the first legislation in Arizona that was passed January 22, 2001. The legislation allowed the state of Arizona, for the first time in the U.S., to provide a birth certificate resulting in stillbirth, upon request, to the grieving parents.
Dr. Cacciatore’s daughter Cheyenne died in 1996 during childbirth at full term. At the time, she received only a “Certificate of Fetal Death” rather than a birth certificate, after having given birth.
“The ‘Certificate of Fetal Death’ was a cruel and oppressive reminder of a woman’s failure to produce a healthy, living baby,” said Cacciatore, MISS Foundation founder. “Women who endure the experience of stillbirth must still go through childbirth. They are emotionally invested in their babies, and that does not change when a baby is stillborn. They still are mothers. The passage of this bill is a huge step in the right direction.”
Due to Cacciatore’s efforts, Arizona became the first state to provide grieving families a “Certificate of Birth Resulting in Stillbirth,” thus creating a national trend that not only has increased knowledge about stillbirths, but has also recognized the significance of this tragedy. Approximately 25,000 babies are stillborn each year in the United States. The cause of death for more than half the number of full-term (40-week) stillbirths is unknown.
Since the first “MISSing Angels” bill passed into law in 2001, there are now 43 state laws that offer a “Certificate of Stillbirth” or a “Certificate of Birth Resulting in Stillbirth.” There are also four states that offer a one-time state tax exemption during that year.
At the federal level, the MISS Foundation worked behind the scenes with the National Institute of Health (NIH) researchers and appropriations staff to help secure $2 million for stillbirth research, the first grant ever awarded. Later, MISS advocates helped secure an additional $1 million to advance the research. The groundbreaking research helped leading doctors from Maryland, Florida, Texas and New York create the first contextual basis for comparative research in the effort to find common causes regarding stillbirths.
Their research helped with the passage of the 2013 Stillbirth Research and Awareness Act to mandate all hospitals to create and collect universal data for comprehensive analysis. The standardized collection of stillbirth data is a monumental achievement to provide researchers the necessary information previously unavailable.
While these legislative and congressional initiatives have been groundbreaking, there is still much MISS Foundation families can do to further these campaigns. Such initiatives include advocating to further NIH appropriated research funds, and passing the “Certificate of Birth Resulting in Stillbirth” in the 7 remaining states and in the District of Columbia.
Lastly, the MISS Foundation advocates to legislatively amend the “Certificate of Stillbirth” designation to a “Certificate of Birth Resulting in Stillbirth.” While they are both worded very similarly, a “Certificate of Birth Resulting in Stillbirth” and a “Certificate of Stillbirth” are not the same thing. Legislators, policy analysts, and state health departments agree, there is a subtle, yet immense difference in the two.
The MISS Foundation advocates that all states should acknowledge births as birth, whether live or stillborn. Thus, our goal, for those states that offer a “Certificate of Stillbirth” is to legislatively change the certificate to a “Certificate of Birth Resulting in Stillbirth” – which we view as a “birth” certificate.
The MISS Foundation through its grassroots efforts with families has achieved significant legislative advocacy accomplishments in our journey, yet there is still more work to be done.
The 43 states listed below offer an official, legal document that include the words certificate of birth in the title to the parents of stillborn babies. They are considered ‘MISSing Angels States’.
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Alabama |
Alaska – State Tax Exemption for Stillborn Children |
Arizona – State Tax Exemption for Stillborn Children |
Arkansas |
| California | Colorado |
Connecticut |
Delaware |
| Florida | Georgia |
Illinois |
Indiana – State Tax Exemption for Stillborn Children |
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Idaho |
Iowa |
Louisiana |
Maine |
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Maryland |
Massachusetts |
Missouri – State Tax Exemption for Stillborn Children |
Minnesota |
| Mississippi | Montana |
Nebraska |
Nevada |
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New Hampshire |
New Jersey |
New Mexico |
New York |
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North Carolina |
North Dakota |
Ohio |
Oklahoma |
| Oregon |
Pennsylvania |
Rhode Island |
South Carolina |
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South Dakota |
Tennessee |
Texas |
Utah |
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Virginia |
Washington |
West Virginia |
Wisconsin |
The 8 States/District listed below do not have MISSing Angels Statutes.
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District of Columbia |
*Hawaii – 2021 Legislation introduced |
Kansas |
Kentucky – shall be reported on a combination birth-death or stillbirth certificate |
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*Michigan – parents can claim their stillborn child as a one-time dependent on their taxes. 2021 legislation introduced. |
Vermont |
Wyoming |
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If your state does not have a MISSing Angels bill, and you would like to help champion its passage, please contact MISS Foundation Legislative Liaison Richard May (rmayaustin@gmail.com). While passing legislation can be a difficult process, we will try assist you throughout the process. The biggest challenges of helping to pass legislation are patience and persistence.