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Why do CRVS systems underperform?

Demand-side challenges

From the perspectives of individuals and families, there are many reasons why they do not register births and deaths. For example:

  • People may not know about civil registration or be aware of the legal requirement to register births and deaths.
  • Families may not be aware that a notification form issued by a health agency or community leader is not the same as an official registration, so do not take the notification form to the registration office. This is particularly a problem when the death notification form has been issued to permit burial.
  • Families may be prevented from registering births and deaths due to the costs involved. The UN advises that as a matter of principle, the registration of births and deaths should be free of charge. 
  • There may be indirect and opportunity costs of registration – for example, travel to the local registration office (often for multiple visits), the requirement to bring witnesses, or the need to forgo other activities such as paid or informal employment. 
  • Distances to registration facilities may be problematic and travel difficult, especially during adverse weather conditions.
  • Families may face long queues and delays at registration offices.
  • Tight deadlines for registration and penalties for noncompliance may have the perverse effect of increasing nonregistration.
  • Families may be unaware of the benefits of registering vital events – for example, how birth registration underpins legal identity and facilitates access to benefits and social, health and education services. 
  • In general, deaths are less likely to be registered than births because people perceive no benefits in doing so. One way of overcoming this is to make the issuance of a burial permit contingent on the death registration. However, this will not be effective unless registration offices are readily accessible and open on a continuing basis so that people can register while complying with religious stipulations regarding burial.
  • Families may fear being blamed for a death when registering the event. 
  • Cultural practices may hinder certain groups from registering. For example, in some settings, only men are allowed to officially declare and register vital events. 
  • Information requested at the time of registration may inhibit registration. For example, for birth registration, asking for marital status of the mother, or the name of the father.
  • Women, especially unmarried women, may be unable to register their own children. 
  • Some populations – for example, marginalised or particular ethnic groups or religious affiliations – may be inhibited from registering vital events because of perceived discrimination. 
  • Families may be unwilling to register a birth until the child has been named.
  • Families sometimes hesitate to register a birth – especially if the infant is unwell – until they are sure of survival beyond the neonatal period. 
  • Should an infant die within a short period of birth, especially within the first few days, the family may not perceive the necessity of registering either the birth or the death. As a result, statistics on early (neonatal) deaths are likely to be seriously underestimated.
  • Families are particularly reluctant to declare fetal deaths (stillbirths) and do not understand that such information is of utility to the health authorities in development of intervention strategies. 

Barriers to death notification (Ghana)

Interview with Francis Yeji, Research Officer at the Ghana Health Service and Fellow at the University of Melbourne's Bloomberg Philanthropies Data for Health Initiative.

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Barriers to death notification in the Solomon Islands

What are the barriers to death notification in the Solomon Islands and how does the country plan to use innovative methods to improve data? Dilip Hensman, Technical Officer, World Health Organization explains. Watch Dilip describe the outcomes to improved death data:

Open video

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