(August 2005) According to the United Nations Children’s Fund (UNICEF), an estimated one-third of all newborns worldwide are never officially registered—making gaining admittance to school, accessing health care, and gaining legal protection or standing difficult for these children.
But a new campaign by UNICEF and the nonprofit development organization Plan is pushing governments and the United Nations to recognize birth registration as a basic human right. “Having an identity is children’s first right,” said Maja Cubarrubia, Plan USA ‘s chief operating officer. “Once they have that, they can get access to other essential services.”
The Synergy Between Registration and Health
Cubarrubia says that a birth certificate is a fundamental tool of empowerment for a child. For instance, it makes admittance into school easier in many countries worldwide by providing proof that a child has attained the minimum age to begin primary school. Birth registration also permits children to sit for exams in secondary school in Togo and in Nepal, advance to secondary school and enroll in university in Tanzania, and apply for scholarships in Malaysia—to give but a few examples.
Birth Registration Levels by Received Vaccination
Source: Plan International, The ‘Rights’ Start to Life, 2005.
A birth certificate also opens the door to health care by establishing where a child was born and is entitled to receive free or subsidized treatment. Research by UNICEF shows the link between registration and health care is especially critical. A birth certificate makes it easier for children to receive health services: Registered children are more likely to be vaccinated (see Figure 1) and to be treated for acute respiratory infections.
“Unregistered children are harder to reach for community health care workers and may be overlooked entirely in public health planning,” adds Jonathan Todres, who chairs the American Bar Association’s International Health Law committee and is vice-chair of the ABA ‘s International Human Rights committee
Finally, a certificate also confers legal protection on a child. In countries that have and uphold inheritance rights, registration helps protect children from loss of inheritance when parents die because of disease or natural disaster. And in countries where border guards examine all travelers’ official documents, as Malian authorities have been doing since 2001, birth certificates help reduce the incidence of trafficking.
But birth registration efforts are also increasingly relying on health service providers to gain better coverage. For instance, registration officials accompany field workers for Plan who are carrying out vaccination campaigns in Nicaragua. Traditional birth attendants working with Plan in Kenya help deliver babies born at home and then register the births immediately, sparing the parents sometimes long and arduous trips to a government center. And analysts say that involving the health sector in registration also provides governments with data for identifying health threats and for allocating resources to combat them.
“Birth registration is a great way to start improving health information systems,” said Lexi Bambas Nolen of the World Health Organization’s (WHO’s) Commission on Social Determinants of Health Secretariat. Bambas Nolen recently published an article in the online journal PLoS Medicine that advocated greater international spending to advance less developed countries’ health information systems. She says that such systems build on vital registration systems (which collect birth and death records) and on census and survey data to track health problems and health disparities.
The Challenges of Improving Data Collection
But while Bambas Nolen stresses the importance of linking universal birth registration to existing vital registration systems, she adds that health information systems work better in some places than in others.
Only 57 of the 192 WHO member countries—most of which are more developed countries—have a vital registration system that covers at least 90 percent of their populations. Only 39 of the 192 countries have a health information system sufficient to support basic analysis of socioeconomic inequalities and health. In sub-Saharan Africa, such systems often are insufficiently supported or unable to accurately record causes of death. (See Figure 2 for a breakdown of unregistered children by world region.)
Percent of Unregistered Children by Region
Note: “CEE” stands for the countires of Central and Eastern Europe; “CIS” stands for the Commonwealth of Indepedent States, made up of Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan.
Source: Plan International, The ‘Rights’ Start to Life, 2005.
In such situations, Bambas Nolen says, international organizations and donor nations could strive to help local areas document their births, or they could aid countries in boosting the capacity of their vital registration systems. But significant technical and financial support will be required for either effort—which won’t be an easy sell to funders or recipients.
“It’s a challenge, especially in countries where per capita spending on health is under $10,” says Bambas Nolen. “People ask: ‘Can’t we spend money on addressing needs instead of collecting information?'” The answer, she says, lies partly in conveying to policymakers and citizens the long-term value of information as an effective mechanism for health-sector planning.
“Health information systems can explain disease dynamics, highlight health disparities among groups, and lead to interventions that otherwise could not have been discovered,” she says. For instance, a strong health information system would provide information on:
- The national rate of maternal mortality;
- Women at risk—likely poor rural women in certain geographic areas or of certain ethnic, racial, or religious groups;
- Rates of other health problems within those populations—for example, poor nutrition and lack of prenatal care;
- Access to safe birthing, including the availability of trained attendants in the area to assist women of all socioeconomic groups; and
- The effectiveness or shortcomings of past policies to reduce maternal mortality.
There is also a feedback mechanism at work here, notes Bambas Nolen: These information systems can play an important role in supporting human rights to health. When the data are collected, analyzed, and released to the public, people become aware of how health status is patterned—fairly or unfairly—within society. And that awareness can prompt them to advocate for and develop their own opportunities for better health.
Nicola Sharp, a policy researcher with Plan International in London, adds that funding registration efforts have short-term benefits for policymaking. “We work to convince people of the link between birth registration and government priorities,” she said. “Money spent on birth registration systems is cost-efficient and cross-cutting and can be perceived as a quick win.”
Allison Tarmann is a former senior editor at PRB, where she edited the newsletter Population Today.
Lexi Bambas, “Integrating Equity Into Health Information Systems: A Human Rights Approach to Health and Information,” PLoS Medicine 2, no. 4 (April 2005), accessed online at www.plosmedicine.org, on July 12, 2005.
Dara Carr, “The Poor-Rich Health Divide” (Washington, D.C.: Population Reference Bureau, Jan. 2004), accessed online at www.prb.org, on July 12, 2005.
The International Confederation of Midwives and the International Council of Nurses, “Every Child Has a Right to a Name and Nationality” (press release), The Hague, June 20, 2003, accessed online at www.icn.ch, on July 11, 2005.
Nicola Sharp, Universal Birth Registration—A Universal Responsibility (London: Plan International, February 2005).
Jonathan Todres, “Birth Registration: An Essential First Step Toward Ensuring the Rights of All Children,” Human Rights Brief 10, no. 3 (2003), accessed online at www.wcl.american.edu, on July 11, 2005.
United Nations Children’s Fund (UNICEF), The ‘Rights’ Start to Life: A Statistical Analysis of Birth Registration (New York: UNICEF, February 2005).