Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
International Center for Equity in Health, Federal University of Pelotas, Mal. Deodoro, 1160, 3d Floor, Pelotas, RS, 96020-220, Brazil.
Int J Equity Health. 2017 Aug 18;16(1):148. doi: 10.1186/s12939-017-0635-6.
Birth registration, and the possession of a birth certificate as proof of registration, has long been recognized as a fundamental human right. Data from a functioning civil registration and vital statistics (CRVS) system allows governments to benefit from accurate and universal data on birth and death rates. However, access to birth certificates remains challenging and unequal in many low and middle-income countries. This paper examines wealth, urban/rural and gender inequalities in birth certificate coverage.
We analyzed nationally representative household surveys from 94 countries between 2000 and 2014 using Demographic Health Surveys and Multiple Indicator Cluster Surveys. Birth certificate coverage among children under five was examined at the national and regional level. Absolute measures of inequality were used to measure inequalities in birth certificate coverage by wealth quintile, urban/rural residence and sex of the child.
Over four million children were included in the analysis. Birth certificate coverage was over 90% in 29 countries and below 50% in 36 countries, indicating that more than half the children under five surveyed in these countries did not have a birth certificate. Eastern & Southern Africa had the lowest average birth certificate coverage (26.9%) with important variability among countries. Significant wealth inequalities in birth certificate coverage were observed in 74 countries and in most UNICEF regions, and urban/rural inequalities were present in 60 countries. Differences in birth certificate coverage between girls and boys tended to be small.
We show that wealth and urban/rural inequalities in birth certificate coverage persist in most low and middle income countries, including countries where national birth certificate coverage is between 60 and 80%. Weak CRVS systems, particularly in South Asia and Africa lead rural and poor children to be systematically excluded from the benefits tied to a birth certificate, and prevent these children from being counted in national health data. Greater funding and attention is needed to strengthen CRVS systems and equity analyses should inform such efforts, especially as data needs for the Sustainable Development Goals expand. Monitoring disaggregated data on birth certificate coverage is essential to reducing inequalities in who is counted and registered. Strengthening CRVS systems can enable a child's right to identity, improve health data and promote equity.
长期以来，人们一直认为出生登记以及拥有出生证明作为登记证明是一项基本人权。功能完备的民事登记和人口动态统计系统（CRVS）的数据使政府能够受益于关于出生率和死亡率的准确和普遍数据。然而，在许多低收入和中等收入国家，获得出生证明仍然具有挑战性且不平等。本文研究了出生证明覆盖范围方面的财富、城乡和性别不平等问题。
我们使用人口与健康调查和多指标类集调查，分析了 2000 年至 2014 年期间来自 94 个国家的具有代表性的家庭调查数据。在国家和区域层面检查了五岁以下儿童的出生证明覆盖率。使用绝对不平等衡量标准衡量了按财富五分位数、城乡居住和儿童性别划分的出生证明覆盖率的不平等程度。
共有超过 400 万儿童被纳入分析。在 29 个国家，出生证明覆盖率超过 90%，而在 36 个国家，这一比例低于 50%，这表明在这些国家接受调查的五岁以下儿童中，超过一半没有出生证明。东非和南非的出生证明覆盖率最低（26.9%），各国之间差异很大。在 74 个国家和大多数儿童基金会区域都观察到出生证明覆盖率方面存在显著的财富不平等现象，而在 60 个国家都存在城乡不平等现象。出生证明覆盖率在女孩和男孩之间的差异往往很小。
我们表明，在大多数低收入和中等收入国家，包括出生证明覆盖率在 60%至 80%之间的国家，财富和城乡出生证明覆盖率不平等仍然存在。在南亚和非洲，民事登记和人口动态统计系统薄弱，导致农村和贫困儿童被系统地排除在出生证明所带来的利益之外，并且使这些儿童无法被纳入国家卫生数据。需要更多的资金和关注来加强民事登记和人口动态统计系统，而且随着可持续发展目标数据需求的扩大，公平分析应该为这些努力提供信息。监测出生证明覆盖率的分类数据对于减少谁被计入和登记的不平等至关重要。加强民事登记和人口动态统计系统可以使儿童的身份权得到保障，改善卫生数据并促进公平。
