A paper co-authored by Dr. Lindsay Stark, Mailman School of Public Health associate professor of Population and Family Health, argues in favor of a more systematic approach to national birth registration, particularly in Indonesia. The country accounts for more than 10 percent of the world’s 230 million children under age five who do not have a birth certificate. The article, “Barriers to Birth Registration in Indonesia” is published online in the April issue of The Lancet Global Health.
[Photo: Dr. Lindsay Stark]
“What is an easily ignored document in most of the world can be a life-or-death necessity in developing countries facing a youth bulge,” said Dr. Stark, whose recent population survey demonstrated a close correlation between the percentage of unregistered children in Indonesia and severe poverty in three provinces. “We found that 24 million children in Indonesia are undocumented. That amounts to a population as large as Australia’s with no bearing on international aid, resource allocation, or public health outreach.”
“Without a functioning civil registration system, countries’ capacity to effectively plan and deliver adequate services and allocate resources across all development sectors, is limited,” according to Dr. Stark’s co-author Dr. Santi Kusumaningrum. “Access to health, education, social assistance, legal protection, and economic opportunities may be impeded.” The authors make the point that a child who lacks legal documentation faces a lifetime of greater vulnerability. Restricted access to services can lead to a vicious cycle in which succeeding generations of undocumented adults face similar vulnerabilities as their parents.
At the population level, what is often called “a scandal of invisibility” severely impairs progress against the newly announced Sustainable Development Goals – measurements themselves that will be impossible without an accurate population count.
Drs. Stark and Kusumaningrum, with co-author Dr. Putu Duff, show that the main impediments to a child obtaining legal documents in the provinces studied involve complexity of the registration system and prohibitive (often hidden) costs. As Dr. Kusumaningrum explains, “Currently, six separate documents are required for registering a child for a birth certificate, including a marriage certificate from the birth parents. Because many religious marriages continue to go unregistered by the state, securing a birth registration often requires parents to visit multiple government agencies.” These agencies include the courts, the civil registration office, the department of religious affairs, and finally the civil registration office.
For Drs. Stark and Kusumaningrum, the solutions are straightforward. Dr. Kusumaningrum’s Center on Child Protection has been working with the Government of Indonesia to pilot one-stop shops at the community level to simplify the registration process and eradicate the hidden costs in the system. Ultimate success necessitates a greater understanding of the importance of legal documentation for every individual, and optimizing existing schools and health facilities to become sites for registration.