3.5m missing births:: How hospitals can close Nigeria’s registration gap

In the heart of Lagos, a new mother named Aisha Adeyemi clutched her newborn son tightly, her eyes glistening with joy. Yet, as she looked around the crowded maternity ward, a sense of urgency gripped her. She knew that before leaving the hospital, she needed to ensure her child's future was secure. This moment, though personal, reflects a national crisis in Nigeria: over 3.5 million children lack formal birth certificates, rendering them legally invisible despite being alive and well within their families. The issue is not confined to remote villages; it spans major urban centers such as Lagos, Ogun, Oyo, Osun, Ondo, Ekiti, and Edo states. Emmanuel Joseph, a father in Lagos, recently experienced both the ease and complexity of birth registration firsthand. After giving birth to a daughter, he immediately sought to register her. He approached the nurse in charge, only to be met with confusion. The nurse questioned whether he had a name for the child, implying that registration required more than just a birth. Joseph was directed to the National Population Commission (NPC) registration unit within the hospital. There, he filled out forms and received a free birth certificate. For Joseph, the process was straightforward. However, for many others, especially those in rural areas, the path to legal identity is fraught with obstacles. According to officials' reports, these 3.5 million children live among us, some in cities, some in villages, but remain unregistered. Their births may occur in hospitals, yet they leave without a legal identity. This gap exists even in health facilities where medical professionals are present. The challenge lies in ensuring that registration becomes an automatic part of the care process rather than an additional burden on parents. Experts argue that integrating birth registration into routine maternal and newborn care is crucial. Just as immunization, weighing, and postnatal checks are standard procedures, so too should birth registration be embedded within healthcare services. This approach would eliminate the need for families to travel long distances to registration offices, making the process accessible and efficient. The civil registration system acknowledges this potential. Strategies emphasize the integration of birth registration with primary healthcare services, along with decentralization, digitalization, and improved data sharing. The goal is to expand registration points to local levels, including wards and health facilities. This shift aims to make registration a seamless part of the healthcare experience, ensuring that every child receives a legal identity at birth. Healthcare facilities, particularly maternity units and primary healthcare centers, hold a unique advantage. They witness the birth of a child and have direct contact with caregivers. Leveraging this proximity, these institutions can serve as the initial point of registration. This model aligns with global best practices, which advocate for community-based registration systems to improve coverage and reduce disparities. Despite these efforts, challenges persist. Many families, especially in underserved regions, face logistical and financial barriers. Additionally, awareness about the importance of birth registration remains low. Efforts must focus on educating communities about the benefits of legal identity, including access to education, employment, and government services. As Nigeria continues its push toward universal birth registration, the role of healthcare providers becomes increasingly vital. By embedding registration into routine care, hospitals can transform themselves from mere sites of childbirth into catalysts for legal empowerment. This initiative holds the promise of ensuring that every child, regardless of location or socioeconomic status, begins life with a documented existence.