Improve Birth Registration Research Articles

A global and regional assessment of the timing of birth registration using DHS and MICS survey data

Registration of birth within the first year of life is important to ensure children receive its full benefits and that fertility statistics derived from these data are informative for policy. This study provides an up-to-date global and regional assessment of the timing of birth registration by using all available birth registration data of children aged less than five years reported in Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 2010 onwards. We calculated adjusted age-specific birth registration completeness by converting period age-specific completeness data into a hypothetical cohort. Timing of birth registration was analysed using ratios of adjusted age-specific completeness, with differentials by region, over time, and level of completeness assessed using bivariate and multivariate analyses. Almost 20% of registered births in countries with incomplete birth registration (less than 95%) were not registered until after 12 months, and this has not improved since 2010. In several countries this figure is greater than 50%, particularly in South Asia. There remains considerable scope to improve the timeliness of birth registration, particularly in countries where the overall level of completeness is lower. Strengthening and enforcing legislation for the mandatory registration of births before age 12 months and greater involvement of the health sector in registration processes are two ways which will improve birth registration timing.

Trends and Determinants of Birth Registration Completeness in Zimbabwe, 2005-2015

Childbirth registration in Zimbabwe has decreased over the years, yet the risk factors associated with this incompleteness have not been explored. This study investigates the trends in birth registration completeness and factors associated with the decrease in birth registration among children aged 0-5 years from 2005-2015. We use data from the, 2005-06, 2010-11 and 2015 Zimbabwe Demographic and Health Survey. Trends in birth registration completeness based on survey year were calculated and multivariable logistic regression models were used to estimate the predictors of birth registration. Birth registration completeness was 75.4 percent, 47.3 percent, and 43.8 percent in 2005, 2010, and 2015, respectively. Inequities in birth registration completeness become apparent when examined by wealth, urban/rural location, geographical region, maternal education, healthcare utilisation, and marital status. Child age, maternal education, marital status, household wealth status, residence, province, and delivery place were significant predictors of birth registration. Efforts to improve birth registration in Zimbabwe should target children born at home, children born to single and young mothers, and children whose mothers are poor and reside in rural areas.

Improving Birth Registration Using the Health System: A Case Study from Somali Region of Ethiopia

Birth registration is the process by which the event and characteristics of a child’s birth are recorded in a country’s civil registry. Ethiopia has one of the lowest levels of civil registration in general globally, and of birth registration in particular with only 3 per cent of children under the age 5 registered with civil authorities. In Somali Region of Ethiopia, only 1% of children under 5 have their births registered. A major gap identified in the civil registration system in Ethiopia is the linkage between the health and the civil registration sectors with most children delivered at the health facilities or in the communities not appropriately registered. This case study used qualitative and quantitative methods to describe the process and outcome of a pilot project on improving birth registration using the health system (health facilities and the community health structures) in 2 project woredas (districts) in Somali region of Ethiopia where no birth had been registered more than five years prior the pilot.
 Within the one-year study period, all 577 births assisted by health extension workers were provided with birth notification slips and 795 (98%) newborns have their birth registered and received birth certificates out of 809 total births reported in the project sites. The study demonstrated the effectiveness of health workers and community structure (mentor mothers) through their community sensitization and mobilization and active reporting process in facilitating registration of births in the civil registration system.

Counting on birth registration: mixed-methods research in two EN-BIRTH study hospitals in Tanzania

BackgroundBirth registration marks a child’s right to identity and is the first step to establishing citizenship and access to services. At the population level, birth registration data can inform effective programming and planning. In Tanzania, almost two-thirds of births are in health facilities, yet only 26% of children under 5 years have their births registered. Our mixed-methods research explores the gap between hospital birth and birth registration in Dar es Salaam, Tanzania.MethodsThe study was conducted in the two Tanzanian hospital sites of the Every Newborn-Birth Indicators Research Tracking in Hospitals (EN-BIRTH) multi-country study (July 2017–2018). We described the business processes for birth notification and registration and collected quantitative data from women’s exit surveys after giving birth (n = 8038). We conducted in-depth interviews (n = 21) to identify barriers and enablers to birth registration among four groups of participants: women who recently gave birth, women waiting for a birth certificate at Temeke Hospital, hospital employees, and stakeholders involved in the national birth registration process. We synthesized findings to identify opportunities to improve birth registration.ResultsStandard national birth registration procedures were followed at Muhimbili Hospital; families received birth notification and were advised to obtain a birth certificate from the Registration, Insolvency, and Trusteeship Agency (RITA) after 2 months, for a fee. A pilot programme to improve birth registration coverage included Temeke Hospital; hand-written birth certificates were issued free of charge on a return hospital visit after 42 days. Among 2500 women exit-surveyed at Muhimbili Hospital, 96.3% reported receiving a birth notification form and nearly half misunderstood this to be a birth certificate. Of the 5538 women interviewed at Temeke Hospital, 33.0% reported receiving any documentation confirming the birth of their child. In-depth interview respondents perceived birth registration to be important but considered both the standard and pilot processes in Tanzania complex, burdensome and costly to both families and health workers.ConclusionBirth registration coverage in Tanzania could be improved by further streamlining between health facilities, where most babies are born, and the civil registry. Families and health workers need support to navigate processes to register every child.

Birth Certificates, Birth Registration and the Denial of Human Rights: Evidence from Tanzania National Panel Data 2010/11

In many countries, a birth certificate is necessary to attend school, receive health care, inherit property, open a bank account, gain access to credit, obtain other forms of identification, vote, and receive a death certificate (Hunter and Brill, 2016). A birth certificate is proof of identity, citizenship and serves as a gateway to the realisation of other rights for children. It also serves as evidence that a child has been registered. Using evidence from the Tanzania National Panel Data 2010/11, I show that birth registration predicts lower odds for possessing a birth certificate for children in Tanzania. Instead, the education of the mother and the ability of households to pay for their own malaria bed nets, serve as the strongest predictors for possessing birth certificates in Tanzania. The article concludes with recommendations for improving birth registration and certification in Tanzania.

Improving the demand for birth registration: a discrete choice experiment in Ethiopia

IntroductionBirth registration remains limited in most low and middle-income countries. We investigated which characteristics of birth registration facilities might determine caregivers’ decisions to register children in Ethiopia.MethodsWe conducted a discrete...

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999–2016

IntroductionAlthough global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in birth registration coverage by wealth, urban/rural location, maternal education and access to...

Strategic yet delicate: the dilemma of involving health workers in facilitating birth registration in Indonesia

BackgroundBirth registration provides the basis for population data. Previous studies have examined that collaboration between the health sector and civil registration can help improve birth registration rate. However, there was a little exploration into health workers’ understanding of civil registration and vital statistics (CRVS) and their perceived role in it. This study aims to fill this gap by focusing on the perspective of both health personnel in a managerial position and those who are involved in direct service provision to the community. Finally, we discussed the opportunities and challenges to strengthen the birth registration presented by health workers’ diverse views.MethodThis study uses a qualitative approach through semi-structured in-depth interviews with 23 provincial to village health personnel in Pangkajene Kepulauan (Pangkep) district of South Sulawesi province. The participants were selected through consultation with the Department of Planning and the head of the Department of Health at provincial and district level based on the relevance of their position with CRVS. At the frontline level, the informants were identified using a snowballing technique and recommendation from community members.ResultsThis study finds that at the village level, health workers perceive CRVS as important since it supports them in delivering healthcare to community members. They see identification document like birth certificate as crucial for healthcare seekers to access the government’s health insurance and with that, proper and affordable treatment. Some health workers have been facilitating birth registration on a discretionary basis. Local health officials agree that accurate birth data lead to effective planning and financing for healthcare services and insurance. Despite the positive perception of birth registration, the majority of health workers do not want the additional burden for registering births. Health officials, however, are more open to taking some responsibilities.ConclusionThis study concludes that the level of health workers’ understanding and appreciation of the CRVS system provides opportunities to engage them systematically in birth registration. It recommends that institutionalizing health workers’ participation in birth registration must consider their current workload, revision of legal instruments, capacity building plan, and operable linkage with civil registration authority.

The bureaucracy of birth registration in Tanzania

ABSTRACTBirth registration is a basic human right. It is also considered a ‘gateway right’ which aids in the realization of many other civil, political, economic and social rights. After decades as an ‘orphan’ policy issue, birth registration is gaining prominence among experts and policy actors in the fields of international development and global health. This article examines the challenges of improving birth registration policy and implementation in Tanzania, which has one of the lowest rates of birth registration in the world. Ethnographic interviews with families and government workers in Dar es Salaam reveal that policies intended to discipline families into registering children’s births promptly instead serve to create numerous barriers to birth registration. This case study contributes to a greater understanding of the unintended consequences of policy implementation in developing country contexts, demonstrating the importance of ethnographic studies that examine the perspectives of both the targets and the implementers of policies.

Obstacles to birth registration in Niger: estimates from a recent household survey

Despite progress made towards increasing birth registration rates over the last dozen years, almost one in two children may still not get registered at birth in Niger according to a recent nationally representative household survey. What can be done to improve birth registration rates? This paper relies on a simple approach to measure how solving various obstacles to birth registration faced by parents could help increase birth registration rates. Controlling for other factors affecting birth registrations, the analysis relies on local-level reasons declared by households for not registering their children. The estimation method provides measures of potential gains in birth registration rates from different actions, including providing services closer to where households live, improving household knowledge about the fact that birth registration is both mandatory and beneficial for children, and reducing the out-of-pocket costs of birth registration. The analysis remains exploratory, but it provides hopefully useful insights about the likely benefits that could be derived from various policies utilized for increasing rates of birth registrations.

Registered or unregistered? Levels and differentials in registration and certification of births in Ghana

BackgroundThe birth of a child is a vital event that needs to be registered but this is not always the case as an estimated 40 million births go unregistered annually. Birth registration safeguards the basic rights of children and gives them an identity, citizenship/nationality and legal protection against violence, abuse and human rights violations. It is therefore necessary that all births are registered and even more critical that the registration of a birth is followed by the issuance of a birth certificate. But sadly, birth registration in many African countries continues to remain below acceptable international standards and not all registered births are certified. This paper examined birth registration and certification in Ghana. Differentials in the characteristics of children and mothers of children whose births are registered and certified, children whose births are registered but not certified and children whose births are not registered were examined.MethodsThis paper analysed data from the 2014 Ghana Demographic and Health Survey drawing on variables from the household and children’s data files. Descriptive analytical tools (frequencies, percentage and cross tabulations) and multinomial logistic regression analysis were used to examine differentials in birth registration status among an analytical sample of 3880 (weighted) children aged 0–4 years.ResultsThe birth of about every 1 in 4 (28.89%) children in Ghana have never been registered. Birth registration and certification was lowest among children born to young mothers (15–19 years), children whose mothers have no formal education, mothers who reside in rural areas and mothers in the poorest wealth quintile. Additionally, home births and births that were not assisted by a medical professional were observed to have the lowest proportion of registered and certified births. Furthermore, the birth of children who are less than a year old was significantly more likely not to be registered or issued with a birth certificate.ConclusionEfforts aimed at improving birth registration and certification in Ghana need to target groups of children and mothers with low levels of registration and certification particularly children who are born at home, children born to young mothers and children whose mothers are poor and or reside in rural areas.