A missed opportunity: birth registration coverage is lagging behind Bacillus Calmette–Guérin (BCG) immunization coverage and maternal health services utilization in low- and lower middle-income countries|
Rahman, M. Hafizur; Cox, Amber Bickford & Mills, Samuel L.
Background: Civil registration and vital statistics (CRVS) systems lay the foundation for good governance by
increasing the effectiveness and delivery of public services, providing vital statistics for the planning and monitoring
of national development, and protecting fundamental human rights. Birth registration provides legal rights and
facilitates access to essential public services such as health care and education. However, more than 110 low- and
middle-income countries (LMICs) have deficient CRVS systems, and national birth registration rates continue to fall
behind childhood immunization rates.
Using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data in 72 LMICs, the
objectives are to (a) explore the status of birth registration, routine childhood immunization, and maternal health
services utilization; (b) analyze indicators of birth registration, routine childhood immunization, and maternal health
services utilization; and (c) identify missed opportunities for strengthening birth registration systems in countries
with strong childhood immunization and maternal health services by measuring the absolute differences between
the birth registration rates and these childhood and maternal health service indicators.
Methods: We constructed a database using DHS and MICS data from 2000 to 2017, containing information on
birth registration, immunization coverage, and maternal health service indicators. Seventy-three countries including
34 low-income countries and 38 lower middle-income countries were included in this exploratory analysis.
Results: Among the 14 countries with disparity between birth registration and BCG vaccination of more than 50%,
nine were from sub-Saharan Africa (Tanzania, Uganda, Gambia, Mozambique, Djibouti, Eswatini, Zambia, Democratic
Republic of Congo, Ghana), two were from South Asia (Bangladesh, Nepal), one from East Asia and the Pacific
(Vanuatu) one from Latin America and the Caribbean (Bolivia), and one from Europe and Central Asia (Moldova).
Countries with a 50% or above absolute difference between birth registration and antenatal care coverage include
Democratic Republic of Congo, Gambia, Mozambique, Nepal, Tanzania, and Uganda, in low-income countries.
Among lower middle-income countries, this includes Eswatini, Ghana, Moldova, Timor-Leste, Vanuatu, and Zambia.
Countries with a 50% or above absolute difference between birth registration and facility delivery care coverage
include Democratic Republic of Congo, Djibouti, Moldova, and Zambia.
Conclusion: The gap between birth registration and immunization coverage in low- and lower middle-income
countries suggests the potential for leveraging immunization programs to increase birth registration rates. Engaging
health providers during the antenatal, delivery, and postpartum periods to increase birth registration may be a
useful strategy in countries with access to skilled providers.
Birth registration; Immunization; Maternal health service indicators