Countries need to know how many people are born and die each year – and the main causes of their deaths – in order to have well-functioning health systems. The only way to count everyone and to track all births and deaths is through civil registration. Civil registration provides the basis for individual legal identity but also allows countries to identify their most pressing health issues.
WHO receives reliable, high-quality cause-of-death statistics from only 31 of its 193 Member States. Globally, two-thirds (38 million) of 57 million annual deaths are not registered. And every year, almost 40% (48 million) of 128 million global births go unregistered.
When deaths go uncounted and the causes of death are not documented, governments cannot design effective public health policies or measure their impact. Civil registration is something that all developed countries have, and that developing countries need. Information on births and deaths by age, sex and cause is the cornerstone of public health planning.
Civil registration is the way by which countries keep a continuous and complete record of births, deaths and the marital status of their people.
For health agencies like WHO, civil registration systems are the most reliable source of statistics on births and deaths, and causes of death.
Countries that do not have a well-functioning civil registration system only have approximate ideas of the numbers, the longevity and the health of their population.
Civil registration brings multiple benefits. An individual’s right to be counted at both extremes of life is fundamental to social inclusion. In the absence of insurance or inheritance, death registration and certification are often required prerequisites for burial, remarriage, or the resolution of criminal cases. There are risks associated with civil registration. The information it provides can be used to discriminate against certain groups, however there are ways to design systems to reduce these risks.
Many barriers prevent people from registering births and deaths. Many countries do not have the necessary laws or infrastructure to make it obligatory to register births and deaths. In some countries, only people who live in cities have access to registration services.
It takes years to establish well-functioning civil registration systems but there are interim measures that countries can use to gather information.
Censuses and surveys can be used to estimate population numbers, but do not provide information on causes of death. Sample registration, which involves tracking a small part of the population, can also be used in the absence of full civil registration. This system exists in China and India.
WHO standard verbal autopsy questionnaires are recommended to improve the comparability of causes of death from systems without medical certification of deaths.
It has taken more than three centuries for civil registration systems in countries such as France and the United Kingdom of Great Britain and Northern Ireland to evolve from church registries. International standards and guidelines for setting up civil registration systems have been developed by United Nations agencies. It is possible to establish a functional system in the span of a few decades as shown by experiences in Jordan, Malaysia, South Africa, Sri Lanka and Thailand.
There is no single agency within the United Nations responsible for helping countries set up and manage civil registration. However, the United Nations Statistics Division (UNSD), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA) and the United Nations Development Programme (UNDP) all work with developing countries to improve different aspects of their population statistics. WHO, and its partner the Health Metrics Network, focus on improving health information systems and the ability of countries to track major causes of death.