Estimating completeness of birth registration in South Africa, 1996 - 2011.

Objective To estimate the completeness of live birth registration through South Africa's civil registration and vital statistics system between 1996 and 2011. Methods The number of births registered by the civil registration and vital statistics system was compared with independent estimates of the true number of births derived using: (i) the reverse survival method applied to 2011 census data; (ii) the application of estimated age-specific fertility rates to population estimates from censuses and surveys; and (iii) data from the public-sector district health information system. Findings In 1996, an estimated 25% of births were registered within the calendar year of birth and 33% were registered before the end of the subsequent calendar year. By 2008, 76% of registrations occurred within the calendar year of birth, 84% occurred by the end of the following year and 90% occurred before the child's fifth birthday. These improvements were seen in all provinces and differences in completeness between provinces narrowed markedly. Improvements in the completeness of registration coincided with government efforts to strengthen the system, new legislation on vital registration and the introduction of child support grants, which required birth certificates. Interprovincial migration of children influenced the completeness of registration in affected provinces. There was some terminological confusion among government agencies on defining the timeliness of registration and the year of birth. Conclusion The completeness of birth registration in South Africa increased rapidly between 1996 and 2004. To allow international comparison, the method for measuring the completeness of birth registration needs to be standardized.