Investing in civil registration and vital statistics systems can yield big returns for governments, especially those with the most stretched budgets. Live, well-managed, and intelligently used databases of all births, deaths, marriages, and divorces help governments control costs by more efficiently targeting resources to priority development programs and ensuring that everyone has access to the services and support designed to meet their needs, CRVS experts argue.
“A strong CRVS system is at the heart of gender equality. It all starts there.”— Lisa Grace Bersales, professor, University of the Philippines School of Statistics
In particular, improving the collection and use of data about women and girls — many of whom remain “invisible” to decision-makers — is a powerful way of helping states not only meet the Sustainable Development Goals but improve the health and economic empowerment of whole communities.
Irina Dincu, senior program specialist at the Centre of Excellence for Civil Registration and Vital Statistics Systems, sits down with Devex to discuss why such systems are key in the push for gender equity.
“A strong CRVS system is at the heart of gender equality. It all starts there,” said Lisa Grace Bersales, professor in the School of Statistics at the University of the Philippines and former national statistician and civil registrar general of the Philippines. “If countries have really committed to gender equality and the SDGs, they should commit to systems that start that process.”
Better policies, less waste
As governments around the world rush to control the spread of COVID-19 and provide medical, nutritional, and financial support where it is most needed, the importance of a well-functioning CRVS system has been thrown into sharp relief. Access to accurate and complete data about the age and family structure of populations in specific towns or villages, as well as the locations and causes of deaths as they happen, offers immediate value to governments during such times of crisis, said Gloria Mathenge, social statistician at regional development organization The Pacific Community and current chair of the Global Civil Registration and Vital Statistics Group.
Smart use of the same data also brings longer-term benefits. With more insight into the needs and challenges of citizens at all stages of their lives, governments can design policies and services that are sufficient and appropriate, producing faster, better, and evidence-based solutions for problems such as noncommunicable disease or adolescent pregnancy and reducing the waste of vital resources. Without such insights, governments are “operating in the dark,” Mathenge said.
A stronger CRVS system can also provide some of the information — for example, mortality data — that is often gathered through household surveys. This can cut the cost of such exercises, which are important but hugely expensive and must be repeated after several years, said Daniel Cobos, senior scientific collaborator of the health systems and policies research group at the Swiss Tropical and Public Health Institute.
While most countries already operate a CRVS system, many of these still feature glaring data gaps, with the births of tens of millions of children and an estimated two-thirds of deaths never registered, according to the World Health Organization. Barriers to women accessing registration services are part of the problem, and a disproportionate number of the data omissions — especially concerning deaths — also relate to women and girls.
In some countries, women and girls live their lives entirely under the radar, with their births, and particularly their deaths, going unregistered. And where data is collected, it is often not timely, complete, analyzed, or disseminated to make it useful to decision-makers.
The social and economic reasons for women and girls being underrepresented in CRVS systems — and therefore underserved by their governments — are as complex as the consequences.
In many countries, women’s deaths — including their cause — are far less likely to be registered than men’s. With inheritance being a major incentive for death registration in most societies, the tendency of women to have less to bequest creates little economic incentive for their families to shoulder the time and cost of registering their deaths, Mathenge said. The resulting lack of data means that issues related to women’s health and safety — ranging from death in childbirth to domestic violence — are less likely to be addressed by governments.
Birth certificates are also vital for demonstrating age, helping to protect girls from child marriage, and ensuring they receive their rightful quota of education, Cobos said. However, the burden of registering a birth — a process that can involve one or more long journeys to civil registration points — falls to women, in most societies. Yet women are often unable to pay to make the journey and take the time away from the household. Social stigma or shame can also dissuade young or unmarried mothers from interacting with officials to register their children, Mathenge said.
In some countries, such as Jordan or Lebanon, a marriage certificate is a requirement to register the birth of a child, according to Romesh Silva, technical specialist of health and social inequalities at the United Nations Population Fund. Marriage registration has been a neglected component of civil registration systems, yet marriage certificates can be crucial for women having their rights to child custody, property, or other inheritance upheld, he added. Women who are displaced by war or natural disaster can be particularly vulnerable to discrimination or poverty while seeking refuge or on their return home if they lack such documentation.
There are several success stories that governments can draw on as evidence of the tangible benefits that investment in CRVS systems can bring to women and girls.
In 2016 — as part of a national strategy aimed at reducing unintended teenage pregnancy and the associated economic and development barriers this creates for young women — Uruguay’s government leveraged the digitization of its birth registration system to improve localized monitoring of the adolescent birth rate and guide health and social interventions where assistance was most needed. By 2018, Uruguay’s adolescent birth rate had fallen to nearly 35 per 1,000 women, down from around 60 per 1,000 in 2014-15.
Launched in 2018, Jordan’s Maternal Mortality Surveillance and Response System is working to combine CRVS data with information held by the Ministry of Health to plug data gaps and better track maternal death and its causes, including that of Syrian refugees. UNFPA, its partner, is now supporting the development of similar systems across the Arab region. “This speaks very directly to the SDGs and to a government priority of ending preventable maternal deaths, harnessing the power of civil registration data in an active, continuous manner,” Silva said.
The Philippines — where laws making civil registration mandatory were passed in the 1930s — provides a long-running example of how strong legislative frameworks for CRVS systems can support women and girls. The country’s well-established CRVS system specifically makes Philippine women the custodians of their own birth certificates and other documents, meaning they can receive education, apply for credit, and access benefits for them and their children without the permission or involvement of a male relative, Bersales said. “This is so empowering,” she added.
Governments can take action
There are several actions that governments can take now to prioritize improving their CRVS systems.
As a first step, apply systems approaches such as business process management to analyze the system and improve its design and efficiency, Cobos recommended. CRVS systems can be very “siloed,” so bringing together the various government ministries that feed into them is crucial. “If different stakeholders are not coordinated and aligned, the process will not have the deliverables that we want,” he said.
Working with other agencies is key to help fill data gaps, Bersales said. The Philippine Statistics Authority, for example, partners with the Department of Health to reach medical practitioners to improve the quality of data on the cause of death on death certificates. To help reach the target of 99% birth registration by 2024, it works with mayors and village chieftains to facilitate mobile birth registration. A public-private partnership has also enabled the digitization of all documents to overcome difficulties that citizens in the scattered archipelago face in accessing certificates.
To fulfill the 2030 Agenda for Sustainable Development’s pledge to leave no one behind, governments should ensure efforts to make CRVS systems accessible to their populations — including, for example, those who live in remote locations or who do not speak the dominant language, Silva said. Unlike one-off surveys, CRVS systems are a continuous work in progress, so governments should commit to “measure early and measure often” to fix blind spots and plug data gaps, he advised. Creating a culture of better and more timely production and usage of vital statistics from civil registration data will bring governments the fastest results for the smallest outlay, he added.
That said, governments should also bear more responsibility for facilitating registration of vital events, rather than placing the onus on individuals, Mathenge said. A human-centered approach to the design of processes — for example, by providing civil registration service points in health facilities to make it easier for mothers to register births — would help. Public education is also key to increasing participation in a CRVS system across the population, she stressed. “They need to know why it’s important for them and the societies they live in.”
For more information on the gender dimensions of CRVS systems and why CRVS systems are so important for gender equality, click here.