Thriving beyond survival: Understanding utilization of perinatal health services as predictors of birth registration: A cross-sectional study (BMC International Health and Human Rights)

Background: An estimated 230 million children remain unregistered and invisible worldwide. To understand ways to best leverage existing health system-related resources and ensure greater protective measures for Indonesia?s vulnerable children, this study explores the predictive relationship between the utilization of perinatal health services and birth certificate ownership in two provinces, offering opportunities and suggestions for ways forward to increase registration coverage. Methods: This study employed a cross-sectional design with interviewer-administered household surveys to heads of households in West Nusa Tenggara (NTB) and East Nusa Tenggara (NTT) from May to July of 2013. The primary outcome of interest was birth certificate ownership among children under the age of 5?years old. Bivariate and multivariable regression analyses using Generalize Estimating Equations (GEE) considered a set of covariates that represented child and household socio-demographic characteristics along with health services utilization variables during pregnancy and post-pregnancy periods. Results: In total, 389 heads of households were interviewed, yielding data on a sample of 451 children under the age of 5. Fewer than than 28% of the children in this sample possessed a birth certificate. Nearly 57% (n?=?259) of children were delivered in a clinical facility, though only 36% (n?=?93) of these children were legally registered. Of those born in the home (n?=?194), registration dropped to 16% (n?=?31). Adjusted analyses accounting for socio-demographic factors suggest that children born in a clinic facility (AOR?=?2.33, 95%CI: 1.27, 4.33), hospital (AOR?=?2.38, 95%CI: 1.12, 5.09), or in the presence of a skilled birth attendant (AOR?=?2.35, 95%CI: 1.31, 4.23) were significantly more likely to be registered. Children whose mothers sought post-natal care were 2.99 times more likely to possess a birth certificate (AOR?=?2.99, 95%CI: 1.1, 7.57). Pre-natal care was not associated with birth registration. Conclusion: These findings suggest that the use of perinatal health services can increase the likelihood of registering a child?s birth despite a lack of formal integration of vital registration with the health sector. Opportunities to formally leverage existing community-based perinatal services and health workers already serving the community may serve to increase registration rates in hard to reach areas of Indonesia.