|Year : 2015 | Volume
| Issue : 1 | Page : 16-21
Socio-demographic determinants of birth registration among mothers in an urban community in southern Nigeria
Alphonsus R Isara1, Antony O Atimati2
1 Department of Community Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Child Health, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||7-Jan-2015|
Alphonsus R Isara
Department of Community Health, University of Benin Teaching Hospital, P. M. B. 1111, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: Birth registration is both a fundamental human right and an essential means of protecting a child's right to identity.
Objective: The aim was to assess the awareness, knowledge and practice of birth registration by mothers and the socio-demographic determinants of birth registration in an urban community in southern Nigeria.
Methodology: A community-based descriptive cross-sectional study was carried out among mothers in an urban community in Ovia North East local government area of Edo State, Nigeria. A structured interviewer administered questionnaire was used for data collection. Data were analyzed using SPSS version 20.
Results: Awareness of birth registration was high (69.6%) with mass media as the major source of information (60.5%), but the composite knowledge of it was poor. Awareness of the agency responsible for birth registration was poor. Only 44.2% of the respondents registered the births of their children, two-thirds of those who registered births possess a birth certificate. Marital status and level of education were significantly associated with the knowledge of birth registration. Age, level of education, marital status, occupation, and place of delivery were the determinants of the practice of birth registration.
Conclusion: There is a need for a change of strategy in the campaign for birth registration so that awareness can translate into better knowledge and practice. We advocate the establishment of community-based birth registration centers to improve accessibility and practice of birth registration.
Keywords: Birth registration, socio-demographic determinants, southern Nigeria
|How to cite this article:|
Isara AR, Atimati AO. Socio-demographic determinants of birth registration among mothers in an urban community in southern Nigeria. J Med Trop 2015;17:16-21
|How to cite this URL:|
Isara AR, Atimati AO. Socio-demographic determinants of birth registration among mothers in an urban community in southern Nigeria. J Med Trop [serial online] 2015 [cited 2019 Jun 17];17:16-21. Available from: http://www.jmedtropics.org/text.asp?2015/17/1/16/148567
| Introduction|| |
Birth registration is the official recording of the birth of a child through an administrative process of the State.  It is both a fundamental human right and an essential means of protecting a child's right to identity.  The United Nations general assembly resolution in 2002, titled "a world fit for children" reaffirms governments' commitment to ensure the birth registration of all children and to invest in, care for, educate and protect children from harm and exploitation. 
Birth registration serves both a legal and statistical purpose for children within a given country. For legal purposes, birth registration is part of an effective civil registration system that legally acknowledges the existence of a person, entitles the child to a birth certificate, establishes the child's family ties, and tracks major life events from live birth to marriage and death.  The demographic data emerging from civil registration allows a country to keep track of its own population statistics, trends and differentials. The use of such data can lead to more accurate planning and implementation of development policies and programmes, particularly in health, education, housing, water and sanitation, employment, agriculture and industrial production. 
The process of birth registration and the legislative framework varies among different countries. Nigeria operates a central vital registration system and the practice of birth registration dates back to 1863 in Lagos colony with the promulgation of ordinance 21 while nationwide comprehensive legislation of vital events was introduced in 1917.  There was, however, no uniformity of operations nor complete coverage until 1979 when a nation-wide uniform system of vital registration was promulgated.  The national population commission (NpopC), which was established in 1988, is charged with the statutory responsibility of producing vital and demographic data in the country and the decree authorizing it to register births and issue a birth certificate was promulgated in 1992. Nigeria in 2003 enacted the child's right act which mandatorily requests the registration of every child within 60 days of birth. 
Birth registration is highly practiced in developed countries such as the United Kingdom with a rate as high as 99.9%.  This is not, however, the case in developing countries where about 51 million births remain un-registered every year despite government, civil society, UNICEF and international organizations' efforts to universalize birth registration in a free and timely manner.  In Nigeria, birth registration coverage from 1994 to 2007 ranged from 0.01% to 23.9%. 
The major factors that influence the birth registration level in the country include: The magnitude of national commitment of birth registration as a priority; the value that families and individuals place on birth registration; the existence of an adequate legislative framework; the existence of sufficient infrastructure to support the logistical aspects of registration; and the number of barriers families encounter during registration. 
A survey on the coverage of birth registration in three states of Sudan revealed a low coverage of 31% in 2004 and an overriding lack of awareness of the importance and significance of birth registration and the issuance of birth certificate.  There are few studies that have assessed the registration of births in Nigeria. Previous studies have examined birth registration from the general perspective of vital registration with fathers, mothers and care-givers as respondents. , This study is therefore aimed at assessing the awareness, knowledge and practice of birth registration by mothers, who are the custodians of the child's well-being even before it is born, in an urban community in southern Nigeria. It also examined the sociodemographic determinants of birth registration in the community.
| Methodology|| |
This community-based descriptive cross-sectional study was carried out in Isiohor Community in Ovia North East Local Government Area of Edo State, Nigeria. Isiohor Community is located in the suburb of Benin City, adjacent to the Ugbowo campus of the University of Benin. The study was approved by the Ethics and Research Committee of the University of Benin Teaching Hospital, Benin City, Nigeria. Permission to carry out the study was also obtained from the head of Isiohor Community while the respondents gave informed verbal consent before participating in the study.
The study population comprised women of reproductive age group (15-49 years) who had given birth to at least one child in the last 5 years preceding the study. All women of reproductive age group who are nonpermanent residents of the community as at the time of the study were excluded from the study. The minimum sample size required for this study that was calculated using the Cochrane formula  for sample size determination in a descriptive study was 290. The women who met the inclusion criteria were identified and recruited consecutively in a house to house manner starting from the house of the community leader until the required sample size was attained.
The tool for data collection was a structured interviewer-administered questionnaire. The questionnaire consisted of four sections namely; socio-demographic characteristics, knowledge and practice of birth registration by the respondents and the factors affecting birth registration. The data collected were checked for correctness, coded and analyzed using IBM SPSS statistics version 20.0 software. Continuous variables were summarized using means and standard deviations while categorical variables were summarized using proportions. The occupations of the respondents were classified according to the UK registrar generals' classification of occupation.  The official recording of the birth of a child following delivery was regarded as the correct meaning of birth registration, the registration of birth within the first 60 days of delivery was regarded as the correct timing of birth registration, immediately after birth registration was regarded as the correct time to request for birth certificate and either both or any of the parents as the correct answer to who should register the child. Twelve questions ranging from general awareness of birth registration to more specific questions on the importance of birth registration were used to assess the knowledge of mothers on birth registration. A score of 1 was given for correctly answered questions and 0 for wrong answers giving a maximum score of 12. A composite score of 9-12 was adjudged good knowledge; 6-8; fair knowledge and a score of 5 and below was adjudged to be poor knowledge. Chi-square and Fishers exact statistical tests were used to test for associations between the socio-demographic characteristics of the respondents and their knowledge and practice of birth registration. The level of statistical significance was set at a P < 0.05.
| Results|| |
A total of 319 women of reproductive age who had had at least one child prior to the study was interviewed. [Table 1] shows their socio-demographic characteristics. The mean age of the women was 32.1 ± 3.1 years with more than half of them in the age group 25-34 years and only 24 (7.5%) were aged 45-49 years. Majority (86.2%) were married, while a higher proportion (66.4%) had attained at least a secondary level of education. Those with no formal education constituted only 4.1%. More than half of the respondents were either engaged in the unskilled occupation 141 (44.2%) or were unemployed 38 (11.9%).
The place of delivery of the respondents' children revealed that slightly less than half (46.7%) of them delivered in a health facility. Other places of delivery were "at home" 65 (20.4%), traditional birth attendants 85 (26.6%) and churches 20 (6.3%). A higher proportion (69.6%) of the respondents were aware of birth registration with their major source of information being the mass media 193 (60.5%), followed by the hospital 52 (16.3%). However, most (91.5%) of them were not aware of the existence of the NPopC as the body charged with the responsibility of birth registration in Nigeria [Table 2]. Although majority (74.3%) of the respondents knew the correct meaning of birth registration, only 76 (23.8%) knew that birth registration should be followed with the issuance of a birth certificate. Similarly, only about one-third of them knew when to request for a birth certificate (32.5%) and the person who should ensure that a child is registered (33.9%). The overall composite knowledge of birth registration among the respondents showed that the majority (78.4%) generally had poor knowledge of birth registration, while only very few (2.2%) of them had good knowledge of birth registration [Figure 1].
|Figure 1: The composite score of knowledge of birth registration by respondents|
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[Table 3] shows the practice of birth registration by the respondents. Only less than half (44.2%) claimed to have registered the births of their child/children. However, of these, one-third of them do not possess the birth certificates of their child/children. The cross-tabulation of the socio-demographic characteristics by the knowledge and practice of birth registration by the respondents is shown in [Table 4] and [Table 5]. A higher proportion of the respondents who had fair/good knowledge of birth registration were married and with at least a secondary level of education. There was a statistically significant association between marital status (P = 0.038) and level of education (P < 0.001) and the respondents' knowledge of birth registration. Concerning the practice of birth registration, a higher proportion of the respondents aged 35 years and above, married and with at least a secondary level of education had better practice of birth registration. The same was also observed for those in a non-manual skilled occupation and those who delivered their child/children in a health facility. There was a statistically significant association between the socio-demographic characteristics (age group, marital status, level of education, place of delivery [P < 0.001] and occupation [P = 0.002]) and the practice of birth registration by the respondents.
|Table 4: Sociodemographic characteristics by respondents' knowledge of birth registration |
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|Table 5: Sociodemographic characteristics and place of delivery by respondents' practice of birth registration |
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| Discussion|| |
Birth registration is not only a fundamental right itself, but also a key to ensuring the fulfillment of additional rights for children. But the value of birth registration as a fundamental human right is often overlooked due to the continuing lack of awareness that registration is a critical measure to secure the recognition of any person before the law. 
The high awareness of birth registration in this study is comparable to previous reports in Nigeria. ,, It was however, observed that the depth of knowledge of the respondents regarding the process of birth registration especially as it relates to NPopC as the body responsible for birth registration, when to register and who should register the child were quite poor. This disparity might be related to the source and mode of transmission of information on birth registration. Since majority of the respondents quoted the mass media as a source of information, it can be deduced that either the information was not complete or was not properly understood. It will, therefore, be beneficial to transmit information on birth registration and other relevant issues to the public in a simple and clear language so that every necessary detail can be understood. Most notable was the respondents' very poor awareness (8.5%) of the existence of the NPopC as the body responsible for birth registration. The NPopC had reported inadequate publicity among other challenges such as inadequate registration centers and financial constraints as contributory factors to poor birth registration coverage in Nigeria.  Increased publicity by the NPopC on birth registration through information, education and communication materials-billboards, posters, etc. should be embarked upon to increase people's awareness on the location and activities of the NPopC in Ovia North-East Local Government Area of Edo State. This finding is contrary to the report of Akande et al.  in Kwara state where the awareness of, and the role of NPopC was high (65.2%). The impact of NPopC in the study locale (Oke-Oyi) of Akande's study is better felt since government agencies accounted for the majority (63.1%) of the respondents' source of information, and a high proportion of them are aware of the location of NPopC's office.
The disparity between the practice of birth registration among the respondents in this study (44.2%) and the level of awareness (69.6%) may be accounted for by the overall poor knowledge of birth registration. This further buttresses the fact that knowledge is a major driving force behind the practices of a given people. This may be the reason why about a third of those who registered their children do not possess a birth certificate, since only less than a quarter of them are aware that the birth certificate should be obtained following birth registration. Birth certificate, apart from establishing the child's right to name and nationality also empowers him/her to access other rights including health care, education and social assistance.  It can also serve as an identity document which help protect children against early marriage, child labor, premature enlistment in the armed forces or, if accused of a crime, prosecution as an adult.  The implication of not possessing one becomes quite obvious when there is a need to access these services.
The proportion of children whose births were registered in this study was similar to what was reported (48.8%) in the Nigeria Demographic and Health Survey (NDHS) of 2008 for urban communities.  However, two-thirds of our study population who possessed a birth certificate was higher than the 45.1% reported in the NDHS.
Educational status has a great influence on the awareness level of so many events. The observation of secondary and tertiary education as significant determinants of the respondents' knowledge and practice of birth registration in our study was, therefore, not unusual. The same finding was also reported in Egor local government area of Edo state by Tobin et al.  This further buttresses the need to embark on public awareness campaigns, perhaps in local languages, in addition to other social networks in a bid to increase the awareness of birth registration among the less educated populace. The fact that married women had significantly better knowledge, and practice of birth registration in this study was similar to the finding of Tobin et al. who reported better practice, but not knowledge among respondents who were married. The sharing of information especially as it relates to the care of the child coupled with the assistance from a spouse who may possess a higher level of education are possible reasons for this finding. The extent and frequency of such communication no doubt will affect the quality and amount of information shared. In developed countries with a long standing tradition of birth registration, joint parental registration is being advocated, as this is believed positively to impact on joint acknowledgement and involvement in children's upbringing. 
Delivery within a health facility was significantly associated with the practice of birth registration in this study. Considering the fact that birth registration centers are located within some health facilities may have contributed to this finding. Attaching birth registration centers to health facilities has been one of the suggested strategies by UNICEF  to improve coverage of birth registration in developing countries. In developing countries especially in the rural regions where deliveries occur more outside health facilities, it will be advantageous to enlighten birth attendants in those places on the importance of birth registration and the places where such services can be accessed. This also underscores the need for community-based birth registration centers to carter for those who deliver outside the facilities.
| Conclusion|| |
The knowledge of birth registration in this study was poor despite the fact that a high proportion of the respondents has heard of birth registration. A very high proportion has not even heard of the agency responsible for birth registration in Nigeria. There is a need for a change of strategy in the campaign for birth registration so that awareness can translate into better knowledge and practice of birth registration. We also advocate the establishment of community-based birth registration centers to improve accessibility and practice of birth registration.
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National Population Commission. Reports on Live Births, Deaths and Still Births Registration in Nigeria (1994-2007). Abuja: NPopC; 2008. Available from: http://www.ibenaija.org/uploads/1/0/2/10128027/report_on_birth-death-stillbirth-registration.pdf. [Last accessed on 2014 Apr 05].
United Kingdom Department for Work and Pensions. Joint birth registration: Promoting parental responsibility. DWP, 2007. Available from: http://www.gov.uk/government/uploads/system/uploads/attachment_data/228776/7160.pdf. [Last accessed on 2014 Apr 05].
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]
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