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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
BACKGROUND: Birth 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 b...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562988/ https://www.ncbi.nlm.nih.gov/pubmed/28821291 http://dx.doi.org/10.1186/s12939-017-0635-6 |
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author | Bhatia, Amiya Ferreira, Leonardo Zanini Barros, Aluísio J. D. Victora, Cesar Gomes |
author_facet | Bhatia, Amiya Ferreira, Leonardo Zanini Barros, Aluísio J. D. Victora, Cesar Gomes |
author_sort | Bhatia, Amiya |
collection | PubMed |
description | BACKGROUND: Birth 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. METHODS: We 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. RESULTS: Over 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. CONCLUSIONS: We 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-017-0635-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5562988 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-55629882017-08-21 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 Bhatia, Amiya Ferreira, Leonardo Zanini Barros, Aluísio J. D. Victora, Cesar Gomes Int J Equity Health Research BACKGROUND: Birth 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. METHODS: We 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. RESULTS: Over 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. CONCLUSIONS: We 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12939-017-0635-6) contains supplementary material, which is available to authorized users. BioMed Central 2017-08-18 /pmc/articles/PMC5562988/ /pubmed/28821291 http://dx.doi.org/10.1186/s12939-017-0635-6 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Bhatia, Amiya Ferreira, Leonardo Zanini Barros, Aluísio J. D. Victora, Cesar Gomes 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 |
title | 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 |
title_full | 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 |
title_fullStr | 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 |
title_full_unstemmed | 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 |
title_short | 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 |
title_sort | 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 |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562988/ https://www.ncbi.nlm.nih.gov/pubmed/28821291 http://dx.doi.org/10.1186/s12939-017-0635-6 |
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