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Correlates of birth registrations in East and Southern Africa and implications for civil registration and vital statistics systems
Authors: A.Onagoruwa and Q.Wodon
Source: Public Health, Volume 195; DOI:
Topic(s): Children under five
Service utilization
Country: Africa
  Multiple African Countries
Published: JUN 2021
Abstract: Objectives To analyze the role of both demand- and supply-side factors affecting birth registrations in East and Southern Africa by combining information on children, mothers, and their household on the one hand and information on the areas where they live on the other hand. Study design The study used deidentified data from recent Demographic and Health Surveys implemented in five East and Southern African countries: Malawi (2015), Mozambique (2011), Uganda (2016), Tanzania (2015), and Zambia (2013–2014). The analysis was based on children under the age of five whose mothers provided information on whether the child's birth was registered administratively and whether they have a birth certificate. Methods Multivariate logistic regression was conducted, and the odds ratios with the 95% confidence intervals are reported. The dependent variable is binary and indicates whether a child was registered or not. Separate analyses were performed for each country to test for similarity in results across countries. In addition, regression analysis was carried out on a pooled sample of the countries. Results There are differences between countries in the variables for which statistically significant associations with the likelihood of birth registration are observed. For example, the birth order of the child is statistically significant only for Mozambique with later children more likely to be registered. In addition, delivery in a healthcare facility is associated with a marginal gain in the likelihood of registration, except for Mozambique. By and large, when considering all five countries, there is no large gain or loss of residing in an urban area after controlling for the other independent variables included in the analysis. Generally, a higher level of educational attainment for the mother is associated with a higher likelihood of registration, with especially large gains in Tanzania and Mozambique at the postsecondary level. The effect of education remains statistically significant in the pooled sample. Conclusions Birth registration matters for a wide range of development outcomes and ensuring universal registration is a key target under the Sustainable Development Goals. Unfortunately, many low-income countries continue to have low rates of birth registration, especially in sub-Saharan Africa. Changing the status quo will require considering both demand-side and supply-side factors constraining birth registrations.