The Sustainable Development Goals (SDGs) are embedded in the principle of leaving no one behind. Often overlooked is one of the root causes of being left behind - the lack of a legal identity that can facilitate access to social benefits and protections. A fundamental component of this is birth registration and the provision of a birth certificate through the civil registration and vital statistics (CRVS) system as recognized by Goal 16. Moreover, to monitor progress towards achieving the SDGs and ensure everyone is included, the information provided by a CRVS system is critical. Thus, a key indicator to monitor progress of Goal 17 tracks the proportion of countries that have achieved 100 per cent birth registration and 80 per cent death registration by 2030.
Understanding inequalities in civil registration as a crucial part of the “leave-no-one-behind” agenda
Certain population groups or geographical areas are more likely to have lower civil registration rates. Factors such as gender, citizenship, ethnicity, religion, geographical location, income and education can be barriers to civil registration, exacerbated further by external and institutional factors such as non-institutional births, distance to registration centre and cost of registration alongside legislative barriers. Disadvantage is further intensified when multiple factors and vulnerabilities intersect.
Consequently, certain population groups may lose out on the benefits of civil registration, including people living in rural, remote and isolated areas; indigenous people; migrants; asylum-seekers; refugees; stateless people; and persons with disabilities, to name a few. This impacts the individual through the lack of a legal identity and the community through the lack of information on the community’s vital events.
The lower inclusion of some population groups calls for a thorough examination of disparities in birth and death registration. The Regional Action Framework on CRVS in Asia and the Pacific includes assessing inequalities in CRVS as an implementation step. At the same time, the COVID-19 pandemic has highlighted the importance of universal death registration and recording of causes of death, reinforcing the need for thorough identification of those likely to be left behind.
How can disparities in birth and death registration be assessed?
A crucial step towards achieving universal registration and full inclusion is implementing inequality assessments of birth and death registration. These involve assessing differences in coverage and completeness by sociodemographic characteristics. While coverage is about the population for which registration is actually possible (due to geographical reach of the CRVS system), completeness is a measure of the proportion of vital events in that population which have been captured.
However, countries often struggle with operationalizing such assessments, especially for hard-to-reach populations. Special surveys to measure completeness using questions about registration of vital events are ideal, as these allow for purposive questions and over-sampling in geographical areas or among targeted population groups. These are, however, expensive and not sustainable.
An alternative is to tap into existing secondary data sources such as censuses, household surveys, administrative data such as from health information systems, health and demographic surveillance sites, and sample registration sites. Various national agencies are typically custodian of these data sources. Thus, successful inequality assessments require not only data availability but also access to the data and effective inter-agency data sharing.
There are two ways these data can be used to assess inequalities. First is to assess coverage if there is a data source which directly captures registration of vital events, such as questions on birth registration of young children in household surveys. Second is to estimate the expected number of vital events of different population groups and compare with the numbers recorded in the CRVS system. However, these estimation techniques often require a high level of demographic expertise.
Secondary data sources are not without shortcomings. For example, some population groups may represent a very small proportion of the overall population and there also is a possibility that certain marginalized groups may be excluded or not fully enumerated. Data triangulation may be needed to meet the deficits of any one data source.
From inequality assessments to policy…
Inequality assessments are of relevance even in countries with rapidly improving or well-functioning CRVS systems since there could still be population groups with lower rates of civil registration. In cases where significant disparities exist, targeted interventions are needed -- such as alleviating hindrances pertaining to distance to registration centre, registration costs, legal restrictions and cultural factors. A multi-sectoral CRVS national strategy should ideally set national targets for different population groups to enhance coverage and completeness of civil registration. The involvement of all relevant stakeholders is critical from the start of the inequality assessment process.
ESCAP recently launched a project to provide technical support and capacity strengthening to implement CRVS inequality assessments using secondary data sources in Bangladesh, Fiji, Lao People’s Democratic Republic, Pakistan and Samoa. This involves building demographic analytical capacity of national stakeholders to undertake assessments and promoting dialogue with policymakers. National and regional workshops are being organized to strengthen relevant skills and refine the methodology for the inequality assessments. Each project country will develop its own report of the inequality assessment to facilitate policy dialogue and action.