Birth Registration Can Be Boosted by Deploying More Health Workers

Birth registration is the starting point for most civil registration systems. Photo: ADB
Birth registration is the starting point for most civil registration systems. Photo: ADB

By Stefan Schipper, Sean Crowley, Brad Earvin T. Zuniga

Civil registration systems are vital for providing legal identity and accessing essential services, as shown by discrepancies in COVID-19 mortality data and the ongoing challenges in birth registration, especially in poorer communities.

One of the most important benefits a country can bestow on its people is civil registration. A comprehensive civil registration and vital statistics system that accurately records important information about a person’s life like birth, marriage, death, and location, is fundamental to ensuring legal identity, access to social services, protection of human rights, and efficient governance.  

 The striking importance of civil registration systems as data sources was evident during the COVID-19 pandemic, when there was a substantial difference between reported COVID-19 deaths (5.4 million between January 2020 and December 2021) and the estimated number of excess deaths associated with COVID-19 (14.9 million for the same period), according to a World Bank blog post by Haishan Fu and Steve MacFeely.

One particularly important indicator is birth registration. It’s the starting point for most civil registration systems. No birth registration often means barriers to accessing immunization programs, child health care, schooling, and higher education.

The  children born into poor families are most likely to be unregistered, leading to lifelong discrimination, marginalization, and lack of economic mobility. Women and girls face unique barriers, including laws in some countries that require the signature of a husband or father on official registration documents.

Many countries handle the issue well, with 19 developing countries in Asia and the Pacific reporting at least 90% of births registered in 2022, with Cook Islands (2017) and Uzbekistan (2022) reporting a 100% birth registration rate, according to the Asian Development Bank’s Basic Statistics series.

Even so, challenges remain. World Bank data show that more than 1.1 billion people worldwide are unable to prove who they are. Many countries in Asia and the Pacific still struggle to register more than 60% of their newborns, including Bangladesh, Pakistan, and Papua New Guinea, ADB Basic Statistics data show.

Across the region, civil registration plays a key role in access to education, healthcare, employment, and social protection. It is the poor and dispossessed who suffer disproportionately, so upping these percentages is a development imperative.

We know quite a bit about the barriers that prevent people from benefiting from civil registration. Institutional impediments include inadequate laws, infrastructure, budgets, and human capacity. At least as important are social barriers such as lack of awareness of the importance of registration, linguistic and cultural differences, and the stigma associated with teen births or single mothers. 

Civil registration systems are essential for ensuring legal identity and access to social services, with significant disparities in birth registration impacting the most vulnerable populations.

The above factors are all challenging to collect reliable data on, making it difficult to ascertain which to focus on in the battle to make civil registration universal. A different approach is to analyze similar datasets to see if there’s a causal link between the two. So, when we correlate data from other SDG indicators, such as SDG 3.1.2, the proportion of births attended by skilled health personnel, something interesting emerges.

Countries such as Papua New Guinea, Pakistan, and Bangladesh with low birth registration rates also have the lowest proportion of births attended by skilled health personnel, according to ADB’s Basic Statistics. In almost all civil registration systems, the health sector plays a critical role in the collection of information. Part of the job of health professionals is to accurately report births and deaths to the civil registrar. 

Conversely,  where the percentage of health workers present at births is high, birth registration levels are correspondingly healthy. So, there’s a clear link, and this correlation is not a statistical aberration, but evident in datasets from many reputable sources worldwide.

Across Asia and the Pacific there have been many national programs to boost birth registration, usually focusing on awareness campaigns, deployment of new technology, and simplifying the procedure. Results have been mixed. Maternal and child health care is an obvious solution right in front of us.

Some of the ways that this can be pursued include building hospitals with modern surgical and maternity services; providing better access to health services in rural communities; building reproductive health care centers and primary health care centers near densely populated areas; and supporting access to maternal and child health services, staff development, and the training of skilled birth attendants. Targeting support to vulnerable communities and ethnic minorities is also vital.

 In a region where giving birth is still often a matter of life and death for mother and child, improving maternal and child health services must be a priority. Not only will it save countless lives, it will also ensure that newborns have more chance of being registered and live a life less marginalized, and with better access to health, social, and education services as they grow up.