Inclusive Growth

Invisible Children: The Road to Registered Births

Lessons learned from South Africa’s path to universal birth registration.

Invisible Children: The Road to Registered Births

March 22, 2017

Citizenship promises a number of basic rights, like access to health care and education—rights that one-third of the world’s youngest children do not enjoy. As of 2013, 230 million children under age five did not have their births registered, according to UNICEF.

The effects of legal registration are far-reaching. Beyond providing access to public services and education, citizenship helps protect young people from exploitation. Without documents, children are far more vulnerable to human trafficking and other human rights violations, note researchers at the Munk School of Global Affairs and the University of Toronto in the report “Reaching the Hard to Reach: A Case Study of Birth Registration in South Africa.” An article in The Lancet called this widespread lack of citizenship “a scandal of invisibility.”Although the numbers are staggering, several countries have made striking progress in registering births. Jordan, Malaysia, South Africa, Sri Lanka, and Thailand have all implemented effective systems in just a few decades, according to the World Health Organization.

South Africa is a notable success story, the authors of “Reaching the Hard to Reach” write. Between 1991 and 2012, the portion of births that were registered—including retroactive registrations—increased from just 25 percent to 98 percent. Aiding this rise, the share of births taking place in health facilities also rose, from 78 percent in the 1990s to 95 percent in 2008, the report notes.

“South Africa has done a remarkable job of not only ensuring greater access for all South Africans to the birth registration process,” the authors write, “but also raising awareness of the importance of registering the births of children.”

Obstacles overcome in South Africa

Getting to that 98 percent was not easy. South Africa faced several hurdles to increasing the number of births registered.

Historical racism: Black South Africans were understandably reluctant to register their children’s birth for fear of surveillance under the apartheid regime. But new voting rights in the post-apartheid era would create incentives for many to register as citizens. “Acquiring identification, registering to vote, applying for social programs and registering one’s child thus became important dimensions in exercising one’s democratic rights,” the authors write.

Lack of access to health care and registries, especially in remote and rural areas, was another impediment. User fees at health facilities were also too high for many, which reduced access. Travel costs and missed days of work because of long-distance travel to registration sites were also prohibitive for many families.

In response, the country began using mobile registration units, effectively bringing the services to the people. The mobile units frequently included social services, such as registration for school or mobile health clinics, which drew families. The country built more health facilities in remote areas. South Africa also started including registry as part of hospital delivery and eliminated rural health care user fees in 1996.

Bureaucratic hassles: For many, the fees for registering a birth were too high and the registration process was complicated, inconvenient, and inconsistent. The South African government has since streamlined administrative processes, reducing the need to make multiple trips to different offices to register a birth. In many facilities, child social services once provided by different government agencies are now in the same building. Streamlining administrative processes has also made it easier for parents to acquire a birth certificate and apply for the Child Support Grant (see below), itself an incentive to register births.

Cultural traditions and lack of awareness of the importance of registering births: In some communities, naming traditions dictate that a newborn not be given a name for several months. In other communities, parents do not leave their homes for three months after a child is born. In both cases, the family would miss the 30-day window to register the birth, and thus would have to pay fines and provide more documentation for a late registration. In other cases, parents were often unaware of the longer-term benefits of birth registration.

In response, several government departments joined together to increase awareness among both new parents and health professionals about birth registration and its benefits, including media and grassroots campaigns, workshops, and outreach.

Notably, South Africa also created a large incentive to register births with the Child Support Grant in 1998. The grant is a monthly stipend for poor families with children. In the 2000s, the grant was equal to about R300 (approximately $22 US). The hitch was that to receive the grant, the child’s birth must be registered. This, the authors suggest, was one of the more important boosts to birth registrations. Indeed, there was a significant spike in birth registrations after 1998.

Going the last mile

Despite progress, some families will continue to fall through the cracks, and these families are the hardest to reach, as argued in the Bulletin of the World Health Organization.  It is difficult to go that “last mile,” to reach the most marginalized or remote groups, notes the Center for Global Development.  But lessons from countries like South Africa reveal where others can start.

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