The document summarizes a presentation on the state of birth registration in Bangladesh given at the 9th Tanahashi Rounds meeting. It provides details on Bangladesh's legislative requirements for birth registration within 45 days, the institutional structures in place, and current registration rates. Analysis of a survey of 19 unions found availability of registration units is high, but only 2.1% of children under 1 have effective coverage with registration and certification within 45 days. Recommendations are given to increase awareness, strengthen the role of health workers, and improve coordination between registration offices and health institutions.

1. The Center of Excellence for Universal
Health Coverage (COE-UHC) at the
James P Grant School of Public Health,
and UNICEF co-hosted the 9th round
of the Tanahashi Rounds on 11th May,
2014. It showcased a presentation on
“State of Birth Registration in Bangla-
desh within 45 days of Birth” by AKM
Saiful Islam Chowdhury, Project Direc-
tor (Additional Secretary) of the Birth
and Death Registration Project, Local
Government Division.
The discussion was moderated by Dr.
Malabika Sarker, Co-PI and Dr. Pascal
Villeneuve, UNICEF Representative.
Mr. AKM Saiful Islam Chowdhury
provided a detailed picture of the state
of birth registration in Bangladesh, both
in terms of the legislative environment
and actual practice. Article 7 of the Con-
vention on the Rights of the Child stipu-
lates that a child be registered immedi-
ately after birth and have the right to a
name and nationality as well as to know
and be cared for by his or her parents.Center of Excellence for
Universal Health Coverage (CoE-UHC) project,
James P Grant School of Public Health
(JPGSPH)
Level-6, icddr,b, Mohakhali
Dhaka, Bangladesh
Secretariat
REPORT
11th May, 2014
Mr AKM Saiful Islam Chowdhury Presenting at Tanahashi Round 9
State of Birth Registration in Bangladesh
Within 45 Days of Birth
Tanahashi Round-9

2. REPORT
Programme Description:
In Bangladesh, according to the
Birth and Death Registration Act,
the father, mother or guardian of a
child are responsible for submitting
information relating to the birth of
the child within 45 days of the
child’s birth. Mr. Chowdhury
explained that acquiring a birth
certificate is the right of every child
born in the country. Birth registra-
tion is important because it validates
the existence of the child, but also
its right to health services, school-
ing, and protection from child labor,
child trafficking, child marriage and
other forms of exploitation. Regis-
tering the baby in time is also
important for gathering statistics to
inform fact-based planning, moni-
toring and budgeting.
In terms of the institutional struc-
ture that oversees the registration of
births and deaths, the Birth and
Death Registration Act 2004 was
amended in 2013 to provide a legal
basis for establishment of the
Office of the Registrar General, to
implement its mandate of register-
ing births within 45 days. Birth
registration service points are
embedded in local government
administrations nationwide and in
some Bangladeshi missions abroad.
All 4,996 registrar offices are
currently using the online Birth
Registration Information System
(BRIS). Currently, the national plan
is to improve civil registration and
vital statistics with a focus on accel-
erating registration of children
within 45 days of their birth.
According to the Bangladesh
government, 160.8 million births
have been registered online in the
systemand manually. The rate of
registration of children under the
age of five has increased from 9.8 %
in 2006 to 31 % in 2011. However,
between January and December
only approximately 37,759 children
(1.42% of expected births) were
registered within 45 days of birth.
Effective coverage of birth registra-
tion is defined as births registered
within 45 days of birth with a
certificate. The rate of increases
and decreases in birth registration
are thus measured through the
official government census, sample
vital registration system and surveys
such as the multiple indicator cluster
survey.
Tanahashi Round-9
Average, 100
Average, 73.1
Average, 12.4
Average, 4.8
Average, 2.1
88.6
43.7
28.8
0.00
15.7
0.00
6.8
0.00
Birth Registration within 45 Days in 19 deprived
Unions in Bangladesh, 2013

3. REPORTTanahashi Round-9
Difference Domains Bo lenecks
Enabling Environment
(Management and
coordina on)
Lack of coordina on and clarity between Directorate of
Health and Local Government Division on the role of EPI
workers and how they will coordinate in the grassroots level
in providing informa on to the parents on when, where and
how to register the birth of their children.
Supply (Availability of
essen al commodi es/
inputs)
No essen al campaign or drive to promote and disseminate
the importance of birth registra on.
Supply (Access to
adequately staffed
services, facili es and
informa on.
Though EPI workers have a role to provide informa on and
support the parents to register birth of the children, EPI
workers are not very clear about their specific roles for
informing the parent about Birth Registra on.
Demand (Social and
cultural prac ces and
beliefs)
The community people do not demand the informa on on
birth registra on as they do not see any importance un l
they need the birth cer ficate for access to services.
Availability
Accessibility
BR Bottleneck Analysis - 1
The survey done of 19 unions in
2013 showed some interesting
results:
1) Availability: All birth regis-
tration units in 19 unions have
adequate resources and staff.
2) Accessibility: An average of
73% of parents know how and
where to report births to obtain a
birth certificate.
3) Utilisation: The proportion
of children born in the last 12
months whose parents applied for
birth registration is low at only 12.4
per cent.
4) Adequate coverage: Only
4.8% of children born in the last 12
months who were registered, were
actually provided with a birth
certificate.
5) Effective coverage: Only
2.1 percent of children under the
age of one had their births regis-
tered with a certificate issued within
45 days.
Bottleneck analysis examines the
barriers and bottlenecks to reaching
effective coverage of birth registra-
tion as a service. Within the 19
unions, in retrospect, the highest
performers are those with the
greatest resources and least
constraints; on the other hand, the
lowest performers are working with
the most constraints and are thus
under extreme pressure. As a
result, there is a bottleneck or
“sliding-down” effect.

4. Tanahashi Round-9
REPORT
Bhairab Paurashava registered 644
births within 45 days in 2013,
amounting to 28 percent of
estimated births. According to Mr.
Chowdhury, after the initial
inspection stage by the Project
Director, this paurashava was able
to double its performance upon
handed over the correct equip-
ment and data-gathering tech-
niques.
Keys for success:
1) Health workers are also
responsible for birth registration.
Furthermore, they prepare preg-
nant mothers’ lists and frequently
visit and sensitize mothers to-be
on the importance of birth regis-
tration as well as other health
services.
2) Health workers completed
the birth registration application
between delivery and first date of
immunization and sent the form
to the Sanitary Inspector who is
authorized to register births by the
Mayor.
3) To avoid missing births,
Birth Registration Number is
entered on the EPI card on the
first date of immunisation.
4) If there were any missing
births, health workers support
parents to submit BR application.
The key barriers to effective
coverage of birth registration
are as follows:
1) Many residents of Bangla
-
desh, including those from higher
socio-economic classes, are not
aware of the significance of a
birth certificate.
2) Some parents wait until
their child is enrolled in primary
school to register their birth;
3) Sometimes, teachers
change the date of birth to ease
enrolment into schools.
Best Practice
Mr. Chowdhury made the follow-
ing recommendations to increase
effective coverage of birth regis-
tration:
Stimulating demand for birth
registration:
1) Mandatory registration of
births within 45 days should be
encouraged and it is necessary to
raise the awareness of parents and
communities on the importance
of registering births within 45
days.
2) Online birth registration
application should be encouraged.
Role of health/EPI workers in
birth registration:
3) EPI workers should verify
the birth certificate and write the
birth registration number on the
EPI register and card during the
first EPI contact. If EPI workers
have a functional internet connec-
tion, they can send birth registra-
tion applications online to regis-
tration offices.
4) If a baby is brought to an
EPI point without a birth certifi-
cate, health workers should
support parents to submit a birth
registration application to the
Registrar Office and collect the
birth certificate before the second
doze of immunization
Birth registration after more than
45 days:
5) No births can be regis-
tered by a Registrar without
formal permission from a higher
authority after 6 months of birth.
6) When children enroll in
primary school, schools should
verify the enrolment age through
the birth certificate. If the child
does not have a birth certificate,
schools should advise and
support parents to obtain one.
Coordination and capacity-
building:
7) Capacity of birth and
death registration units should be
strengthened with time.
8) Systematic coordination
between health institutions and
birth-death registration units in
facilitating birth registration of
newborn children should be
strengthened.

5. Tanahashi Round-9
REPORT
Questions and Answers
Points to consider which were
brought up during the Q/A session
were:
1) Efforts should be made to ensure
birth registration is made within 45
days of birth, including penalizing
parents that fail to comply.
2) On partnerships especially in
hard-to-reach and remote areas, the
linkage of birth registration to the
EPI service is being strengthened.
The Office of the Registrar General
is willing to collaborate with NGOs,
grassroots organizations operating
at local levels to increase effective
coverage in hard-to-reach and
underperforming areas.
3) New unions created from existing
ones take time to set up the birth
registration service. It was suggested
that local governments be made
more responsible for registration
with continuing support of the
Office of the Registrar General in
promptly setting up BRIS in new
unions carved out of existing
unions.
4) Use all options and contact with
health services such as post-natal
care to increase coverage of birth
registration.
In conclusion, the presentation
highlighted the benefit of the Tana-
hashi approach - specifically in dem-
onstrating the equity gap between
the low performing and best
performing areas; and showing
where focused efforts must be
directed in order to close the gaps,
and achieve effective coverage.
Difference Domains Bottlenecks
Enabling Environment
(Management and
coordination)
Lack of coordination and clarity between Directorate of
Health and Local Government Division on the role of EPI
workers in Birth Registration. EPI workers did not see birth
registration as their duty.
Although BR issues have been included in the reporting
format of EPI workers, none of the stakeholders in the EPI
reporting chain have been held accountable for this job.
Supply (availability of
essential commodities
and inputs)
As the first contact person for newborn babies, EPI workers
are supposed to help parents fill in forms. However, EPI
workers often do not have birth registration forms with
them.
Demand (Financial
access)
Sometimes the Registrar Offices illegally asks for money for
birth registration which often discourages parents to apply
for birth registration for their children.
Demand (timing and
Continuity of use)
Children do not need the birth certificate until they seek
admission to school so parents do not apply for it until they
need one to access this service.
Accessibility
Utilization
BR Bottleneck Analysis -2

6. Nadia Ishrat Alamgir
Lecturer III
Center of Excellence for Universal Health Coverage (CoE-UHC) project
JPGSPH, Level-6, icddr,b, Mohakhali
Email: nishrat@bracu.ac.bd
Contact
REPORT
Tanahashi Round-9
Pascal Villeneuve of UNICEF and Dr Malabika Sarker of BIGH moderated the session with Mr Saiful Islam
Tanahashi organizing team:
Overall Supervision:
Dr. Sadia A. Chowdhury
Dr. Syed Masud Ahmed
Overall coordination and
Report preparation:
Nadia Ishrat Alamgir
Nabila Chowdhury
Invitation and Reception:
Md. Tarek Hossain
Nabila Chowdhury
Design/Communications:
Kazi Shamsul Amin
Imran Jamal
IT support:
Tapan Biswas
A. Rouf Sarker
Logistics:
Sohel Rana
Support:
Mansura Akter