Invisible girls and boys because of the pandemic
Last week, INEGI published “Statistics on registered births for 2021” https://www.inegi.org.mx/contenidos/saladeprensa/boletines/2022/NR/NR2021.pdf. Press release 552/22 does not talk about births, as interpreted by some newspapers that mentioned “…births rise sharply after the pandemic…” https://www.eluniversal.com.mx/cartera/se-disparan -nacimientos- en-mexico-en-2021-tras-de-la-pandemia or “Baby boom in a pandemic: Birth rate rises for the first time in 11 years” https://www.elfinanciero.com.mx/nacional/ 21 /09/2022/baby-boom-in-pandemic-birthrate-in-mexico-rises-for-first-time-in-11-years/. The statement said “…Statistics on Registered Births (ENR) are generated annually from the information collected during the registration of births carried out by civil registry offices distributed throughout the country… 1,912,178 births registered in 2021, represent an increase of 17.4% compared to those registered in 2020…” So, INEGI – instead of talking about a vital event (birth) – refers to the statistics of the administrative act of obtaining a birth certificate in the civil services register (registered birth). It is advisable to make some clarifications to avoid distorted interpretations.
- Around the world, births are first reported and then legally certified. Notification is usually done by the professional who assisted the woman during the birth, and legal certification is done by the designated civil authority. While the medical birth notification leads us to the statistics of live births, the legal accreditation of the birth is what gives a civil identity of any person who is brought before the lawful authority to obtain a certificate of birth that he was born in that nation. An omission in birth notification is a failure in the statistical system of live births. But an omission in the birth certificate is a person who has no civil identity, in other words, is invisible to the legal eyes of society and therefore has no legal capacity to exercise his rights.
- In Mexico, notification of births is made by health personnel by filling out a format called Birth Certificate issued by the Directorate General of Information (DGIS) of the Ministry of Health. Since 2007, the Birth Certificate is a unique national format for free and mandatory issuance, on an individual and non-transferable basis, in which the birth of a live-born child and the circumstances accompanying the event are recorded. This document is issued in medical units, and statistical reports exclude the majority of births that occurred at home.
- On the other hand, the legal accreditation of a birth in Mexico is done by issuing a birth certificate at one of the 4,504 Civil Registry offices distributed throughout the country. For this purpose, both parents or the mother of the newborn must present to the authority both the person who will be registered and a set of documents (including a birth certificate). Requirements vary by state and the age of the person who will be registering. For this reason, the statistics of registered births include not only births that occurred in the year of registration, but also include extemporaneous records of people who were born in years other than the date of registration.
Based on these clarifications, we can interpret that neither of the two sources mentioned has the necessary accuracy to report the number of births in Mexico in a given year, and therefore the changes in trends published in the newspapers may be artificial. Although the birth information subsystem statistics, SINAC http://sinaiscap.salud.gob.mx:8080/DGIS/ publishes births that occurred in the year they were certified, it only records births in clinics and hospitals and very few that happen in homes.
To date, we are not sure how many births occur in or outside medical units. According to ENSANUT 2021, 98.8% of women reported being attended by medical personnel during childbirth. INEGI’s statement in 2021 said that 88.4% of registered births occurred in the medical field, and SINAC reported that this year 97.5% of certified births occurred in medical facilities. The difference in both relative and absolute terms is large. According to SINAC, 41,716 births occurred outside medical units, while for INEGI the figure rises to 222,186.
Unlike SINAC, INEGI counts, in addition to births occurring in the year of registration, births registered late. For example, of the 1.9 million births recorded in 2021, 61.3% occurred that year, 26.4% in 2020, and 12.3% in 2019 or earlier. However, 8 out of 10 born in 2020 are registered in 2021, before their first birthday. The above allows INEGI to say that 83.2% of registrations occurred in children under one year, although it would be useful to say: of these, 1 in 4 was born in 2020. But the national average hides the differences in the backlog in birth registration. While in Chiapas only 52.2% of children under one year were registered in the same year, in Querétaro it reached 96.2%. This is to be expected in Chiapas, almost 1 in 15 births was registered after the age of 8, and the extreme case is Southern California, where in 2021 1 in 7 births was registered after 8 years of birth.
When direct sources fail, demography and household surveys come to the rescue of birth statistics. In Mexico, we have two birth estimates for 2020 and 2021, which are tabulated. The problem is that CONAPO’s birth rate estimate was made before the 2020 census and the pandemic. On the other hand, the UN Population Division (which includes the census and the pandemic in its models) estimates 10% fewer births than CONAPO. The table also shows us that if the number of births according to the United Nations is considered the expected value, registered births and certified live births are respectively 8% and 12% below this value.
It is known that both 2020 and 2021 are special years in state functions and in the behavior of the population. If INEGI had published a graph of the distribution of births registered by month over the years, readers would have understood that this was not an increase in births in Mexico, but that families decided to go register their children when they were able to go out on their homes, houses, but births do not change their trend during these two years.
The ERN shows us the potential number of children without birth certificates or invisible who are leaving the pandemic in Mexico. It is recommended to deepen the country-by-country analysis, but in addition, it is highly recommended that the National Population Register and the civil registries of the countries take action on the matter and implement actions or programs to regulate this situation. They can reach up to 300 thousand minors located in the most marginalized states of the country. Perhaps the headline of the articles on September 22 was not an increase in the birth rate due to the pandemic, but rather an increase in the invisibility of children in the country.
*The author is a professor at the University of Washington in the Department of Health Measurement Sciences and the Institute for Health Metrics and Evaluation (IHME) https://www.healthdata.org/about/rafael-lozano