Supporting Global Efforts to Strengthen CRVS
by Amelia Pittman and Deirdre Appel
Civil registration and vital statistics (CRVS) systems are crucial to protecting the rights of women and children, and concerted global effort is needed to strengthen these systems to support gender equality. These systems record births, marriages, divorce, and deaths, and serve as a fundamental component of the legal identity system. They make it possible for women and children to prove their identities to access crucial public services and social protection. But as essential as they are, many countries lack robust CRVS systems, and many gender-related barriers and inequalities persist. Women and children stand to benefit most from CRVS systems and yet face the greatest barriers to access.
To inspire a global commitment to strengthening CRVS systems, the Centre of Excellence for Civil Registration and Vital Statistics (CRVS) Systems at the International Development Research Centre (IDRC) has launched a Knowledge Brief Series on CRVS and Gender. Created in partnership with Open Data Watch, this collection of three briefs, — each consisting of four papers — aims to provide knowledge and tools to governments, international organizations, and the research community to help protect and empower women and children around the world. Following the publication of the first brief earlier this year, the Centre of Excellence has recently launched the second brief.
Authored by CRVS systems experts, the second knowledge brief, Strengthening CRVS Systems, Overcoming Barriers and Empowering Women and Children, contains four papers discussing the barriers women and children face in accessing CRVS systems with solutions to address them.
The involvement of a wide range of stakeholders is crucial to supporting the adoption of good practices to strengthen CRVS systems. In addition to writing the last paper on “Empowering Women and Girls Through Civil Registration Systems,” the authors, Carla AbouZahr, et al., have created a reference guide that maps the supply-side gendered dimensions of CRVS. More research is needed to explore the demand-side. This guide provides an overview for those seeking a comprehensive understanding of a complex subject.
This guide consists of two tables, one highlighting gender issues in relation to the registration of births, and the other in relation to the registration of deaths and cause of death. Each table highlights key gender-related barriers in access to CRVS and provides examples of country experiences in overcoming them. Additionally, they point to areas where further research is needed. The tables are available directly below, and a PDF version of this guide is available for download.
As awareness and understanding of these issues increase among both new and existing actors, global commitment to strengthening these systems will grow.
GENDER ISSUES RELATED TO BIRTH REGISTRATION
Legal impediments to birth registration that particularly affect women and children
BARRIERS TO
ACCESS
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- Local regulations place primary responsibility for registration on the father or other male relative.
- Stipulations that if the mother is unmarried, the father must acknowledge paternity before the birth can be registered.
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OVERCOMING
BARRIERS
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- Modify regulations to permit either parent to register birth if the other parent is not available.
- Remove stigma associated with “out-of-wedlock” births.
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AREAS FOR FURTHER RESEARCH
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- Legal changes to enable women to register births of their infants when unmarried.
- Provision for e-signature if one parent is not available at the time of registration.
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Gender gaps in birth registration in communities
BARRIERS TO
ACCESS
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- Registration of girls is lower in settings with strong son preference.
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OVERCOMING
BARRIERS
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- Awareness raising with community leaders and religious authorities.
- Community health workers designated as notification agents to registration offices.
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AREAS FOR FURTHER RESEARCH
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- Dimensions of female under registration (statistical analyses).
- Facilitating access to the birth certificate on registration and to copies when needed.
- Impact on birth registration of linkage to unique identification (UID) systems.
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Lack of knowledge and autonomy among women and children about birth registration
BARRIERS TO
ACCESS
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- Women and children have limited knowledge about the importance of birth registration.
- Customary restrictions on women’s mobility.
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OVERCOMING
BARRIERS
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- Offer incentives to women to register birth (e.g. ‘baby kits’).
- Raise awareness, particularly directed to adolescent mothers, those who are unmarried, poorly educated, marginalised and living in remote areas.
- Work with community leaders and the entire community so that both men and women are aware of the importance of vital events registration.
- Introduce active notification of births by health administrators to reduce reliance on declaration by family members.
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AREAS FOR FURTHER RESEARCH
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- Use of e-notification of births through digital health innovations and technologies.
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Direct and indirect costs of registration
BARRIERS TO
ACCESS
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- Costs of travel to registration offices.
- Multiple visits to complete the registration/certification process.
- Requirement for witnesses at registration.
- Fees for birth registration & certification.
- Penalties for late or delayed registration
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OVERCOMING
BARRIERS
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- Remove fees for birth registration.
- Provide 1st copy of the certificate free of charge.
- Minimize penalties for late or delayed registration.
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AREAS FOR FURTHER RESEARCH
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- Estimation of costs (financial and in terms of time and opportunity) to families of birth registration.
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Poor registration service availability and quality
BARRIERS TO
ACCESS
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- Distance to registration offices.
- Long delays at registration centres.
- Complex forms.
- Language barriers.
- Unsympathetic registration officials.
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OVERCOMING
BARRIERS
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- Establish mobile registration units for remote areas.
- Simplify notification and registration forms and reduce number of visits required.
- Introduce IT to facilitate registration, bearing in mind local constraints and capacities.
- Designate community-based health workers as birth notification agents.
- Use community workers to help women complete birth registration process.
- Out-post registrars to health facilities and remote areas.
- Make forms available in local languages.
- Provide interpersonal training for registrars.
- Ensure gender balance in the recruitment of registrars.
- Conduct regular client satisfaction assessments in registration offices
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AREAS FOR FURTHER RESEARCH
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- Statistical analyses of registration service availability and quality.
- Use immunization sessions to ensure catch-up of unregistered infants.
- Introduction of “paperless” registration and certification.
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GENDER ISSUES RELATED TO REGISTRATION OF DEATHS AND CAUSE OF DEATH
Direct and indirect costs of registration
BARRIERS TO
ACCESS
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- Costs of travel to registration offices.
- Multiple visits to complete the registration/certification process.
- Requirement for witnesses at registration.
- Fees for death registration & certification.
- Penalties for late or delayed registration.
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OVERCOMING
BARRIERS
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- Remove fees for death registration.
- Provide first copy of the death certificate free of charge.
- Minimize penalties for late or delayed death registration.
- Ensure that deaths in health facilities are notified to the civil registration authorities.
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AREAS FOR FURTHER RESEARCH
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- Costs to families and benefits of death registration.
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Under-registration of deaths in young children, stillbirths, neonates, infants
BARRIERS TO
ACCESS
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- Lack of community recognition of the benefits of registering deaths in young children.
- Fear of registering deaths due to blame culture.
- Obligation to register both a birth and the death when death occurs in young infants.
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OVERCOMING
BARRIERS
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- Ensure notification to registration authorities of all infant deaths in health facilities.
- Enhance roles of health care workers and community workers in notification of stillbirths, neonatal and infant deaths.
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AREAS FOR FURTHER RESEARCH
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- Potential for collaboration with morticians, religious authorities and community leaders to encourage registration of deaths in young children.
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Lower registration of female deaths compared to males
BARRIERS TO
ACCESS
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- Women have fewer assets to pass on to families so reduced incentive to register their deaths.
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OVERCOMING
BARRIERS
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- Develop regulations and standards of practice (SOPs) to ensure notification of deaths of females by health facilities.
- Train community health workers to identify and notify deaths (including female deaths) to the local registration office.
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AREAS FOR FURTHER RESEARCH
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- Reasons for under registration in females.
- Impact of link between death registration and unique identification systems (UIDs).
- Understanding the benefits of registration of deaths for women..
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Lack of reliable data on the cause patterns of mortality
BARRIERS TO
ACCESS
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- Stigma associated with certain causes of death impedes registration (AIDS, suicide, abortion).
- Certifying physicians reluctant to share stigmatizing causes of death with family of decedent.
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OVERCOMING
BARRIERS
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- Modify SOPs to ensure that certifying physician does not share cause of death (COD) directly with family.
- Train physicians to correctly complete the medical certificate of cause of death, including with regard to conditions that particularly affect women.
- Ensure strict confidentiality of cause of death information throughout the CRVS system.
- Implement verbal autopsy to ascertain probable causes of death and distributions of causes of death among women..
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AREAS FOR FURTHER RESEARCH
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- Conduct literature reviews and community-based research to better understand the impact of sex and gender issues on the ascertainment of deaths in women and children.
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Deaths of women due to external causes (accidents, violence, etc.)
BARRIERS TO
ACCESS
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- Underreporting of deaths in women associated with domestic abuse and violence.
- Underreporting of deaths due to sexual abuse and physical abuse in women and children.
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OVERCOMING
BARRIERS
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- Raise awareness among community workers, coroners, pathologists the police and judiciary.
- Support physicians in correctly reporting such deaths.
- Develop clear guidance and legal structures around determination of cause of unnatural deaths in women and children.
- Ensure that post-mortems are conducted for deaths of women and children due to unnatural causes.
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AREAS FOR FURTHER RESEARCH
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- Perform record linkage studies to follow up cases of reported violence that may have resulted in death.
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Registration service availability and quality
BARRIERS TO
ACCESS
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- Lack of incentives for death registration.
- Distance to registration offices.
- Long delays at registration centres.
- Complex forms.
- Language barriers.
- Unsympathetic registration officials.
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OVERCOMING
BARRIERS
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- Work with morticians and religious leaders to support registration of deaths.
- Make death notification a condition for permission to dispose of the body.
- Establish mobile registration units for remote areas.
- Simplify notification and registration forms and reduce number of visits required.
- Introduce IT to facilitate registration, bearing in mind local constraints and capacities.
- Designate community-based health workers as death notification agents.
- Use community workers to support families through death registration process.
- Out-post registrars to health facilities.
- Make forms available in local languages.
- Provide interpersonal training for registrars.
- Recruit female registrars.
- Conduct regular client satisfaction surveys in registration offices.
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AREAS FOR FURTHER RESEARCH
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- Role of multiple health programmes to ensure that all deaths are notified.
- Effectiveness of public health legislation on the safe disposal of bodies.
- Dimensions of unregulated cemeteries and informal disposal of bodies.
- Introduce “paperless” registration and certification.
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⇒ Download the PDF version of this guide here
Author: Open Data Watch
Open Data Watch is an international non-profit, non-governmental organization that works at the intersection of open data and official statistics. It monitors the accessibility and comprehensiveness of official data in over 180 countries and provides practical information and assistance in implementing open data policies and systems. The Open Data Watch team has unparalleled experience in development data and is committed to making open data a global reality in support of Sustainable Development Goals.
