CRVS, Deming Dual and the Forty-Five Pregnant Women

Birth or Death? There was a Birth, certainly
We had evidence and no doubt. I had seen birth and death,

From – The Journey of the Magi – by T.S. Eliot

Recently I attended a workshop on Civil Registration and Vital Statistics (CRVS) a topic that is closely related to identification of individuals in a country. Among other data, it records births and deaths and is thus the immutable record of everyone who has come to and gone from this planet. It is about living and dying, and how we ought to keep our papers in order. It is thus fairly, important. The workshop was organized as a voyage of self-discovery in a collective sort of way and we were implored to find out how CRVS was done, how it could be improved, and I suppose what it helped us do better.

Before proceeding further, I would like to admit that I am no CRVS expert and only accidentally crash-landed on its unforgiving terrain precisely twenty-six years, eight months and four days ago. I remember the day so precisely as it was day-one of operation Desert Shield in the gulf, CNN broadcasting it live, and on a hot and dusty day in central India we had just arrived to trace birth records from village to village on the outskirts of Bhopal.

At the recent workshop, all this came back to me and much more.

Births and deaths take place in every part of every country in a non-stop, relentless sort of a way. So, a CRVS system and the people that run it, work 24/7 to record them. I imagined then that it must be every demographer’s nightmare to miss some of these vital events, and thereby lose count of the people in the land. In fact, currently only about fifty countries (with a combined population of less than 20% of the world, can boast of a near 100% birth and death registration record. Another one hundred countries with about 60% of the world’s population have a tolerable record (75% birth registration or more), however it is the balance fifty-odd countries with a count of over 1.6 billion people that is the cause of concern and thus the subject of innumerable conferences and workshops like the one I attended, where often less than half the births are ever recorded and the number of deaths, even less.

Why does this important coming and going of human beings on this planet get such short shrift in so many parts of the world? Some blame the logistics of it and some say that governments are simply incapable. Yet others report that individuals often have little incentive to complete even simple birth and death registration formalities. Some link it to socio-economic conditions like poverty, some to age-old cultural habits and some simply to the laws that dictate how and when it should be done, who can do it, and the uses and access to such records. Human rights advocates speak in many voices – that every human being must be recorded, and yet – it is not the recording that matters, but the affording of rights and privileges. Consequently, improvements do happen yet unspeakable tragedies like human trafficking continue, and thus the debates often end inconclusively and even acrimoniously.

In Bhopal that day and the next, I came to understand what the field health workers did. They assisted at-home deliveries in remote villages in their charge, but this meant a year-round vigil – trace pregnant mothers, chart the roster of delivery dates, provide basic mother-care and if some cases looked difficult, exhort them to visit the nearby district hospital.

But how many pregnant mothers should they look for? This question looped back to the vital statistics part of CRVS thus. There was a record of the total population in your region – usually a few villages – with a gender and age break-up. Thus, you knew the total number of females in the child-bearing age. This superimposed by statistics such as the fertility rate, gave you an indicative figure of how many live births to expect. Thus, my health worker that year had to look for forty-five pregnant mothers for every one thousand people in her region. This included the losing of a mother or two during child-birth and a few infants soon after birth as well, due to a variety of reasons, the sadness of it obscured behind clinical terms like maternal mortality and infant mortality rates. For many decade now, human development in countries is being measured using infant mortality rate (or a related index – the under-five mortality rate) conveying the sense that if a country can take care of mothers and infants in this most delicate and vulnerable moment, then we are on our way. Such is its importance.

This was to explain the forty-five pregnant women in the title. Now what of the Deming-dual?

Statistics and statisticians are closely entwined to questions of birth and death records, and consequently population studies. All these, coincidentally also evolved into formal disciplines around the middle of the seventeenth century, almost together. Today, nearly four centuries later, the principles remain the same – birth and death counts are cross-checked using sample surveys, which in turn are tallied against a census, the physical population count usually carried out in countries every ten years. In theory, all should tally, but in practice they vary, because for example of under-counting births, thus giving rise to the fact that less than 100% births were registered. The reality is usually more complex. Both births and deaths are miscounted and so are census counts. Then there are migrations. Each figure carries errors, but statisticians have astonishing ways to reconcile all this in the end.

In 1949, two statisticians, Chandrasekharan and Deming came up with a statistical calculation that reconciles the civil registration and sample survey numbers. Magically, it also estimates the numbers that might have been missed out in both. Decades later this is still one of the most robust ways to determine how well a country records its births and deaths and is known as the Deming dual. Today, in addition there are computer models of population clocks that continuously tick-over births and deaths in close approximation to the reality, or at least what is reported of it. These too need periodic recalibration as newer statistics arrive.

However, some say that the games that CRVS initiates, are played elsewhere, often to vicious ends.

CRVS is the responsibility of the state and there are times when population records become victims of politics – when used to manipulate electoral outcomes, for example. Such cynical number-games are known to often cause humanitarian crises and in extreme cases, even genocides. Millions of individuals are also physically displaced due to war and internal conflicts, and being distanced from such records, result in the loss of their identities that can only be reconstructed painstakingly over time. Despite application of humanitarian considerations like the Geneva Convention, conquering nations even today choose to destroy the civil records of the nations they defeat and in a single stroke, take away everything that the subjugated individuals might possess.
These extreme cases are important to understand the centrality of civil registration as a civilizational cornerstone, which is reflected in the complexities of the legal codes that surround it. Every nation has laws that make civil registration – continuous, permanent, compulsory and universal – and is supplanted by international charters and declarations. Nations that still do not have such laws are being encouraged and supported to do so, without further ado. Among the myriad Strategic Development Goals to be achieved by 2030, the United Nations has set out (refer 16.9) – legal identity for all with birth registration. It is clear, that one cannot do without the other.

They say that numbers often conceal the enormity of a situation, and this is the story of the last – barely recorded – 1.5 billion people on this planet, and thus, much needs to be done now.

Some ask for the carrot and stick to make CRVS happen better: law – the stick, to unambiguously make any lapse a severely punishable offence; and carrots, promising material gains (and lifestyle changes) if you do it right – ranging from access to credit to unimaginable lotteries. Personally, I wouldn’t recommend such measures for death registration, though.

Some place their bets on the middle-path – improved, responsive administration and easier access, maybe just an SMS to do the needful. Yet others prescribe more drastic measures – wrest control from the state and its demanding clerks, and have the efficient private sector do it better. After all, three centuries ago, municipal clerks wrested this responsibility from parish priests. So why not savvy identity managers now?

Technologists too claim their space. Tools like biometrics to identify and the blockchain to secure, deepen chasms in some parts of the digital divide and yet provide bridges at others and when the humanists irreverently claim that citizenship and the state might have outlived their utility and meaning, the ghosts of Weber and Voltaire too, tip-toe away without saying their lines. Yet, from economic well-being to global warming, identity matters more today, than ever before.

So, where does the individual stand? All she needs is dignity and empowerment, and a place on this planet in her time – to live, breathe and dream of doing extraordinary things.

Sanjay Dharwadker

Categories: Uncategorized

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: