Determinants of birth registration in India: Evidence from NFHS 2015-16.

OBJECTIVES: Official data on birth is important to monitor the specific targets of SDGs. About 2.7 million children under age five years do not have official birth registration document in India. Unavailability of birth registration document may deprive the children from access to government-aided essential services such as fixed years of formal education, healthcare, and legal protection. This study examines the effect of socioeconomic, demographic and health care factors on birth registration in India. We also examined the spatial pattern of completeness of birth registration that could be useful for district level intervention. METHODS: We used data from the National Family Health Survey (NFHS-4), 2015-16. We carried out the descriptive statistics and bivariate analysis. Besides, we used multilevel binary logistic regression to identify significant covariates of birth registration at the individual, district, and state levels. We used GIS software to do spatial mapping of completeness of birth registration at district level. RESULTS: The birth registration level was lower than national average (80.21%) in the 254 districts. In Uttar Pradesh, 12 out of 71 districts recorded lower than 50% birth registration. Also, some districts from Arunachal Pradesh, J&K, and Rajasthan recorded lower than 50% birth registration. We also found a lower proportion of children are registered among children of birth order three and above (62.83%) and rural resident (76.62%). Children of mothers with no formal education, no media exposure, poorest wealth quintile, OBC and muslims religion have lower level of birth registration. Multilevel regression result showed 25 percent variation in birth registration lie between states while the remaining 75 percent variation lie within states. Moreover, children among illiterate mother (AOR = 0.57, CI [0.54, 0.61], p<0.001), Muslims households (AOR = 0.90, CI [0.87, 0.94], p<0.001), and poorest wealth quintile (AOR = 0.38, CI [0.36, 0.41], p<0.001) showed lower odds for child's birth registration. CONCLUSION: We strongly suggest linking the birth registration facilities with health institutions.

Trans Parenthood and the Meaning of 'Mother', 'Father' and 'Parent'-R (McConnell and YY) v Registrar General for England and Wales [2020] EWCA Civ 559.

In R (McConnell and YY) v Registrar General for England and Wales [2020] EWCA Civ 559, the Court of Appeal held the Registrar General was correct to register a trans man, who had given birth after the issuing of his gender recognition certificate, as 'mother' on his son's birth certificate. In their judgement, the court rejected the appellants' contention that the Gender Recognition Act 2004 should be construed to allow registration as either 'father' or 'parent'. The court further held that the interference with the appellants' Article 8 rights which resulted from the registration as 'mother' was proportionate and justified.

Improving birth and death data for African decision making

The scarcity of current, complete, and accurate primary data on causes of death in most of sub-Saharan Africa restricts the ability of countries to measure progress against many of the Sustainable Development Goal targets, measure the impact of programmatic interventions, prioritise and plan to address their health needs, and achieve the goals of the Africa On Aug 10, 2018, the Agenda 2063.1 first African Civil Registration and Vital Statistics (CRVS) Day was celebrated, underscoring the importance of working towards compulsory, uni versal CRVS systems across the However, progress towards continent.2 establishing these systems has been slow; even with substantial inputs and political will, universal CRVS will probably take decades to be functional in all countries.

The Relationship Between Tobacco Use and Legal Document Gender-Marker Change, Hormone Use, and Gender-Affirming Surgery in a United States Sample of Trans-Feminine and Trans-Masculine Individuals: Implications for Cardiovascular Health.

PURPOSE: Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and medical/surgical interventions for gender transition. METHODS: Data came from an Internet-based survey of U.S. trans-feminine (n = 631) and trans-masculine (n = 473) individuals. We used multivariable logistic regression to investigate the relationship between past 3-month tobacco use and legal document gender-marker change, hormone use, and gender-affirming surgery controlling for demographic covariates and enacted and felt stigma. RESULTS: Compared to trans-feminine participants, trans-masculine individuals reported significantly higher rates of lifetime (74.4% vs. 63.5%) and past 3-month tobacco use (47.8% vs. 36.1%), and began smoking at an earlier age (14.5 vs. 15.5 years). Trans-feminine smokers reported significantly more frequent and heavier use. Adjusting for demographic covariates and enacted and felt stigma, legal document gender-marker change was associated with lower tobacco-use odds among trans-feminine individuals, whereas gender-affirming surgery predicted lower smoking odds among trans-masculine individuals. There were no significant differences in tobacco use by hormone use status. CONCLUSION: In this study, trans-masculine individuals were more likely to smoke and trans-feminine individuals reported heavier use. It is concerning that individuals receiving hormones did not report lower smoking rates, given the elevated CV risk of this combination. This is a missed opportunity to intervene on a major public health issue and highlights the need for smoking cessation interventions in this population.

Registered or unregistered? Levels and differentials in registration and certification of births in Ghana.

BACKGROUND: The birth of a child is a vital event that needs to be registered but this is not always the case as an estimated 40 million births go unregistered annually. Birth registration safeguards the basic rights of children and gives them an identity, citizenship/nationality and legal protection against violence, abuse and human rights violations. It is therefore necessary that all births are registered and even more critical that the registration of a birth is followed by the issuance of a birth certificate. But sadly, birth registration in many African countries continues to remain below acceptable international standards and not all registered births are certified. This paper examined birth registration and certification in Ghana. Differentials in the characteristics of children and mothers of children whose births are registered and certified, children whose births are registered but not certified and children whose births are not registered were examined. METHODS: This paper analysed data from the 2014 Ghana Demographic and Health Survey drawing on variables from the household and children's data files. Descriptive analytical tools (frequencies, percentage and cross tabulations) and multinomial logistic regression analysis were used to examine differentials in birth registration status among an analytical sample of 3880 (weighted) children aged 0-4 years. RESULTS: The birth of about every 1 in 4 (28.89%) children in Ghana have never been registered. Birth registration and certification was lowest among children born to young mothers (15-19 years), children whose mothers have no formal education, mothers who reside in rural areas and mothers in the poorest wealth quintile. Additionally, home births and births that were not assisted by a medical professional were observed to have the lowest proportion of registered and certified births. Furthermore, the birth of children who are less than a year old was significantly more likely not to be registered or issued with a birth certificate. CONCLUSION: Efforts aimed at improving birth registration and certification in Ghana need to target groups of children and mothers with low levels of registration and certification particularly children who are born at home, children born to young mothers and children whose mothers are poor and or reside in rural areas.

Baby M Turns 30: The Law and Policy of Surrogate Motherhood.

This article marks the 30th anniversary of the Supreme Court of New Jersey's Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature. First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can be taken to minimize the potential exploitation of women who are willing to rent their wombs for income? Third, what criteria should govern the eligibility to serve as a surrogate mother and an intended parent? Fourth, what principle(s) should serve as the basis for determining the parentage of children born through surrogacy? Fifth, is regulatory uniformity in the surrogacy realm desirable? Is it achievable? The article concludes that courts and legislatures should accept the validity of surrogacy contracts, determine parentage according to intent, and identify transparent criteria for the eligibility of both surrogates and intended parents.

An Evaluation of New York City's 2015 Birth Certificate Gender Marker Regulation.

PURPOSE: In 1971, the New York City (NYC) Department of Health and Mental Hygiene amended Section 207.05 of the NYC Health Code to allow individuals who had undergone "convertive surgery" (interpreted by the code to mean genital surgery) to amend the gender on their birth certificates. This surgery requirement was removed in 2015. In a survey evaluating the regulation change, we sought to characterize the transgender population newly eligible to obtain a gender-congruent NYC birth certificate by comparing respondents with and without genital surgery. METHODS: We mailed a 42-question survey with each newly issued birth certificate. We compared respondents across current gender identity, race, Hispanic ethnicity, age, insurance status, income, current general health status, other transition-related care obtained, and healthcare access, stigma, and discrimination. RESULTS: Of 642 applicants, 219 responded and were thus enrolled in our 5-year study (34.1%). Most (n = 158 out of 203 who answered, 77.8%) had not received genital surgery. Compared to respondents with genital surgery, respondents without surgery were significantly more likely to be transgender men (50.0% vs. 20.0%); younger (median age 32 vs. 56.5); on Medicaid (31.6% vs. 11.1%); identify as Hispanic (28.5% vs. 8.9%); and live in households making <$20,000 annually (35.3% vs. 12.8%). CONCLUSIONS: Removing a genital surgery requirement more equitably enables transgender men and those with limited resources to obtain a gender-congruent birth certificate. Jurisdictions with such requirements should consider similar regulation changes to address the inequities that this requirement likely imposes in accessing birth certificates.

How Would Children Register Their Own Births? Insights from a Survey of Students Regarding Birth Registration Knowledge and Policy Suggestions in Kenya.

Birth registration and obtaining physical birth certificates impose major challenges in developing countries, with impact on child and community health, education, planning, and all levels of development. However despite initiatives, universal registration is elusive, leading to calls for new approaches to understanding the decisions of parents. In this paper, we report results of a survey of students in grades six to eight (age ~12-16) in an under-registered area of Kenya regarding their own understanding of registration issues and their suggestions for improvement. These students were selected because they themselves were also nearing the age for high school enrollment/entrance examinations, which specifically requires possession of a birth certificate. This assessment was also a companion to our previous representative survey of adults in the same Kenyan region, allowing for parent-child comparison. Results supported previous research, showing that only 43% had birth certificates. At the same time, despite these low totals, students were themselves quite aware of registration factors and purposes. The students also made quite prescient sources for understanding their households' motivations, with many of their suggestions-for focus on communication of pragmatic benefits, or automatic measures shifting responsibility from parents-mirroring our own previous suggestions, and showing a level of pragmatism not witnessed when surveying their parents. This paper therefore adds evidence to the discussion of registration policy planning. More generally, it also builds on an important trend regarding the treatment of children as stakeholders and important sources of information, and raising an intriguing new avenue for future research.

Changes and inequalities in early birth registration and childhood care and education in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2006 and 2011.

INTRODUCTION: Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam. DESIGN: The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth. RESULTS: There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas. CONCLUSION: Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.

Prematuridade e fatores associados em Santa Catarina, Brasil: análise após alteração do campo idade gestacional na Declaração de Nascidos Vivos / Premature birth and associated factors in the Brazilian State of Santa Catarina: an analysis after alteration of the gestational age section of the Live Birth Declarations

Estimar a prevalência de prematuridade e os fatores associados, após a alteração do campo idade gestacional na Declaração de Nascidos Vivos, no Estado de Santa Catarina, Brasil, em 2012.Métodos:estudo seccional com base nos dados do Sistema de Informações de Nascidos Vivos (SINASC). Razões de Prevalência (RP) de prematuridade, brutas e ajustadas, por Regressão de Cox Robusta para o ano de 2012, foram calculadas e os resultados comparados aqueles reportados para 2005.Resultados:as taxas de prematuridade aumentaram de 6,1 por cento, em 2005, para 10,6 por cento em 2012. Ao se comparar os dois anos, maiores diferenças foram encontradas entre as mulheres com menor número de consultas pré-natal, menor nível de escolaridade e de cor não branca. Após o ajuste pelos fatores de confusão, as taxas de prematuridade se mostraram associadas à menor frequência de consultas de pré-natal (RP=2,64; IC95 por cento: 2,58-3,28), menor escolaridade (RP= 1,65; IC95 por cento: 1,11-2,45), idade materna <20 anos (RP= 1,24; IC95 por cento: 1,17-1,31) e maior que 39 anos (RP= 1,32; IC95 por cento: 1,17-1,49) e de cor não branca (RP=1,14; IC95 por cento: 1,07-1,21.)Conclusões:mudanças no campo idade gesta-cional, agora preenchido como semanas completas de gestação, resultaram em medidas mais confiáveis das taxas de prematuridade no Brasil...

To estimate the prevalence of premature birth and associated factors, after alteration of the gestational age section of Live Birth Declarations in the Brazilian State of Santa Catarina, in 2012.Methods:a cross-sectional study was carried out based on data from the Live Births Information System (SINASC). Prevalence rates for premature birth, raw and adjusted by Cox’s robust regression were calculated for the year 2012 and the results compared with those reported for 2005.Results:the prevalence of premature birth rose from 6.1 percent, in 2005, to 10.6 percent in 2012. Comparison of the two years found greater differences among non-Caucasian women and those with fewer prenatal consultations and a lower level of schooling. After adjustment for confounding factors, the prevalence of premature birth was found to be associated with a lower frequency of prenatal consultations (PR=2.64; CI95 percent: 2.58-3.28), lower levels of schooling (PR= 1.65; CI95 percent: 1.11-2.45), maternal age <20 years (PR= 1.24; CI95 percent: 1.17-1.31) and > 39 years (PR= 1.32; CI95 percent: 1.17-1.49) and non-Caucasian (PR=1.14; CI95 percent: 1.07-1.21.)Conclusions:changes in the gestational age section, now recorded as full weeks of gestation, have resulted in more reliable measurement of the preva-lence of premature birth in Brazil...

Birth of identity: understanding changes to birth certificates and their value for identity resolution.

INTRODUCTION: Identity information is often used to link records within or among information systems in public health and clinical settings. The quality and stability of birth certificate identifiers impacts both the success of linkage efforts and the value of birth certificate registries for identity resolution. OBJECTIVE: Our objectives were to describe: (1) the frequency and cause of changes to birth certificate identifiers as children age, and (2) the frequency of events (ie, adoptions, paternities, amendments) that may trigger changes and their impact on names. METHODS: We obtained two de-identified datasets from the Utah birth certificate registry: (1) change history from 2000 to 2012, and (2) occurrences for adoptions, paternities, and amendments among births in 1987 and 2000. We conducted cohort analyses for births in 1987 and 2000, examining the number, reason, and extent of changes over time. We conducted cross-sectional analyses to assess the patterns of changes between 2000 and 2012. RESULTS: In a cohort of 48 350 individuals born in 2000 in Utah, 3164 (6.5%) experienced a change in identifiers prior to their 13th birthday, with most changes occurring before 2 years of age. Cross-sectional analysis showed that identifiers are stable for individuals over 5 years of age, but patterns of changes fluctuate considerably over time, potentially due to policy and social factors. CONCLUSIONS: Identities represented in birth certificates change over time. Specific events that cause changes to birth certificates also fluctuate over time. Understanding these changes can help in the development of automated strategies to improve identity resolution.