To save the lives of women and girls, we need to register — and count — every death, regardless of geography, race, nationality, wealth, or social status.
Just like birth and marriage registration, death registration is critical to protecting the rights and meeting the needs of women and girls. When it is complete, accurate, compulsory, and universal, death registration is the key to knowing, on a continuous basis, why, where, and at what ages women and girls are dying.
But in many parts of the world, women are being failed. Decision-makers do not have the timely information they need to determine how, where, and when to intervene to protect the lives of women and their children.
Consider a woman in the third trimester of her second pregnancy who lives hours away from the nearest clinic. She starts to experience severe headaches that do not go away. Her vision becomes blurry, and her hands and face begin to swell. She has not attended prenatal care in this or her previous pregnancy — not because she did not want to, but because she simply could not afford the long, tiring journey.
Health practitioners in many countries will be familiar with this type of story. When the woman’s vision and headaches become worse, she begins to worry. But she doesn’t have the money or the means to even attempt a trip to the clinic. She goes into a premature and difficult labour, attended at home by family members, and gives birth to a stillborn baby. The mother drifts in and out of consciousness after the birth, has a seizure, and dies shortly afterwards.
She is buried in the family graveyard, her death unregistered, unnoticed, uncounted, and seemingly inconsequential. Eclampsia — one of the world’s leading causes of maternal and infant mortality — is probably what caused her death. But the state does not know she has died, let alone why she died.
Her disappearance leaves her surviving child without legal proof of the death — a situation that can perpetuate a vicious cycle of poverty and suffering. A death certificate issued because of registration provides the legal survivors with the proof they need to access or claim a pension, inheritance, and transfer property rights and other assets to which they’re entitled. It also permits a surviving spouse to remarry. A child with an uninvolved or distant father faces a particularly stark future if there is no proof of his mother’s death, which hinders access to social benefits and rights.
Unregistered deaths also affect the ability to prevent similar deaths. Death registration feeds into national mortality statistics, which helps governments and policymakers to identify causes of death and what they can do to reduce them. To truly prevent and stop conditions such as preeclampsia and eclampsia, it is critical to know, in real time, who is dying from them, where, and why. Timely and accurate death registration is key to understanding this.
Death registration is critical to monitoring progress towards reaching Sustainable Development Goal 3 on health, which lists reducing maternal mortality as its first target. In other words, complete and accurate death registration, including cause of death information, is an expression of existing national commitments because it helps to develop targeted policies and programs aimed at eliminating maternal mortality.
World Health Organization data shows that only approximately half of all deaths are registered with cause of death information. Evidence suggests that male deaths are more likely to be registered than women’s deaths. For example, Romesh Silva found that male deaths are about twice more likely to be reported than female deaths in Morocco. Given the kind of access to social protection that a legal death certificate can provide, the preference for male death registration is a reflection of entrenched gender inequities. Where women may not have property, wealth, or land to transfer to surviving dependents, there may be no incentive or need to register their deaths — a cruel injustice.
Non-registration of women’s deaths means that many women and girls often disappear silently; uncounted, unregistered. Authorities at the national level articulate and implement health, economic, and social policies without considering the critical factors that impact the health and lives of women and girls.
Three critical areas of action can help to change this reality. We can:
- make the case for accurate, timely and complete death registration as a way of monitoring and meeting commitments to gender equality;
- carry out and disseminate research that examines the social, cultural, economic, and political drivers that explain why female deaths are less likely to be registered; and
- prioritize death registration within civil registration improvement programs and fund mobilization efforts where this type of registration tends to be neglected.
More is needed to protect the rights, dignity, and health of all women and girls. Simply put, each death is a story whose circumstances — the why, when, and how it happened — give critical clues that help to prevent similar deaths. Accurate and timely death registration could be a game changer for national development plans.
The Centre of Excellence for Civil Registration and Vital Statistics (CRVS) systems is committed to supporting efforts to scale up and strengthen CRVS systems, including complete and accurate death registration for the protection, health, and wellbeing of women and girls.