Why is it Important to hand out Birth Certificates at the time of Discharge

“A child not registered at birth is invisible – nonexistent in the eyes of the government or the law. Without proof of identity, children are often excluded from education, health care, and other vital services, and are more vulnerable to exploitation and abuse.”- Ex-UNICEF Executive Director Henrietta Fore.

0
Why is it important to hand out Birth Certificate at the time of Discharge

1 in 10 children under age 5 do not have a birth certificate in India; it is among the five countries that contribute to half of the world’s 166 million children whose births have not been registered. A child who is not registered at birth is in danger of being denied the right to an official identity, a recognised name and a nationality. But does this affect all children equally? Children belonging to the poorest sections, scheduled castes and tribes, and families with no formal education, right at the intersection of all kinds of marginalisation, are more likely not to have a birth certificate, putting them on a back foot from the time they are born. The disadvantages they face in life keep adding up henceforth.

“A child not registered at birth is invisible – nonexistent in the eyes of the government or the law. Without proof of identity, children are often excluded from education, health care and other vital services, and are more vulnerable to exploitation and abuse.”- Ex-UNICEF Executive Director Henrietta Fore.

Also Read: Children in primary school are lagging behind in their studies: Survey

A birth certificate registration provides a child legal recognition for existence, often being the first and the only evidence of legal identity for the child. Children below the age of 18 are unlikely to have a voter’s identification card, and if they have not taken the Class 10 or 12 board exams, they do not have those certificates as well, making the birth certificate their only proof of place of birth and legal existence. The process of obtaining birth certificates one year after the date of birth gets extremely arduous, which makes it inaccessible for the poor.

In a country where the rural literacy rate is 68.91% (according to the 2011 Census), having a birth certificate becomes imperative to avail of public schemes aimed at providing better lives for children coming from the most vulnerable sections of society.

In the absence of documentation to prove birth, women and children, along with people belonging to SC/ST communities, the weakest members of society, suffer the most.

Why is this the case?

  1. India faces a significant shortage of doctors, nurses, and data operators at public facilities. Coupled with that, there is a lack of procedural knowledge among the registration functionaries, leading to low registration levels.
  2. According to the Civil Registration System, birth certificates are issued free of charge by the concerned Registrar for births reported within 21 days. But is 21 days a reasonable timeline?

Most vulnerable children live in remote areas with few delivery units, and families end up travelling around 80-100km for institutional deliveries. At the time of delivery, the government provides ambulances to pick up and drop the family at delivery centres free of cost. If the family doesn’t collect the birth certificate at the time of discharge (which is three days from the date of birth for normal deliveries), they have to travel again to the delivery centre, which costs around Rs. 1500-2000, acting as a disincentive for the family.

  1. There is no immediate demand for a birth certificate for any government social services. The awareness about the importance of registration among guardians is also low. “The ownership of birth certificates may be low because parents in India tend to collect certificates at later dates when it is required for various purposes,” said Chandra Shekhar, professor, International Institute for Population Sciences, Mumbai.

How is Chhatarpur District ensuring that the maximum number of children have birth certificates?

  Fig 1                                                Fig 2

Fig 1 indicates how there is an increase in the proportion of birth certificates being issued in less than 3 days, thereby reducing out-of-pocket costs and efforts of the beneficiaries;

Fig 2 indicates how there has been an ~80% rise across 6 months in the birth certificates being issued at discharge.

Chhatarpur, one of the 112 Aspirational Districts, had an abysmally low rate of handing out birth certificates to beneficiaries at the time of discharge at the district hospital, which has ~7500 deliveries a year and caters to a population of 17L. Around 30% of the deliveries in the hospital are from the adjoining districts of Sagar, Panna, Mahoba, and Tikamgarh. This resulted in beneficiaries making multiple trips to the district hospital, incurring out-of-pocket expenditures, and missing their salaries as daily-wage labourers.

One of the major challenges faced by the staff while adopting this initiative was parents not deciding on the names of their children timely. Some parents wanted to consult pandits, while others wanted to check horoscopes before deciding on a name. The nurse-in-charge and data operators suggested counselling the expectant parents during AnteNatal check-ups and spreading awareness through ASHAs and Anganwadi workers using Village Health Sanitation and Nutrition Day as an essential platform.

Factors that led to the success of this initiative are:

  1. Citizen-focused outlook of District Administration: The district administration believes that any basic service should be provided to the beneficiaries in a simple and hassle-free manner. The citizens should not be inconvenienced and made to run around government offices. The District Magistrate said, “This is a basic requirement for enrollment into schools, and as the administration, we want to slowly start moving to automated and more efficient processes to ensure that people are provided services immediately. We want to eliminate the middlemen involved. We don’t want other benefits dependent on this to be halted. This process saves people time, money, and effort. We want to scale this process to all our Community Health Centres and spread awareness to ensure this for the limited at-home births that occur.”
  2. Convergence of different sections within the district hospital: While identifying operational challenges, a significant gap was the lack of communication between the delivery section, the discharge section, and the birth certificate registration section. Regular meetings were held to ensure that the sections communicated effectively with each other to disseminate services promptly.
  3. Regular monitoring of data: A Whatsapp group was created between different sections used to track the data daily. The data was analysed weekly to identify operational difficulties and address them.

This initiative is currently being decentralised and scaled to the different Community Health Centres and Primary Health Centres, affecting ~61,000 beneficiaries in a year. Another engagement the administration plans to implement is to spread awareness amongst expectant parents through posters, cloth banners, pamphlets, leaflets, radio talks, and advertisements in newspapers on the importance of registration of births.


About the authors:
  • Sohinee Thakurta is a fellow in Chhatarpur, Madhya Pradesh, under the Aspirational Districts Programme which is an initiative by the Government of India implemented by NITI Aayog. She works closely with the district administration to improve the living standards of people in the district. Prior to the fellowship, Sohinee worked at Sattva in the Foundations and Government Advisory vertical. She started her career as a Teach for India fellow.
  • Smriti Gupta is a fellow in Chhatarpur, Madhya Pradesh, under the Aspirational Districts Programme which is an initiative by the Government of India implemented by NITI Aayog. She works closely with the district administration to improve the quality of life of people in the district. Prior to the fellowship, Smriti worked in various organisations in the Education sector like Teach for India, Leverage Education, and stones2 milestones. She has studied economics and sociology.

Summary
Article Name
Why is it important to hand out Birth Certificates at the time of Discharge
Description
“A child not registered at birth is invisible – nonexistent in the eyes of the government or the law. Without proof of identity, children are often excluded from education, health care, and other vital services, and are more vulnerable to exploitation and abuse.”- Ex-UNICEF Executive Director Henrietta Fore.
Author
Publisher Name
THE POLICY TIMES
Publisher Logo