Have inequalities in completeness of death registration between states in India narrowed during two decades of civil registration system strengthening?

Jayanta Kumar Basu,Tim Adair

doi:10.1186/s12939-021-01534-y

Abstract

BackgroundIn India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate. This study aims to identify whether inequalities in the completeness of death registration between states in India, including by sex, have narrowed during this period of CRVS system strengthening.MethodsData used in this study are registered deaths by state and year from 2000 to 2018 (and by sex from 2009 to 2018) reported in the Civil Registration Reports published by the Office of Registrar General of India. Completeness of death registration is calculated using the empirical completeness method. Levels and trends inequalities in completeness are measured in each state a socio-economic indicator – the Socio-Demographic Index (SDI).ResultsEstimated completeness of death registration in India increased from 58% in 2000 to 81% in 2018. Male completeness rose from 60% in 2009 to 85% in 2018 and was much higher than female completeness, which increased from 54 to 74% in the same period. Completeness remained very low in some states, particularly from the eastern (e.g. Bihar) and north-eastern regions. However, in states from the northern region (e.g. Uttar Pradesh) completeness increased significantly from a low level. There was a narrowing of inequalities in completeness according to the SDI during the period, however large inequalities between states remain.ConclusionsThe increase in completeness of death registration in India is a substantial achievement and increases the potential of the death registration system as a routine source of mortality data. Although narrowing of inequalities in completeness demonstrates that the benefits of higher levels of death registration have spread to relatively poorer states of India in recent years, the continued low completeness in some states and for females are concerning. The Indian CRVS system also needs to increase the number of registered deaths with age at death reported to improve their usability for mortality statistics.

Highlights

In India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate
Estimated completeness of death registration in India for both sexes increased from 58% in 2000 to 81% in 2018
Male completeness was much higher than female completeness in most years; male completeness rose from 60% in 2009 to 85% in 2018, while female completeness increased from 54 to 74% in the same period

Summary

Introduction

In India the number of registered deaths increased substantially in recent years, improving the potential of the civil registration and vital statistics (CRVS) system to be the primary source of mortality data and providing more families of decedents with the benefits of possessing a death certificate. A high quality civil registration and vital statistics (CRVS) system should be the primary source of routine mortality data to inform public health policy [1]. The quality of the SRS has been questioned, with one analysis finding that it produces lower estimates of adult mortality than the death registration system in many states and suffers from considerable uncertainty due to it being based on a sample of the population [7]. Data are available at the national and subnational level from household surveys such as the India National Family Health Survey (INFHS) based on retrospective detailed birth histories [2, 8, 9]

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