How effective is death registration in India? Evidence from recent National Family Health Survey-5 (2019-2021)

Background: There is a paucity of research on death registration in many developing countries, including India, but the evidence suggests that it is inadequate, incomplete, and out of date, undermining its effectiveness. Objective: In this study we use a comprehensive national survey to investigate how gender, together with socio-economic and demographic factors, impact the registration of deaths in India. Data: The National Family Health Survey-5, conducted in 2019-2021 by the Ministry of Health and Family Welfare (MoHFW), Government of India, provides information on population, health, and nutrition for India and for each state and union territory. The survey includes questions on deaths in the household in the previous three years, individual information on the deceased, household level information and whether the death was registered in the civil registry or not. The total sample comprises of 636,699 households with 81,336 deceased cases, of which 46,917 cases were males and 34,419 cases were females. Methods: We performed univariate, bivariate and multivariate analysis. We calculated the proportion registered, by gender and other indicators, and then multilevel regression used to examine the risk factors for registration. Results: About 70% of all deaths were reported as being registered, 73% of male deaths and 64% of female deaths, an absolute gender gap in registered deaths of 9%. Infants, children, rural-residents, Muslims, Christians, Scheduled Castes and Tribes, and deaths in eastern India (North-Eastern, Central and Eastern regions) all had significantly lower odds of registering deaths with the civil authorities. Registration was also lower for deaths due to non-external causes, large households and poorer households. Conclusions: The data from the NFHS-5 suggest there are large and gender and other social and locational biases in the registration of deaths. Unless corrected, these biases are liable to cast serious doubts over the credibility of mortality statistics published by the Indian, State and other official statistical agencies. Contribution: Research indicates that India needs targeted-based initiatives to strengthen the death registration systems.