Abstract
This study extends Thaddeus and Maine’s (1994) “three delays” framework to model the interrelated barriers to maternal health care and birth registration. We focus on stateless persons and irregular migrants, populations that are especially at risk of being “left behind” in United Nations member states’ efforts to “provide legal identity to all” as part of the 2030 Sustainable Development Agenda. Drawing on qualitative fieldwork conducted in Sabah, Malaysia, we model delays in accessing maternal health care and birth registration as an integrated, cyclical process. We identify the political and legal barriers that stateless or migrant families confront while deciding to make institutional contact (Phase I), identifying and reaching health or registering institutions (Phase II), and receiving adequate and appropriate treatment (Phase III). We find that exclusion from one system raises the risk of exclusion from the other, resulting in a range of negative consequences, including increased health risks, governments’ impaired ability to monitor population health, and the perpetuation of intergenerational cycles of legal exclusion.
Highlights
In 2016, the United Nations made it a target “to provide legal identity to all, including birth registration” by 2030 as part of its Sustainable Development Goals (SDG) agenda, which succeeds the Millennium Development Goals of 1990–2015
We examine the interconnections between maternal health care and birth registration access by modeling how they may operate within a demographic that is at high risk of being “left behind” in UN member states’ efforts to meet the SDGs: stateless persons, irregular migrants, and their descendants, using Sabah, Malaysia, as a case study
We focus on the case of LMPs in the Malaysian context, because this population exemplifies the need to consider legal and political causes of delays to accessing both maternal health care and birth registration
Summary
In 2016, the United Nations made it a target “to provide legal identity to all, including birth registration” by 2030 as part of its Sustainable Development Goals (SDG) agenda, which succeeds the Millennium Development Goals of 1990–2015. We venture that improving access to health care and improving governments’ ability to monitor population health via expanding civil registration coverage are mutually constitutive goals: Incomplete civil registration systems make it difficult to produce accurate vital statistics and population health indicators, such as infant and maternal mortality Without vital documents, such as birth certificates, individuals, may face challenges establishing a legal identity, without which it may become difficult to regularize one’s status or even claim a nationality. Indonesian migrant workers, those living on remote palm oil plantations in the interior of the state, are often unable to travel to these urban centers for the various legal and resource-related reasons already discussed To expand their service coverage, Indonesian consular representatives often arrange outreach missions to remote plantation areas to conduct campaigns to supply Sabah-born children of Indonesian descent with documents called akta kelahiran (birth certificates). The politicization of birth registration in Sabah, has led to the deprivation of the fundamental right to a legal identity among children born on Malaysian soil
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