Births and deaths need to be accurately registered in Asia Pacific countries

Reviewed by Emily Henderson, B.Sc.Nov 24 2021

A strong, universal, responsive civil registration and vital statistics (CRVS) system is critical for Asia Pacific countries to recover from the COVID-19 pandemic and ensure that the most vulnerable have access to healthcare, immunization and social welfare services.

This was highlighted in the Ministerial Declaration issued at the conclusion in Bangkok of the Second Ministerial Conference on CRVS (16—19 November) in Asia and the Pacific, organized by the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP).

Nearly 40 per cent of global deaths in 2020 were unregistered, according to a WHO report. And preliminary WHO estimates suggest that the total global excess mortality directly or indirectly attributable to COVID-19 amounts to a 1.2 million more than the reported deaths in 2020.

"These last two years have been a tragic reminder of our inability to accurately count the human lives we lost during the COVID-19 pandemic. There is no excuse for this," says Samira Asma, the WHO's assistant director-general for data, analytics and delivery for impact.

"These inaccuracies have cost us immeasurable losses and led to ineffective allocations of our limited resources, including vaccines," she adds.

Even well-functioning CRVS systems faced challenges of backlogs in death registrations and diagnostic uncertainties impeded by government-imposed COVID-19 restrictions, such as lockdowns.

The Universal Declaration of Human Rights Article 6 states: "Everyone has the right to recognition everywhere as a person before the law." Civil registration systems, which record key life events such as births, marriages and deaths, facilitate the realization of rights and support good governance, health and development.

But globally an estimated 1 billion people, including a disproportionate number of women, children, indigenous people, refugees and stateless people, live without proof of legal identity.

According to a UNICEF report, nearly 64 million children under the age of five in the Asia Pacific region still do not have their births registered, which may deny them access to essential services such as education, health and other social protections.

While many countries are close to registering all births and deaths, others are rapidly closing the gap. Nevertheless, we have yet to get everyone in the picture."

Armida Salsiah Alisjahbana, executive secretary of ESCAP

Key findings from ESCAP's review of mid-term progress of the CRVS decade (2015—2024) show that complete registration of deaths is lower than for births in most Asia Pacific countries. Most countries have made progress in death registrations particularly noteworthy scale-ups have been in Samoa, Cambodia, Lao People's Democratic Republic and Bangladesh.

The region has also seen a shift from manual registration of births and deaths to electronic and digitized systems. Most countries have achieved two targets — a certificate is almost always automatically delivered free of cost when births and deaths are registered; and the target of recording causes of death occurring in hospitals.

The conference noted that the registration of timely births and deaths can be greatly facilitated by transferring the primary responsibility for the notification of births and deaths from individuals and families to health sector and civil registration authorities.

For example, in Bangladesh, health workers who visit communities are required to collect data on births and deaths. Known as the Kaliganj model, which has been scaled across the country, it has in a few years led to an increase in complete registration of births from 50 per cent to 83 per cent, and deaths from less than 10 per cent to 90 per cent.

"Determining causes of death is also critical for public health monitoring. In at least 13 countries from Bangladesh to Rwanda to Colombia, a verbal autopsy is performed, whereby family members or people closest to the deceased are interviewed to determine what may have been the cause of death," Philip Setel, vice president, Public Health Programmes and director of CRVS Improvement at Vital Strategies tells SciDev.Net.

One of the commitments in the Ministerial Declaration is to conduct substantive identification and assessment of inequalities related to civil registration and vital statistics systems and take measures to remove all barriers to civil registration of vital events among vulnerable populations.

"We are currently working with five countries to support them in conducting inequality assessments of CRVS systems to be able to identify and quantify who is being left out," Petra Nahmias, ESCAP chief of the Population and Social Statistics Section, tells SciDev.Net.

The UN Sustainable Development Goals (SDGs) call for 100 per cent of births and 80 per cent of deaths to be registered globally by 2030.

"Strong civil registration and vital statistics systems are vital to track progress towards SDGs. We need a clarion call to achieve 75 per cent complete births, deaths and causes of death registration by 2025 and deliver on CRVS goals and targets by 2030," Asma told the conference.