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This study evaluated the efficiency of birth registration in Uganda from 2020 to 2024, identifying regional and health facility-based effects and determined the demand side factors influencing the time-to-notification. Using a quantitative approach, birth registration data from this period were analyzed through descriptive statistics and statistical tests, including the Kruskal‒Wallis and Chi-Square tests, to assess nuances between notification timeliness and demand side factors; regional and facility-level differences in notification-registration conversions. Predictive models for timeliness of notifications and registration based on demand and supply side of factors were explored using multinomial logistic regression models.Findings indicated a balanced sex distribution but significant inefficiencies, with only 7% of births registered on time and a median notification delay of approximately 3 years and 2 months. Regional disparities were evident, as the Central Region accounted for 36% of registered births, while the North Eastern and North Western Regions had the lowest rates (9% each), underscoring infrastructural challenges. Facility-based disparities were also notable, with Medical Centers exhibiting the longest delays and Referral Hospitals the shortest, highlighting the role of healthcare infrastructure in registration efficiency.Addressing these inefficiencies requires targeted public awareness campaigns, improved infrastructure, and digital registration platforms. Integrating birth registration into maternal and newborn care, training healthcare providers, and implementing policy reforms—such as mandatory immediate birth notification and fee waivers—can enhance efficiency. Additional resources should be allocated to underperforming regions, including mobile registration units to improve access. Establishing a nationwide monitoring system will enable data-driven improvements, ensuring timely birth registration and access to legal identity for all children in Uganda.

Background: Civil registration and vital statistics (CRVS) systems lay the foundation for good governance by increasing the effectiveness and delivery of public services, providing vital statistics for the planning and monitoring of national development, and protecting fundamental human rights. Birth registration provides legal rights and facilitates access to essential public services such as health care and education. However, more than 110 low- and middle-income countries (LMICs) have deficient CRVS systems, and national birth registration rates continue to fall behind childhood immunization rates. Using Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data in 72 LMICs, the objectives are to (a) explore the status of birth registration, routine childhood immunization, and maternal health services utilization; (b) analyze indicators of birth registration, routine childhood immunization, and maternal health services utilization; and (c) identify missed opportunities for strengthening birth registration systems in countries with strong childhood immunization and maternal health services by measuring the absolute differences between the birth registration rates and these childhood and maternal health service indicators. Methods: We constructed a database using DHS and MICS data from 2000 to 2017, containing information on birth registration, immunization coverage, and maternal health service indicators. Seventy-three countries including 34 low-income countries and 38 lower middle-income countries were included in this exploratory analysis. Results: Among the 14 countries with disparity between birth registration and BCG vaccination of more than 50%, nine were from sub-Saharan Africa (Tanzania, Uganda, Gambia, Mozambique, Djibouti, Eswatini, Zambia, Democratic Republic of Congo, Ghana), two were from South Asia (Bangladesh, Nepal), one from East Asia and the Pacific (Vanuatu) one from Latin America and the Caribbean (Bolivia), and one from Europe and Central Asia (Moldova). Countries with a 50% or above absolute difference between birth registration and antenatal care coverage include Democratic Republic of Congo, Gambia, Mozambique, Nepal, Tanzania, and Uganda, in low-income countries. Among lower middle-income countries, this includes Eswatini, Ghana, Moldova, Timor-Leste, Vanuatu, and Zambia. Countries with a 50% or above absolute difference between birth registration and facility delivery care coverage include Democratic Republic of Congo, Djibouti, Moldova, and Zambia. Conclusion: The gap between birth registration and immunization coverage in low- and lower middle-income countries suggests the potential for leveraging immunization programs to increase birth registration rates. Engaging health providers during the antenatal, delivery, and postpartum periods to increase birth registration may be a useful strategy in countries with access to skilled providers.

Despite progress made towards increasing birth registration rates over the last dozen years, almost one in two children may still not get registered at birth in Niger according to a recent nationally representative household survey. What can be done to improve birth registration rates? This paper relies on a simple approach to measure how solving various obstacles to birth registration faced by parents could help increase birth registration rates. Controlling for other factors affecting birth registrations, the analysis relies on local-level reasons declared by households for not registering their children. The estimation method provides measures of potential gains in birth registration rates from different actions, including providing services closer to where households live, improving household knowledge about the fact that birth registration is both mandatory and beneficial for children, and reducing the out-of-pocket costs of birth registration. The analysis remains exploratory, but it provides hopefully useful insights about the likely benefits that could be derived from various policies utilized for increasing rates of birth registrations.

In collaboration with development partners, the World Bank Group (WBG) has been working to strengthen civil registration and vital statistics (CRVS) systems in low- and middle-income countries through lending operations, technical assistance projects, advisory services and analytics, and knowledge sharing at various international, regional, and national conferences and fora and through publications. In 2017, it launched a comprehensive CRVS eLearning course, which provides practical tools and approaches to achieving twenty-first-century state-of-the-art CRVS systems that are linked to identity management systems and are tailored to local contexts. Some of the key lessons learned from the various initiatives and projects are presented in the eight peer-reviewed manuscripts included in this issue.

This paper investigates access to birth registration, education, and health care for cross-border migrant children in Thailand. It also emphasizes the importance of integrating migrant populations into Thai society and the role local civil society organizations play in protecting and improving children’s access to these rights. Data collected from previous fieldwork conducted in Thailand’s border areas (Mae Sot-Tak, Chumporn, Ranong, Phang-nga, and Chiang Rai) from 2016 to 2020 is analyzed here. With regional variations, the quantitative survey found that between 40 percent and 80 percent of migrant children born in Thailand had their births registered. School enrollment rates for children aged 7 to 14 ranged from 50 percent to almost 100 percent. Notably, most children were enrolled at NGO-run migrant children’s learning centers (MLCs), with less than half attending Thai regular schools (except for Chiang Rai, where Thai school enrollment surpassed MLC enrollment). When it came to access to health care, a large proportion of children (ranging from 30 percent to 95 percent) in all the surveyed areas lacked health insurance coverage. Qualitative data analysis revealed a discrepancy between Thai laws and their practical application. While regulations permit birth registration, school enrollment, and health insurance access for all migrant children regardless of their parents’ immigration status, numerous obstacles still restrict their access to these rights. The analysis demonstrates that the social integration of migrants and active local civil society organizations can be crucial enablers and mechanisms for protecting migrant children’s rights while simultaneously improving the quality of life for both cross-border migrants and local Thais in the communities surveyed.

Background Birth registration is a child’s first right. Registration of live births, stillbirths and deaths is foundational for national planning. Completeness of birth registration for live births in low- and middle-income countries is measured through population-based surveys which do not currently include completeness of stillbirth or death registration. Methods The EN-INDEPTH population-based survey of women of reproductive age was undertaken in five Health and Demographic Surveillance System sites in Bangladesh, Ethiopia, Ghana, Guinea-Bissau and Uganda (2017–2018). In four African sites, we included new/modified questions regarding registration for 1177 stillbirths and 11,881 livebirths (1333 neonatal deaths and 10,548 surviving the neonatal period). Questions were evaluated for completeness of responses, data quality, time to administer and estimates of registration completeness using descriptive statistics. Timing of birth registration, factors associated with non-registration and reported barriers were assessed using descriptive statistics and logistic regression. Results Almost all women, irrespective of their baby’s survival, responded to registration questions, taking an average of < 1 min. Reported completeness of birth registration was 30.7% (6.1-53.5%) for babies surviving the neonatal period, compared to 1.7% for neonatal deaths (0.4–5.7%). Women were able to report age at birth registration for 93.6% of babies. Non-registration of babies surviving the neonatal period was significantly higher for home-born children (aOR 1.43 (95% CI 1.27–1.60)) and in Dabat (Ethiopia) (aOR 4.11 (95% CI 3.37–5.01)). Other socio-demographic factors associated with non-registration included younger age of mother, more prior births, little or no education, and lower socio-economic status. Neonatal death registration questions were feasible (100% women responded; only 1% did not know), revealing extremely low completeness with only 1.2% of neonatal deaths reported as registered. Despite > 70% of stillbirths occurring in facilities, only 2.5% were reported as registered. Conclusions Questions on birth, stillbirth and death registration were feasible in a household survey. Completeness of birth registration is low in all four sites, but stillbirth and neonatal death registration was very low. Closing the registration gap amongst facility births could increase registration of both livebirths and facility deaths, including stillbirths, but will require co-ordination between civil registration systems and the often over-stretched health sector. Investment and innovation is required to capture birth and especially deaths in both facility and community systems.

The Registration of Births and Deaths Act (RBD) of 1969 in India mandates continuous recording of vital events; however, after more than 50 years of its enactment, universality remains elusive. Birth registration, a fundamental right, is essential for demographic analysis and effective policy planning. Birth registration is closely linked to child development, access to healthcare, and other societal factors. Analysing its trends helps in designing targeted interventions and monitoring progress toward the Sustainable Development Goals (SDGs). This paper aims to analyse the changes in birth registration across Indian states. This paper also examines the impact of institutionalization of births on registration and underscores its significance in policymaking. The study utilises data from the latest two rounds of National Family Health Survey (NFHS-4 & NFHS-5) to analyse birth registration trends in India. Multivariable logistic regression analysis was employed to examine the impact of place of delivery on birth registration. The comparison of NFHS-4 and NFHS-5 data demonstrates varying birth registration rates across Indian states, with notable progress in some regions and persistent challenges in others. Multivariable logistic regression analysis highlights the significant influence of place of delivery on registration likelihood. The interaction between wealth and place of delivery suggests a mitigating effect, indicating that increasing institutional births has a positive impact on birth registration, with this effect being more pronounced at different levels of household wealth. It highlights that wealthier households were more likely to register births due to the higher rate of institutional deliveries. India's journey towards universal birth registration under the SDGs presents progress and challenges. NFHS data shows improvements in birth registration, but disparities still persist. Socio-economic status, place of delivery, and maternal education have strong influences on birth registration. Institutional deliveries significantly increase registration likelihood, facilitated by programs like Janani Suraksha Yojana. Integrating birth registration with health services enhances health data accuracy and service delivery. By prioritising targeted interventions, addressing social barriers, and leveraging existing programs, India can ensure that every child's birth is registered, advancing towards a healthier, more equitable future.

The archaic definition and registration processes for stillbirth currently prevalent in Canada impede both clinical care and public health. The situation is fraught because of definitional problems related to the inclusion of induced abortions at ≥20 weeks’ gestation as stillbirths: widespread uptake of prenatal diagnosis and induced abortion for serious congenital anomalies has resulted in an artefactual temporal increase in stillbirth rates in Canada and placed the country in an unfavourable position in international (stillbirth) rankings. Other problems with the Canadian stillbirth definition and registration processes extend to the inclusion of fetal reductions (for multi-fetal pregnancy) as stillbirths, and the use of inconsistent viability criteria for reporting stillbirth. This paper reviews the history of stillbirth registration in Canada, provides a rationale for updating the definition of fetal death and recommends a new definition and improved processes for fetal death registration. The recommendations proposed are intended to serve as a starting point for reformulating issues related to stillbirth, with the hope that building a consensus regarding a definition and registration procedures will facilitate clinical care and public health. La définition et les méthodes d’enregistrement archaïques des mortinaissances qui prévalent actuellement au Canada entravent à la fois les soins cliniques et la santé publique. La situation est délicate à cause des problèmes de définition que pose l’inclusion des avortements provoqués à ≥ 20 semaines de gestation parmi les mortinaissances : le recours généralisé au diagnostic prénatal et les avortements provoqués en cas d’anomalies congénitales graves ont entraîné une augmentation temporelle artéfactuelle des taux de mortinatalité au Canada et placé le pays dans une position défavorable dans les classements internationaux (de la mortinatalité). Les autres problèmes dans la définition et les méthodes d’enregistrement canadiennes des mortinaissances sont l’inclusion de la réduction fœtale (pour les grossesses multifœtales) parmi les mortinaissances et l’emploi de critères de viabilité inconsistants pour déclarer les mortinaissances. Nous examinons ici l’histoire de l’enregistrement des mortinaissances au Canada, nous justifions une révision possible de la définition de la mort fœtale et nous recommandons une nouvelle définition et des méthodes d’enregistrement améliorées des morts fœtales. Les recommandations proposées se veulent un point de départ à une reformulation des questions liées à la mortinatalité, dans l’espoir que l’établissement d’un consensus sur une définition et sur les méthodes d’enregistrement facilitera les soins cliniques et la santé publique.

Registration of birth within the first year of life is important to ensure children receive its full benefits and that fertility statistics derived from these data are informative for policy. This study provides an up-to-date global and regional assessment of the timing of birth registration by using all available birth registration data of children aged less than five years reported in Demographic and Health Surveys and Multiple Indicator Cluster Surveys from 2010 onwards. We calculated adjusted age-specific birth registration completeness by converting period age-specific completeness data into a hypothetical cohort. Timing of birth registration was analysed using ratios of adjusted age-specific completeness, with differentials by region, over time, and level of completeness assessed using bivariate and multivariate analyses. Almost 20% of registered births in countries with incomplete birth registration (less than 95%) were not registered until after 12 months, and this has not improved since 2010. In several countries this figure is greater than 50%, particularly in South Asia. There remains considerable scope to improve the timeliness of birth registration, particularly in countries where the overall level of completeness is lower. Strengthening and enforcing legislation for the mandatory registration of births before age 12 months and greater involvement of the health sector in registration processes are two ways which will improve birth registration timing.

Foundational behaviours across health, education, sanitation, and energy use remain suboptimal in Mbire District, Zimbabwe. This qualitative formative study examined drivers of and barriers to five priority behaviours: birth notification and registration (BNR), exclusive breastfeeding (EBF), early childhood development education (ECDE), open-defecation-free (ODF) practices, and efficient use of energy (EUE). Between 15 January and 30 March 2023, we conducted 15 focus group discussions (n = 180 participants) and 20 key informant interviews (n = 20 participants). Data were thematically analysed in QDA Miner 6 (Cohen’s κ = 0.82). Drivers of positive behaviours included leadership support, peer networks, and radio/village meetings, while barriers included bureaucratic requirements, cultural norms, and financial constraints. We recommend a multi-sectoral Social and Behavioural Change (SBC) approach integrating community events, subsidies, and culturally sensitive communication. These findings provide actionable evidence to inform district-level programming and contribute to achieving Zimbabwe’s national development targets and relevant Sustainable Development Goals.