Associations between birth registration and early child growth and development: evidence from 31 low- and middle-income countries

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Abstract
Lack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children’s physical growth and developmental outcomes in LMICs. We combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36–59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects. In the total sample, 34.7% of children aged 0–59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (β = − 0.18; 95% CI: -0.23, − 0.14), WAZ (β = − 0.10, 95% CI: -0.13, − 0.07), and ECDI z-scores (β = − 0.10; 95% CI: -0.13, − 0.07) among children aged 36–59 months. Our findings document links between birth registration and children’s early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.

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