Every year, millions of people in Asia and the Pacific die without their deaths being registered. The under-registration of deaths has serious consequences for individuals, families, communities and governments.
As a legal function, death registration supports the provision of social welfare benefits, inheritance rights of survivors and identity management as well as limiting fraud. In addition, unregistered deaths can impede the tracking and monitoring of mortality rates and the development of policies to address public health and social welfare needs. In particular, information from death registration is fundamental for measuring and mitigating critical health challenges which became acutely apparent during the COVID-19 pandemic. This is also helpful for monitoring progress on the 2030 Agenda for Sustainable Development, which includes many indicators benefiting from information on deaths from well- functioning civil registration and vital statistics (CRVS) systems.
However, despite the commitment of Asia-Pacific countries to improve CRVS systems and progress in that regard, many countries still do not have universal and inclusive death registration. Further, there is often not even data on the level of completeness and an understanding of who is not registered is lacking.
To fill this gap, ESCAP has worked to reach the first regional estimate of the level of death registration completeness in Asia and the Pacific.
Estimation of unregistered deaths in Asia and the Pacific
The study used the scarce data available and built upon innovative methods to estimate the number of unregistered deaths in countries for which data was not reported. It compared registered deaths with an estimate based on past records and demographic trends.
Our study estimates that of the approximately 32.1 million deaths in the 58 countries in the region, 23.8 million were reported, resulting in a regional estimate of completeness of approximately 74.3 per cent in 2018. As shown in the figure below, subregional estimates reveal a contrasting picture. The highest completeness rate is observed in North and Central Asia (97 per cent), while all other subregions have completeness rates below 80 per cent, falling as low as 66 per cent in South and South-West Asia. More specifically, the study showed that completeness exceeded 99.9 per cent in 10 countries and was below 50 per cent in 7 countries. 87 per cent of unregistered deaths were found in five countries: China, India, Indonesia, Pakistan and Bangladesh.
Figure 1. Estimates of death registration completeness by ESCAP subregion
Beyond death registration itself, the study also constitutes an overview of the level of publication of vital statistics in the region. The results emerging from the study are encouraging, with 36 countries having published statistics recently, and 17 more having communicated relevant statistics to an international organization.
Registering every death: The fight to leave no one behind
Unregistered deaths have negative consequences for the families of the individuals who may be denied claims to some of their rights. It also creates a blind spot in the design and implementation of public policies in a wide array of topics related to deaths and their causes, especially evident with the COVID-19 pandemic. Studies have shown that in most countries, the official toll of the pandemic was far lower than its actual impact, in part due to the shortcomings of death registration systems.
Those most at risk of being excluded from death registration are hard to reach populations and people in vulnerable situations. People living in rural, remote, isolated or border areas, people with disabilities, minorities, indigenous people, migrants, non-citizens, asylum-seekers, refugees, stateless people, internally displaced people, domestic workers, foundlings and people without documentation can face additional barriers in access to registration. They can therefore be denied this right for them and their families. Women and girls may also be disproportionately excluded from death registration. ESCAP is implementing a project to develop guidelines and provide technical support for inequality assessments of CRVS systems. Ensuring every death is registered is an integral part of leaving no one behind.
The way forward
While the approximately 8.2 million unregistered deaths each year is concerning, there has been significant progress. Countries and development partners are committed to achieve the shared vision of the 2014 Ministerial Declaration to “Get Every One in the Picture”. It establishes that, by 2024, all people in the region should benefit from universal and responsive CRVS systems. The midterm review of the Asia-Pacific CRVS Decade “A Snapshot of Progress Midway through the Asian and Pacific Civil Registration and Vital Statistics Decade” shows that most countries with low death registration completeness at the beginning of the Decade have seen improvements. However, the current level of improvement will not be enough for many countries to achieve universal civil registration by 2024, or even 2030. Increased efforts are therefore needed to build on progress made thus far.
A full description of the findings can be accessed at this link.