Acknowledgements
This report would not have been made possible without the support and important contributions from the IATT working group on civil registration.
In particular, we would like to thank Dr. Simon Heap and Nankali Maksud for their guidance and invaluable inputs in coordinating and sharing resources and internal documents. A special thank you is extended to the respondents of the questionnaire, whose comments, inputs, and personal experiences assisted in unveiling the complex issues surrounding birth registration in the context of HIV and AIDS. Thank you to Dr. Getrude Chanda, Kirk Felsman, Patricia Fernandes, Dr. Simon Heap, Lucy Hillier, Chikwe Mbweeda, Mariana Muzzi, Stanley Ngalazu-Phiri, Chibeta K. Nkwemu, Penina Ochola, Ian Plaskett, Boipelo Seitlhamo Celiwe Seyama, Ann Skelton, Hellen Tombo, Florenica Damião Tomo, Jackson Thoya, and Kimaru Wakaruru.
Thanks are also due to Hye-Young Lim for her analyses on the National Plans of Action on Orphans and Vulnerable Children, and to Mary Crewe for taking time out of their hectic schedules to discuss and reflect on our research findings, and to edit the report. Finally, we would like to express our gratitude to PEPFAR, Plan International, UNICEF, and World Vision who gave us the opportunity to conduct the research through their financial support.
Isabel de Bruin – Cardoso and Ruth Mampane
Centre for the Study of AIDS
University of Pretoria
South Africa
ii. Executive summary Civil registration is of utmost importance for both states and individuals affected by HIV and AIDS. In the context of HIV and AIDS, civil registration systems allow states to monitor their population, enabling effective policies to be formulated and implemented, protecting and fulfilling the rights of people living with HIV and communities affected by the pandemic. Simultaneously, civil registration acts as a source of protection for individuals, as such systems provide legal documentation establishing an individual’s identity, nationality, and kinship, which are necessary proof for securing property rights, and accessing basic services such as health care and education. While civil registration establishes and provides documentation of births, foetal deaths, marriages, divorce and deaths, in the context of HIV and AIDS, birth and death registration are of particular importance in understanding the impact of the pandemic on children’s rights.
The Essay on AIDS & HIV
AIDS means acquired immunodeficiency syndrome. AIDS is past from person to person. The disease attacks the immune system which is not strong enough to fight this deadly disease. The AIDS disease has a number of symptoms and conditions that come with it. HIV causes the disease AIDS. HIV means human immunodeficiency virus. A virus is a very small organism that gets into a person’s body and ...
That said, only reliable statistics and information on birth registration are available. The report hence focuses on the extent to which the HIV pandemic influences accessibility and availability of birth registration systems in Africa, and how Africa’s weak birth registration systems impact on the large number of children affected by AIDS. Birth registration is enshrined in the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, as well as other international legal instruments, as a fundamental right for all children, and it places the obligation on states to ensure this right.
The report focuses on all 45 countries in Eastern, Southern, Western and Central Africa, which have the highest number of people living with HIV and the highest number of children orphaned by AIDS in the world. Eastern and Southern Africa has the lowest birth registration rates in the world, and Western and Central has the third lowest rates. The report analyses birth registration rates in accordance with HIV prevalence rates, and a desktop review and responses to a questionnaire designed by the consultants to gather practical information, challenge the assumption that high HIV prevalence rates correspond to the low birth registration rates in sub-Saharan Africa.
There is no empirical evidence proving HIV prevalence rates to be a pertinent detrimental factor to the availability of birth registration systems. Instead, the report demonstrates that demographics and socio-economic factors, and particularly poverty, do not fail to play key roles in the availability of such systems. Political will and understanding of birth registration as a fundamental human right are also identified to be a key barrier to the availability of effective and sustainable birth registration systems. The HIV pandemic, as a public health emergency, also does not impede access to birth registration mechanisms. However, AIDS, as a full-blown disease impacting on individuals’ well-being, does. People living with AIDS do not access birth registration systems. AIDS physically and financially deters ill parents or caregivers from registering children, and ill parents fear that registering children will induce stigma towards HIV positive children and / or children affiliated with HIV positive family members.
The Term Paper on AFRICA HIV and AIDS
Africa is the world’s largest region affected by the HIV and AIDS virus. According to statistics, Aids in Africa killed an estimated 1.6 million people last year .An estimated population of 22.5 million people in Africa was living with HIV at the end of 2007 while an additional 1.7 million people were infected with the virus during that year. (Avert.org) Today the AIDS crisis has become an ...
Poverty exacerbated by HIV also decreases parents or caregivers opportunities from accessing birth registration systems, as registering children can incur both direct costs (registration fee and birth certificate fee) and certainly indirect costs (transport, unpaid leave from work), rendering 19.7 million or 66% of children unregistered in sub-Saharan Africa. In addition to access being restricted to birth registration systems as a result of poverty, the immediate benefits of birth registration and birth certificates are not realized, as is shown by responses to the questionnaire. In the context of poverty and HIV and AIDS, already meagre finances would rather be spent on material needs, such as food, antiretroviral treatment, shelter and clothing, which prolong the lives of HIV positive caregivers and / or children, and allow them to live positively.
Lack of understanding on the protection benefits offered to children by being registered and owning a birth certificate is common amongst the general populations, as well as by policymakers, however. While all reviewed National Plans of Action (NPA) in Orphaned and Vulnerable Children (OVC) acknowledge the vulnerability of children affected by AIDS, and the dire impact of poverty on OVC, only Zimbabwe has realized that birth registration is a child’s first human right, the fulfilment of which can impact on both a child’s access to basic services, and protection from abuse, violence, and exploitation, including in prisons, inheritance loss and property grabbing. Several NPAs on OVC, including those from Cote d’Ivoire, Ethiopia, Lesotho, Rwanda, Nigeria, Swaziland and Zambia do reflect that birth registration is considered an essential service to which all children have the right to access, yet they do not recognize that birth registration enables easier access to other services, such as education and health care.
The Term Paper on Aids Immune System 6
Introduction The fate of a person who has contracted the virus, which causes AIDS, HIV (Human Immuno-deficiency Virus) is undeniably grim. However when diagnosed with aids it should not be taken as an immediate death sentence. AIDS sufferers can fight off most of the symptoms and live a fairly productive life for many years after diagnosis. The following will be entailed in the body of this AIDS ...
Other NPAs, including those from Kenya and Mozambique, focus solely on the protective legal measures offered by birth registration. The HIV pandemic has exacerbated the vulnerability of children who are not registered and who do not have a birth certificate. Yet it is children orphaned by AIDS without birth certificates who are the most precarious, as they are highly vulnerable to having their inheritance rights violated, affecting their key source of livelihood. Inheritance loss is an economic as well as human rights issue. Furthermore, orphaned children without a birth certificate are also at increased risk of unaccompanied migration and illegal adoption. Central to the report are the following key findings:
o Weak birth registration systems in sub-Saharan Africa existed before the HIV pandemic. HIV and AIDS do not seem to hinder the recent and current processes of changing birth registration legislation and systems from discriminatory colonial legislation to ensuring free and universal birth registration. However, while the majority of countries in the study have ratified the Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, progress in developing specific legislation on birth registration and effective birth registration mechanisms is slow.
o A strong civil registration system helps policy- and decision-makers meet the challenges of HIV and AIDS by planning the appropriate scale of budget allocations and distribution of health services, as well as keep track of the impact of AIDS in terms of the total number of AIDS-related deaths and the survival rate of those on ARVs. Strengthening civil registrations systems is a government responsibility.
The HIV pandemic, as a public health emergency, does not affect availability and accessibility of birth registration systems. AIDS does affect accessibility to these systems, as the disease renders it physically and financially difficult for parents/caregivers to register their children. Money would rather be spent on antiretroviral treatment or nutritious food.
The Essay on The effects of AIDS and HIV in the world
With reference to one animal or human disease, explain why its economic consequences vary spatially. Abstract The AIDS epidemic claimed more than 3 million lives in 2002,and an estimated 5 million people acquired the human immunodeficiency virus (HIV) in 2002 – bringing to 42 million the number of people globally living with the virus. As the world enters the third decade of the AIDS ...
There is a lack of understanding by poor parents/caregivers on the protective measures offered by birth registration and birth certificates. Caregivers do not consider birth registration to address immediate needs, and they will spend money saved by the direct and indirect costs of registering children on material resources, such as food and school fees, in order to ensure children live a decent life. Most NPAs identified fees to be the key barrier to children accessing education and health care, and not the lack of birth certificates. This explains why policymakers do not see the link between birth certificates and the ability to access basic services, as it is not considered a prerequisite to access such services in most countries. Instead, the benefits of birth certificates are usually considered essential in protecting children from abuse, violence, exploitation and inheritance loss.
Weak registration systems do not impact differently on children affected by AIDS compared to other vulnerable children. However, children orphaned by AIDS are particularly affected by weak birth registration systems, as cases of inheritance rights violations attest.
Children’s right to inherit is not established in international or regional child specific laws. Only the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa specifics inheritance as a right. Most countries in the study do not have specific legislation establishing and guaranteeing children’s right to inheritance, and such rights are usually governed by customary laws, which are discriminatory
against children, particularly those born out of wedlock.
In order to strengthen and scale up birth registration in the context of AIDS in sub-Saharan African countries, there is a general need for:
o Further research in high HIV prevalence countries (above 14 per cent) to generate additional evidence on the impacts of HIV and AIDS on accessibility and availability of birth registration systems. In order to understand birth registration in the context of HIV and AIDS in sub-Saharan Africa, the impacts of customary laws surrounding marriage and divorce should also be looked at, as these factors can influence and determine whether a child is registered or not.
The Essay on Aids Immune System 2
Aids by sean ross How is HIV Diagnosed? You can get tested for HIV in a number of locations — including public clinics, AIDS organizations, physicians' offices, and hospitals. Many locations give the test for free. You can choose between anonymous tests, in which you do not give your name to the HealthCare provider, or confidential tests, in which you do give your name. Test sites should ...
o Campaigns and materials to increase demand amongst stakeholders, including parents, caregivers and children affected by AIDS, for free and universal birth registration and comprehensive and accurate registration of deaths. User friendly materials need to be developed for children and elderly caregivers. The campaigns should further include information on will writing and succession planning.
o Advocacy at a regional, national and local level around birth registration and death registration in the context of HIV and AIDS to ensure that children’s rights and child protection mechanisms are addressed and integrated into laws, policies, and action plans pertaining both to HIV and AIDS, children, and poverty reduction strategies.
African Charter on the Rights and Welfare of the Child
Antiretroviral Therapy
Convention on the Rights of the Child
United Nations Food and Agriculture Organization
Global Partners Forum
Inter Agency Task Team on Children Affected by AIDS
International Labour Organization
Orphans and Vulnerable Children
National Plan of Action
President’s Emergency Plan for AIDS Relief
Preventing Mother-to-Child Transmission of HIV.
Regional Inter Agency Task Team on Children Affected by AIDS State of the World’s Children
United Nations General Assembly Special Session on HIV/AIDS
Unaccompanied Migrant Child
United Nations Children’s Fund
World Health Organization
South African Rand
The Acquired Immunodeficiency Syndrome is the final stage of HIV infection. Most HIV positive people will develop AIDS, though increasing numbers will
not due to drug therapies.
Birth certificate
A personal document issued to an individual by the state to prove birth registration.
Birth registration
The official recording of the birth of a child by an administrative process of the state and is coordinated by a particular branch of government. It is a permanent and official record of a child’s existence, and recognizes the official existence of a person before the law.
Civil registration
The compulsory, universal, permanent and continuous recording of the occurrence and characteristics of vital events (birth, foetal deaths, marriages, divorces, deaths).
The Essay on Hiv & Aids
HIV and AIDS Introduction HIV, which stands for human immunodeficiency virus, is the virus that causes AIDS. This virus can be passed from one another through blood to blood and sexual contact. A person with HIV has an incredibly weak immune system, causing them to contract one of numerous disease that causes AIDS, which stands for acquired immunodeficiency syndrome. Causes Someone cannot "get" ...
It establishes and provides legal documentation of such events.
HIV
The Human Immunodeficiency Virus is the virus that causes AIDS. An HIV positive test does not mean a person has AIDS, as there is an interval, ranging between six months to ten years, between the initial infection and the onset of AIDS.
1. Introduction
Civil registration systems are fundamental to safeguarding human rights as such systems establish and provide legal documentation of births, foetal deaths, marriages, divorce and deaths.1 This documentation acts as a source of protection for individuals, because they establish an individual’s
identity, nationality, kinship and age, which is key for citizens’ legal protection and to attain access to a state’s essential services and. Civil registration systems are also critical for states to effectively monitor its citizens, and plan and programme services for their needs.
Knowledge of these statistics is also essential to help the country secure development funds and monitor the progress made towards targeting the Millennium Development Goals.2 Even though civil registration benefits both individuals and states, the October 2007 World Health Organization (WHO) fact sheet states that a majority of countries have unsatisfactory civil registration systems, with only 31 out of 193 WHO member states having reliable systems.3
Within the framework of a civil registration system, birth and death registration are of particular importance to promoting and protecting the rights of the child. These systems can monitor the number of children born, the under 5 mortality rate, the number of dead parents/caregivers4, and consequently the number of orphaned children. Birth and death registration systems place the obligation on the state to ensure that children’s rights continue to be protected once a caregiver dies.
In sub-Saharan Africa, HIV and AIDS5 heavily impacts on the majority of children, leaving them orphaned and / or vulnerable. Weak registration systems further render these children vulnerable as a lack of a birth certificate restricts their access to basic services and protection mechanisms, increasing their susceptibility to abuse, violence and exposure to HIV. Absence of a caregiver’s death certificate increases the violation of a child’s human right to inheriting property, which is key for a child’s sustainable livelihood and food security.6 Even though it is understood by sub-Sahara African states that birth registration systems is a vital mechanism
UN Department of International Economic and Social Affairs Statistics Division (1998).
Handbook on civil registration and vital statistics systems. Preparation of a legal framework. New York, United Nations.
Plan International (2006).
Count me in: The global campaign for universal birth registration. Interim campaign report 2005-2006. London, Plan International.
World Health Organization (2007).
Civil registration: why counting births and deaths is important. Fact sheet No. 324. October. http://www.who.int/mediacentre/factsheets/fs324/en/index.html. Accessed on March 20 2008.
Parents and caregivers will be used interchangeably. The distinction between parents or caregivers will be made only in contexts when a legal distinction is necessary. 5
‘HIV’ should be understood to also include ‘AIDS’. The specific use of ‘AIDS’ will be made only in contexts where that stage of the disease is considered.
6 Rose, L (2006).
Children’s property and inheritance rights and their livelihoods: the context of HIV and AIDS in Southern and East Africa. FAO. To respecting children’s rights,7 most countries are unaware of the importance of death registration systems, and consequently do not have accurate and comprehensive systems recording data on death. As a result, the research will focus on birth registration in the context of HIV in sub-Saharan Africa. UNICEF defines birth registration as an official recording of the child’s birth by the administrative level of the state and coordinated by a particular branch of the government, which is a permanent and official record of a child’s existence and establishes the child’s legal identity.8
Only one out of three children is registered in sub-Saharan Africa.9 Eastern and Southern Africa has a 24 per cent birth registration rate, and West and Central Africa has a 41 per cent registration rate, which are, respectively,
the lowest and third lowest regional rates in the world. In some countries in sub-Saharan Africa, registration levels have declined in the past five years. South Asia has the second lowest birth registration rate, with a total of 36% of children being registered.10
In addition to having amongst the lowest birth registration rates in the world, these regions also have the highest number of people living with HIV in the world. Eastern and Southern Africa has 17.7 million people living with HIV, and West and Central Africa has 6.9 million people living with HIV. Furthermore, the number of children orphaned by AIDS11 in these regions are the only ones in the world that are projected to keep on increasing.12 Accordingly, this research seeks to address the extent to which the HIV pandemic influences accessibility and availability of birth registration systems, and how Africa’s weak birth registration systems impact on the large number of children affected by AIDS.
2. Background: the role of the GPF and IATT in civil registration The third Global Partners Forum (GPF) meeting in 2006 was convened to provide input into the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) review of achieving universal access to prevention, treatment, care and support for children affected by HIV and AIDS. The GPF identified civil, and particularly birth registration to be one of the strategic areas of importance to building a comprehensive response for children affected by HIV and AIDS.13
See Bequele, A. (2005).
Universal birth registration: the challenge in Africa. The African Child Policy Forum. Paper presented for the second Eastern and Southern Africa Conference on Universal Birth Registration. Mombasa, Kenya. September 26-30.
8
UNICEF (2002).
Birth registration: Right from the start. Innocenti Digest No. 9. Florence, UNICEF Innocenti Research Centre.
9 UNICEF (2007) Progress for children. A world fit for children: statistical review. No 6. New York, UNICEF.
10
UNICEF (2008).
The state of the world’s children 2008: child survival. New
York, UNICEF. 11
Children orphaned by AIDS refers to a child who has lost either one parent or both parents. 12
UNICEF (2007).Preceding the third GPF meeting, a two-day technical consultation was held to provide evidence-based recommendations on the identified areas of strategic importance, including on birth registration. The technical consultation on birth registration highlighted birth registration to be a key child protection measure, and stressed the additional vulnerability of a child who is without birth registration and who is orphaned. Such a child would possibly be discriminated against in terms of their socio-economic rights (lack of access to health care and education) and succession rights (violation of right to inherit parental property).14 The evidence-based recommendations set forth by the technical consultation on birth registration15 were presented to the Inter-Agency Technical Team (IATT) on children in the context of HIV and AIDS.
Recommendations included the need to “advocate for civil registration”.16 The IATT is mandated with coordinating the follow up of the recommendations set forth by the GPF, and has set up a working group on civil registration.17 This working group aims to increase understanding on civil registration systems in Africa, and in particular on the impacts of HIV and AIDS on such systems. Specifically, the working group on civil registration has identified the need to improve its knowledge base on the direct and indirect linkages between civil registration and HIV and AIDS in Africa. Consequently, the Centre for the Study of AIDS at the University of Pretoria was contracted to carry out research to address the IATT’s civil registration working group’s need. In line with the scope of the terms of reference, this focuses on birth registration as one aspect of civil registration. As noted, there is a lack of data and information on death registration, and hence death was not included in the research.
3. The research study
3.1 Need for research on birth registration in the context of HIV Available literature on birth registration largely concerns itself with advocating the importance of birth registration, identifying and addressing the barriers to birth registration,18 and designing strategic approaches to establishing effective and efficient birth systems19. The impacts of non-registration on children have also been documented, and the focus of these cases have primarily been on South Asia or sub-Saharan Africa, as these regions account for the lowest birth registration rates in the world. However, more attention is being given to understanding birth registration within the context of other regions, such as in Central
UNICEF (2006).
Report on the third Global Partners Forum on Children Affected by HIV and AIDS: Universal access to prevention, treatment and care. New York, UNICEF. 15
As above. pp. 7-8.
UNICEF (2006).
Members of this working group include the President’s Emergency Plan for AIDS Relief (PEPFAR), Plan International, UNICEF and World Vision.
See for example, UNICEF (2002).
See for example, Lancet (2007) Series on Vital Statistics, and Akoto, E. (2001) Recording of births in Sub-Saharan Africa: what strategies can be adopted to improve on coverage? Paper prepared for consultation on birth registration. Florence, UNICEF Innocenti Research Centre.
Europe and the Commonwealth of Independent States,20 East Asia and the Pacific,21 and Latin America22.
The identified barriers to birth registration are usually reflective of the internal situation of a state, and focus on political will, administrative support, budget, legislation and policy frameworks. External factors, such as HIV and AIDS that influence and impact on a states’ capacity to establish and sustain birth registration systems are largely neglected within the research.23
3.2 Research objectives
The report will specifically address the following questions: o How does the lack of access to birth and civil registration impact on children affected by AIDS, their families and communities?
o How does the HIV pandemic impact on access to, or availability of birth and other forms of civil registration?
The study covers all 45 countries in Eastern, Southern Africa, Western and Central Africa (See Box 1).
As this research aims to understand the impacts on, and relationship between HIV and birth registration, a macro approach to HIV and birth registration within these regions was taken. Country-specific examples will be used to highlight a point, however the focus of the report is not to provide a country specific report on birth registration in African countries or high HIV prevalent countries.24
UNICEF (2005).
Right at birth: birth registration in the countries of Central and Eastern Europe and the commonwealth of independent states. Geneva, UNICEF regional office for Central and Eastern Europe and the Commonwealth of Independent States.
UNICEF (2000).
‘Derecho al Nombre y la Nacionalidad: Propuesta de Tabajo para
America Latina y el Caribe. Santafé de Bogotá, UNICEF Regional Office for Latin America and the Caribbean. 23
An exception to ignoring the role of external factors on birth registration systems is the research conducted on the impact of armed conflict on birth registration systems. (UNICEF (2007a).
Birth registration and armed conflict. Florence, UNICEF Innocenti Research Centre.) 24 For country specific information on the status of birth registration in African countries, see UNICEF, Plan International and World Vision. Birth Registration Questionnaires Pan African Birth Registration Report Card (2008).
Unpublished.
3.3 Research methodology
The research is both desktop and participatory in nature. The desktop research consisted of internal documents from the civil registration working group partners, literature reviews, and relevant data and information, including National Plans of Action (NPAs) on Orphans and Vulnerable Children (OVC) being compiled, reviewed and analyzed. Qualitative field research was also conducted, with key informant’s electronically receiving a questionnaire that was designed by the consultants (see Annex 1).
The questionnaire aimed to understand what the respondents’ perceptions of the relationship between HIV and AIDS and birth registration is. Key informants were identified by the IATT working group on civil registration and by the consultants.
Questionnaires were sent to 40 key informants, including from the civil registration working group organizations and its partners, the Eastern and Southern African regional IATT (RIATT) members, NGOs, research institutions, including different research institutes within the University of Pretoria, a representative from a provincial department of civil registration, and a representative from an established network on HIV and AIDS.
Fourteen questionnaires were answered and returned, a response rate of 35 per cent, allowing these responses to be incorporated into the report. Specifically, responses were received from Plan and UNICEF headquarters, from Plan and UNICEF’s East and Southern Africa Regional office, as well as from several of these organizations’ country offices.25 One response was also garnered from a World Vision country office. In addition to responses from the working groups, responses were also received from Save the Children UK, Centre for Child Law, at the University of Pretoria, the Provincial Department of Civil Registration in Zambézia, Specifically, responses were received from Plan Zambia, UNICEF Mozambique, UNICEF Swaziland, and UNICEF Zambia.
Mozambique, and Constella Group26. One interview was conducted with a representative from USAID. All responses, excluding those from Plan and UNICEF headquarters, stemmed from countries in Southern Africa. The interview also focused primarily on Southern Africa. As has been previously confirmed, this is the region with the highest HIV prevalence rate, implying the weight of the respondent’s insights and perceptions on HIV and birth registration.
3.4 Limitations of the study
From the literature and internal documents from the working group partners, no information explicitly addressed the impacts of HIV and AIDS on accessibility and availability of birth registration, highlighting the fact that such information is not readily available. Any conclusions stemming from the report should be considered as preliminary findings. Further research is needed to substantiate these findings. The questionnaire was one attempt to do so. The majority of respondents to the questionnaires were staff from the civil registration working group members who are based in sub-Saharan Africa.
All of the respondents had directly worked with birth registration or HIV issues, and usually as two distinct programme or research areas. Even though a response was received from one government authority, additional perspectives from stakeholders, such as civil registrars, traditional birth attendants, midwives, parents and other caregivers, and children, are needed. These informants are vital to garnering a detailed understanding of how HIV influences availability and accessibility to birth registration, and how weak birth registration systems impact on children affected by AIDS.
Another limitation to the study is time. In view of meeting the deadline for the completion of the report, most respondents to the questionnaire considered the time allocated to adequately complete it as too short. Most respondents required additional time to review and answer the questionnaire. Those that did return the questionnaire by the allocated deadline might have had to rush, affecting or impacting on the quality of answers. Those who could not adhere to the deadline provided are excluded form the analysis.
4. Birth registration in Africa
“Birth registration in Africa is an alien concept,”27 and as a result birth registration activity in Africa is just beginning to emerge.28 It is only a recent development in many African countries that a duty is placed on the state to provide birth registration services to all children.
Constella Group is a global professional health services company. See http://www.constellagroup.com/ for more information.
Bequele, A. (2005).
Universal birth registration: the challenge in Africa. The African Child Policy Forum. Paper prepared for the second Eastern and Southern Africa Conference on Universal Birth Registration. Mombasa, Kenya. September 26-30.
28 Woll, L. (2002).
Report on the Anglophone Africa Workshop on Birth Registration. UNICEF.
Birth registration in Africa has its roots in colonial times, as colonial legislative instruments included provisions on birth registration. These provisions, however, made birth registration mandatory only for non-Africans, i.e. Europeans and Asians. Under colonial laws, birth registration for Africans was optional.
As such, the HIV pandemic should not be blamed for Africa’s weak birth registration systems. HIV and AIDS have brought to the fore the existing faults in Africa’s socio-political systems, and the pandemic has highlighted the urgency to address the critical impacts that these systems have on children.
Even so, after independence, birth registration continued to be optional for Africans, as the development of national legislations largely stemmed from
colonial laws. National legislations were mere revisions of colonial laws, and were not newly formulated to acknowledge and incorporate peoples’ cultural practices. Provisions pertaining to birth registration in some national legislations continue to disregard peoples’ way of life.
For example, even though Cameroon has a 70 per cent birth registration rate, children from the nomadic pygmies are not legally recognized, obscuring their access to birth registration.29 Furthermore, birth registration forms are only available in Afrikaans and English, two of the country’s 11 official languages, discriminating in particular against those in rural areas.30 Mr. Assefa Bequele of the African Child Policy Forum believes that the impetus to recognize birth registration as a right for all children in Africa stems from the Convention on the Rights of the Child (CRC) and the African Charter on the Rights and Welfare of the Child (ACRWC).
Article 7(1) of the CRC gives every child the right to be registered at birth and places the obligation on the state to ensure this right:
The child shall be registered immediately after birth and shall have the right from birth to a name, the right to acquire a nationality and as far as possible, the right to know and be cared for by his or her parents.
Article 6(2) of the ACRWC also establishes a child’s right to be registered: “Every child shall be registered immediately after birth.”
As of the time of writing, all countries in the study have ratified the CRC, except Somalia. The ACRWC has been ratified by 39 out of the 47 countries in the study.31 Both the CRC and the ACRWC place a legal obligation on state parties to, in accordance with their
Plan Australia (2005).“A birth certificate-the first basic human right”. 19 February http://www.plan.org.au/mediacentre/features/828 Accessed on April 15 2008. Birth Registration Questionnaire: South Africa. Pan African Birth Registration Report Card (2008).
UNICEF, Plan International and World Vision. Unpublished.
31 Countries that have not, as of April 2008, ratified the ACRWC include Central African Republic, Democratic Republic of the Congo, Guinea-Bissau, Liberia, Sáo Tomé and Principe, Somalia, Swaziland and Zambia. Out of these countries, only Liberia does not have data on birth registration rates.
Cconstitutional processes, to adopt the legislative measures to give effect to the CRC32 and ACRWC33. See annex 2 for other relevant international and national legal provisions, policies and plans of action establishing or advocating the right to birth registration, which are applicable for countries in this study. Yet despite the fact that the majority of countries in the research have ratified the CRC and the ACRWC, as well as other relevant international legislations pertaining to birth registration, domestic legislation still needs to be made fully compatible with these human rights instruments in order to make birth registration a reality for all children.34
The Committee on the Rights of the Child raised concerns over the challenges and problems encountered by most African countries in domesticating the necessary legislative measures as stipulated by the CRC in order to provide birth registration to all children.35 For example, the Kenyan delegation to the second Eastern and Southern Africa Conference acknowledged the belief that birth registration and issuing a birth certificate entailed two independent processes.36 In fact, most countries in Africa do not consider birth registration and birth certificates as concurrent issues, and as a result birth registration does not automatically translate into the delivery of a birth certificate. A birth certificate is the “most visible evidence of the government’s legal recognition of the existence of the child as a member of the society”,37 which can only be produced after a child is registered.
To help countries overcome these and other challenges, the Committee on the Rights of the Child agreed on the need to develop essential global guidelines and strategies for all states parties to observe for ensuring the rights of every child to survival, development and accessing quality services. The following guidelines are recommended to all state parties: 1. Universal birth registration: states parties to ensure compulsory and timely birth registration for all children born within the state with special attention on children born in rural areas. Registration should not discriminate children born to marginalised and most vulnerable groups and facilitate parents to register children born abroad.
2. Free registration: birth registration should be free of cost at all stages including birth certificate.
Convention on the Rights of the Child (1989) Article 4.
African Charter on the Rights and Welfare of the Child Article (1990) Article 1(1).
34
Save the Children UK (2006).
Legal and policy frameworks to protect the rights of vulnerable children in southern Africa. South Africa, Save the Children UK Southern Africa Programme. 35
Sharp, N. (2006a).
Global guidelines and strategies for universal birth registration: An analysis of the Concluding Observations and General Comments of the UN Committee on the Rights of the Child. London, Plan International
UNICEF (2005a).
The second Eastern and Southern Africa conference on universal birth registration: improving services to protect the rights of children. Nairobi, UNICEF. 37 UNICEF (2002).
3. Accessible birth registration to all: Birth registration should be well-coordinated (decentralised) and equally accessible to all parents in a national territory 4. Late registration: The state to ensure that late registration for older children is facilitated without enforcing late
registration fees.
5. Preservation of identity: Ensure that children have the right to preserve their identity, name and family relations, especially those born out of wedlock and measures should be taken against simulation of birth certificates. 6. Equal access to services: children should not be denied access to basic services because they lack birth certificates. Provision should be made to ensure that children without birth certificates are accommodated while steps are taken to facilitated access to birth certificate.
Furthermore, General Comment 7 “Implementing Child Rights in Early Development” identified birth registration as an indicator to assessing the effectiveness of states’ systems in realising the rights for young children.39 It was also noted that birth registration is a requirement for immediate remedial action in response to specific violations of rights.40 The Technical Consultation on Indicators Development for Children Orphaned and made Vulnerable by HIV/AIDS also highlighted the need to include birth registration as an indicator for child protection.41
In recognition of the importance of birth registration and the need to strengthen such systems, countries in Eastern, Southern, Western and Central Africa have noted that birth registration needs to be a higher priority for governments. The second Eastern and Southern Africa Conference of Universal Birth Registration has observed that a “greater understanding of the importance of birth registration for the realisation of child rights is developing in the region.”42 Several African countries, in particular Uganda, Kenya, Malawi, Zambia, and Zimbabwe have recently changed, or are in the process of changing, their legislation to enshrine birth registration as an inalienable human right for all newborn children.43 Furthermore, 44 per cent of countries in sub-Saharan Africa have drafted National Plans of Action on Orphaned and Vulnerable Children, wherein either concrete plans or references to birth registration are made.
Committee on the Rights of the Child (2005).
General comment No. 7 Implementing child rights in early childhood. CRC/C/GC/7. 1 November.
Early Childhood Indicators Group (2008).
A framework of early childhood indicators for general comment 7: implementing child rights in early development.
UNICEF (2003).
Technical consultation on indicators development for children orphaned and made vulnerable by HIV/AIDS. Gaborone, Botswana, 2-4 April.
42 UNICEF (2005a).
43 Bequele, A. (2005).
4.1 National Plans of Action on Orphaned and Vulnerable Children Understanding of the multiple benefits offered to children by being registered and owning a birth certificate are not clearly established in the NPAs.44 Only Zimbabwe’s NPA specifies that birth registration is a human right and it also acknowledges Zimbabwean national legislation that is relevant to this right, reflecting a firm commitment to increasing levels of birth registration.45 Swaziland46 and Namibia47 declare their NPAs as right-based, and Lesotho bases its NPA on the guiding principles set forth by the CRC and ACRWC, yet they do not explicitly state birth registration as a human right.
Several National Plans of Action on Orphaned and Vulnerable Children, including those from Cote d’Ivoire, Ethiopia, Lesotho, Rwanda, Nigeria, Swaziland and Zambia reflect that birth registration is considered an essential service to which all children have the right to access, yet it is not recognized that birth registration enables easier access to other services, such as education and health care. For example, Ethiopia’s NPA (2004-2006) encourages the development of OVC care and support guidelines as part of a strategy to ensure access to basic services.48 However, facilitation of birth and death registration falls beyond the scope of these
guidelines, as they are not specifically mentioned as a strategy to ensure children’s access to basic social services.
This could be for two reasons. Firstly, the absence of birth certificates is not considered by the NPA as a barrier to accessing basic services, unlike fees that needed to access education and health care facilities. Secondly, even though Ethiopia has adopted legislation ensuring free and universal birth registration,49 no policy makers perceived birth registration as an inalienable human right. In addition, while 87.5 per cent of policy makers did realize that birth registration is proof of identity, birth date, age, nationality, citizenship and personal history, only 25 per cent considered birth registration as a means of protection from abuse and exploitation, maltreatment, child labour, under age military service, trafficking, early marriage, child prostitution, and ensuring juvenile justice.50 Rwanda’s NPA (2006-2011)51, however, does acknowledge and stress the importance of birth registration in accessing other services such as shelter, education, nutrition, social protection, and water and sanitation. Even though the NPA aims for all 0 to 4 year olds to be registered 44
Out of the 45 countries in the study, 20 have NPAs on OVC. The researchers had access to 11, namely Ethiopia, Cote d’Ivoire, Kenya, Lesotho, Mozambique, Namibia, Nigeria, Rwanda, Swaziland Zambia and Zimbabwe, which were all analysed in light of their birth registration provisions. 45
Government of Zimbabwe (2004) National Plan of Action for Orphans and Other Vulnerable Children.
46
Kingdom of Swaziland. National Plan of Action for Orphans and Vulnerable Children 2006-2011. 47
Government of Namibia (2004).
National Plan of Action on Orphans and Vulnerable Children. 48
Federal Democratic Republic of Ethiopia. Orphan and Vulnerable Children National Plan of Action 2004-2006.
49
UNICEF (2008b).
Summary of UNICEF’s activities on birth registration in 2007. Unpublished. 50
Plan Ethiopia and African Child Policy Forum (2005).
A review of birth registration in Addis Ababa and the regions Oromia, Amhara and SNNPR, Ethiopia. Addis Ababa, Plan Ethiopia and African Child Policy Forum.
51 Government of Republic of Rwanda. National Plan of Action for Orphans and other Vulnerable Children 2006-2011 (Draft).
Aand have access to social services by 2011, it is important to ensure the registration of older children as well. In the context of HIV, children can take on the role of caregivers to their ill parents and younger siblings. The access to health care facilities, basic education and vocational training, and social protection services are not only the rights of these children, but it may also have a wider consequence for the well-being of younger siblings and other dependent family members if they are registered.
Lesotho, which has a 23.2% HIV prevalence rate, does enable retroactive registration, which is integrated into the government’s birth and death registration systems.52 Such a system in a high HIV prevalent country is key for registering the high number of children orphaned by AIDS, creating the obligation by the state to protect their rights of children after the passing away of their caregivers. Mozambique has also noted the importance of increasing access by orphans to birth certificates, yet its NPA does not specify actions to be taken to do so.53
Some NPAs, including those from Kenya, Swaziland and Zambia consider birth registration only to be a legal protective measure, as it can shield children from abuse, violence, exploitation, child labour and trafficking, as well as inheritance loss and property grabbing. For example, birth registration is recognized as one of the seven guiding principles in the Kenyan NPA and four strategies are outlined to ensure the access of such birth registration mechanisms in both urban and rural areas. 54 This NPA emphasizes that birth registration is a means to provide stronger policy and legal protection to children who are orphaned and made vulnerable, yet it makes no link to registered children and basic services.
Swaziland specifically mentions the importance of birth registration for the protection of property rights, adoption and guardianship arrangements, and for ensuring that siblings are not separated, as this facilitates ‘disinheritance’ of parental property. Zambia also addresses these issues by aiming to expand and upgrade their Victim Support Unit, which falls under the jurisdiction of the police, that aims to sort out inheritance issues and “other problems related to family death and upheavals”.55 A potential reason why Zambia’s NPA does correlate birth registration to accessing basic service, is because widespread use of alternative documents, such as under 5 clinic cards, are accepted.56
Namibia’s NPA specifically mentions birth registration in relation to the ability to access various grants, such as the Foster Parent Allowance. Contrary to Namibia, as of 1 June 2008, South Africa’s Department of Social Development does not require caregivers to present their own ID and the child’s birth certificate to access social grants. As of April 2007, more than eight million South African children under the age of 14 were benefiting from a ZAR 200 (US$ 30) monthly grant to caregivers earning less than ZAR R800 (US$ 115) per month.57 52
Birth Registration Questionnaires: Lesotho. Pan African Birth Registration Report Card (2008).
UNICEF, Plan International and World Vision. Unpublished.
Republic of Mozambique (2005).
National Action Plan for Orphaned and other Vulnerable Children 54 Republic of Kenya. National Plan of Action for Orphans and Vulnerable Children 2005/06 – 2009/10. 55 Government of Zambia. National Action Plan for Orphaned and other Vulnerable Children. p 12. 56 Questionnaire response from UNICEF Zambia. 57 Birth Registration Questionnaires: South Africa Pan African Birth Registration Report Card (2008).
UNICEF, Plan International and World Vision. Unpublished
However lack of identity documents owned by caregivers, and their inability to access birth registration systems in rural areas, partly due to registration forms only being available in two of the official 11 languages, limited the reach of the grant.58 The new policy accordingly allows IDs and birth certificates to be replaced by sworn affidavits, which will be considered legal proof of the identity of the child and the caregiver. Caregivers can obtain affidavits at civil registrar offices, and via traditional leaders, school principals, policemen, and clergymen. This move is estimated to allow another 500,000 to 750,000 children to receive the monthly support grant that they are entitled to.59 Even though this addresses South Africa’s reality of it having a weak birth registration system,60 the new policy can result in corruption, as it becomes easier for individuals to pose as caregivers requesting the support grant, and people can also pose as principals, policemen or clergymen, possibly increasing identity theft.
Furthermore, incentives to establish an effective birth registration system could diminish and raising awareness of the importance of birth registration will be futile if birth certificates are not seen as contributing to the access of material resources. While this new and controversial policy development in South Africa makes it easier for caregivers to access the foster care and child support grant, Uganda’s Births and Death Registration Act Uganda permits caregivers, as opposed to only fathers and mothers, to register children.61 Legislation in most African countries place the responsibility of birth registration on parents, and research indicates that ill parents and the death of parents leaves their orphans vulnerable to unfulfilled rights.62 Allowing caregivers to register children increases the likelihood that children will be registered, as the presence, or physical condition, of a parent does not determine whether a child will be registered.
This provision is of extreme importance for children orphaned by AIDS, as it does not deprive them of their right to be registered and it can ensure that they continue to be protected after their parents die. While caregivers are able to register a child, extreme caution should be taken to ensure that the caregiver acts out of the best interest of the child. In the era of AIDS and the increasing number of orphaned children, people can view children as a commodity and ‘buy’ them. After registering the child as their own, caregivers can take the child out of the country. This is particularly dangerous, as it could open the door to illegal adoptions and trafficking of children.
Of course one does not want to make it more difficult for people to register babies, but on the other hand, loopholes to allow trafficking must be closed.63 Despite such NPAs, policies and acts aimed at establishing and sustaining effective birth registration systems within countries in sub-Saharan Africa, “progress is slow and countries 58
IRIN (2008).
South Africa : No Registration, no benefits.
http://www.irinnews.org/Report.aspx?ReportId=75683 Accessed on 2 June 2008. 59
Govender, P. “Fears of social grant fraud”. The Times, 1 June 2008. http://www.thetimes.co.za/PrintEdition/News/Article.aspx?id=776835 Accessed 2 June 2008. 60
See figure 1 to observe that no data is available on birth registration rates in South Africa. 61
Government of Uganda (2005).
Country report for the Eastern and Southern Africa Conference on universal birth registration.
62 UNICEF (2005b).
63 Questionnaire response Centre for Child Law, University of Pretoria
have not had enough opportunities to learn from each other and from global experience”.64 The Committee on the Rights of the Child has also observed that registering children is a major challenge, but particularly so for Sub-Saharan African countries.65
4.2 The regional conferences on birth registration
Since 2002, several regional efforts have been made in both regions to share experiences on birth registration and to identify strategies on how to develop effective systems. Specifically, three conferences have been held within Africa on birth registration. In addition, Western and Central Africa launched a regional campaign on birth registration.
In 2002, Uganda hosted the birth registration workshop for Anglophone countries in Africa,66 in 2003 the Western and Central Africa regional campaign for birth registration on the Day of the African Child was launched in Mali, in 2004 the first regional conference on birth registration in West and Central Africa was held in Senegal,67 and in 2005 Kenya hosted the second Eastern and Southern Africa conference on universal birth registration68. In each of these conferences, there was an overarching awareness that rates of birth registration are extremely low, in particular by those children born and living in rural areas, children who are refugees or internally displaced, children belonging to minority groups, and children born to illiterate parents. It should be noted that no references were made to children infected or affected by HIV and AIDS, and these children were not identified as being vulnerable to not being registered.
Even though these conferences pulled together countries with different socio-economic, political and cultural situations, recommendations stemming from these gatherings raised the same general issues:
o More political will is needed to advance birth registration as a fundamental right of children;
o Increase the level of demand for birth registration, in particular by those living in rural areas and / or already marginalized;
o Mainstream birth registration into existing initiatives, such as into health and education programmes;
o Decentralise birth registration processes so as to allow communities, including traditional leaders and ward councillors, to take on an active and effective role.
It is of importance to note that, while the HIV pandemic’s stronghold lies in sub-Saharan Africa, its influence and effect on civil registration systems at the regional high-level conferences was not discussed. For example, the First West and Central Africa Birth 64
UNICEF (2005a).
Committee on the Rights of the Child (2005).
Woll, L. (2002).
67 Sharp, N. and Heap, S. (2004) First West and Central Africa Birth
Registration Conference: Universal birth registration – the way forward. London, Plan International. 68 UNICEF (2005a).
Registration Conference in 2004 asked stakeholders to synthesize “hot issues” pertaining to birth registration within their countries. The identified stakeholders, namely children, opinion leaders, media and government, singled out seven “hot issues”.69 None of these issues referred to the HIV pandemic. Interestingly, while children in special situations were singled out to be one of the “hot issues”, children affected by AIDS did not fall under this category, unlike children in difficult circumstances, conflict situations, and migratory groups.70 A possible reason for HIV not being mentioned or discussed at the conference in West and Central Africa, is because the burden of the pandemic falls elsewhere, namely in southern Africa.71
However, even the first Eastern and Southern Africa in 2002 conference on birth registration did not incorporate the issue of HIV into its agenda. The pandemic was not identified as a primary barrier to birth registration, unlike political will. Arguably because HIV does not impact on political will, was the pandemic not addressed in the conference. The second Eastern and Southern Africa Conference on Universal Birth Registration in 2005 did refer to birth registration in the context of HIV. The then UNICEF’s Regional Director for Eastern and Southern Africa, Per Engebak, advocated the need for children to own their own birth certificate in a time of HIV and AIDS, since “in a region where many parents are dying of HIV/AIDS…the need for children to own a birth certificate has never been greater”.72 In reference to Mr. Engebak’s message, the conference recognized the impact of HIV on the region, but it did not take the step in specifying it as a barrier to establishing and sustaining birth registration systems.
A possible reason for HIV not being incorporated into the agenda of the birth registration conferences is that states themselves do not recognize the
potential link between the two issues. Looking at Namibia, it saw HIV as a separate and independent issue to children’s socioeconomic rights. In its report submitted to the Committee on the Rights of the Child, Namibia recognized the challenge of HIV and set out a number of measures that the government had taken to address the pandemic. None of these measures included strengthening birth registration systems. Even though birth registration was mentioned in the report, it was in reference to the child’s right to an identity and citizenship, and not to a child’s protection and access to basic services.73 However, Kenya has taken steps to include
69
These seven hot issues are (1) awareness: importance of birth registration; (2) systems: legal frameworks and birth registration mechanisms; (3) institutions: capacity and costs; (4) cooperation and partnership: integration of birth registration with other programmes like health and education; (5) special situations: children in difficult circumstances, conflict situations and migratory groups: (6) gender: gender discrimination; (7) society and culture.
70
Sharp, N. and Heap, S. (2004).
71
UNAIDS / WHO (2007).
Sub-Saharan Africa AIDS Epidemic Update Regional Summary. UNAIDS and WHO.
72 UNICEF (2005a).
73 Government of Namibia (1992).
Committee on the rights of the child. CRC/C/3/Add.12.
22
birth and death registration into its National HIV/AIDS Strategic Plan, as well as its NPA on OVC.74
In the second Eastern and Southern Africa conference explanations have been given concerning why legislative and institutional frameworks have not been
developed, and why adequate resources have not been allocated to enforcing birth registration. However, according to Bequele, none of the explanations seemed convincing.75 A possible reason is that the challenges posed by HIV on institutional mechanisms and on countries’ socio-economic framework, particularly poverty, was not considered.76
5. The status of birth registration and HIV and AIDS in sub-Saharan Africa If indeed there is a statistically significant link between HIV prevalence and birth registration rates, it should be expected that high HIV prevalence countries have low total birth registration rates, rendering in particular children affected by AIDS uncounted. Out of the 11 countries in the sub-region, nine countries have a HIV prevalence rate of 14% or higher.77 Nor surprisingly, the number of orphans and other children made vulnerable by AIDS is also the highest in the world. No other sub-region or region in the world can account for such astronomical levels. See figure 1 for data on HIV prevalence and birth registration rates for countries in the study.
Republic of Kenya NPA on OVC.
Bequele, A. (2005).
76
The AIDS situation in 2005, i.e. when the second Eastern and Southern Conference on birth registration was convened, was not drastically different to what it is today. In fact, in 2005 southern Africa was already established as the epicentre of the global AIDS epidemic (UNAIDS / WHO (2005).
AIDS Epidemic Update. UNAIDS and WHO.)
77
These countries are Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, Zimbabwe.
78
These countries are identified as belonging to a certain region, as per UNICEF’s categorization. See http://www.unicef.org/infobycountry/index.html.
79 UNAIDS (2008).
Country responses. http://www.unaids.org/en/CountryResponses/Countries/ Accessed on April 1 2008.
80 UNICEF (2008).
Looking at figure 1, some statistics would seem to reflect the negative impact and correlation between HIV on birth registration systems. In Eastern Africa, Uganda has the highest HIV prevalence rate (6.7%) and the second lowest total birth registration rate (4%).
In the same region, Comoros has the lowest HIV prevalence rate (
