Who and where are the uncounted children? Inequalities in birth certificate coverage among children under five years in 94 countries using nationally representative household surveys

International Journal for Equity in Health

Research

Amiya Bhatia¹  Aluísio J. D. Barros²  Leonardo Zanini Ferreira²  Cesar Gomes Victora² 

[1] Harvard T.H. Chan School of Public Health, 677 Huntington Ave, 02115, Boston, MA, USA;International Center for Equity in Health, Federal University of Pelotas, Mal. Deodoro, 1160, 3d Floor, 96020-220, Pelotas, RS, Brazil;

关键词: Birth certificates;    Vital statistics;    Health equity;    Child health surveys;    Global health;    Socioeconomic factors;   

DOI  :  10.1186/s12939-017-0635-6

 received in 2017-02-11, accepted in 2017-07-24,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundBirth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage.MethodsWe analyzed nationally representative household surveys from 94 countries between 2000 and 2014 using Demographic Health Surveys and Multiple Indicator Cluster Surveys. Birth certificate coverage among children under five was examined at the national and regional level. Absolute measures of inequality were used to measure inequalities in birth certificate coverage by wealth quintile, urban/rural residence and sex of the child.ResultsOver four million children were included in the analysis. Birth certificate coverage was over 90% in 29 countries and below 50% in 36 countries, indicating that more than half the children under five surveyed in these countries did not have a birth certificate. Eastern & Southern Africa had the lowest average birth certificate coverage (26.9%) with important variability among countries. Significant wealth inequalities in birth certificate coverage were observed in 74 countries and in most UNICEF regions, and urban/rural inequalities were present in 60 countries. Differences in birth certificate coverage between girls and boys tended to be small.ConclusionsWe show that wealth and urban/rural inequalities in birth certificate coverage persist in most low and middle income countries, including countries where national birth certificate coverage is between 60 and 80%. Weak CRVS systems, particularly in South Asia and Africa lead rural and poor children to be systematically excluded from the benefits tied to a birth certificate, and prevent these children from being counted in national health data. Greater funding and attention is needed to strengthen CRVS systems and equity analyses should inform such efforts, especially as data needs for the Sustainable Development Goals expand. Monitoring disaggregated data on birth certificate coverage is essential to reducing inequalities in who is counted and registered. Strengthening CRVS systems can enable a child’s right to identity, improve health data and promote equity.

【 授权许可】

CC BY   
© The Author(s). 2017