An estimated 230 million children under the age of five “do not officially exist,” according to UNICEF, because their births were never registered. As a result, their access to health care and other social services is blocked, leaving them vulnerable to child labour, child marriage and other forms of exploitation.

The issue of civil registration -- the official recording births and deaths -- was a main topic up for discussion at this week’s Maternal, Newborn and Child Health summit, hosted by Prime Minister Stephen Harper in Toronto.

The issue of registration came up in keynote speeches from several high-profile stakeholders in the field of public health advocacy, including Anthony Lake, the executive director of UNICEF, Melinda Gates of the Bill and Melinda Gates Foundation, and Seth Berkley of the GAVI Alliance, which administers vaccines to low-income countries around the world.

Lake told the summit that an obstacle to improving maternal and child health around the world is “the absence of free and universal access to birth registration,” which he described as “a child’s passport to vital public health care services, to education and to social security.”

According to a UNICEF report issued last year, of the estimated 230 million children under age five whose births have not been registered, 59 per cent live in Asia, while another 37 per cent live in sub-Saharan Africa.

“These children are legally invisible,” Lake said. “Their demands for public services are almost inaudible.”

Registering a child’s birth does not automatically mean he or she is issued a birth certificate. However, it is the first step in gaining that important document, which proves their age and provides them with a nationality, both of which are vital for their future.

If a child goes unregistered, “first of all it means she won’t have immediate access to health services,” David Morley, president and CEO of UNICEF Canada, told

“Then, she may not be able to go to school because she’s not registered, she doesn’t exist. So she’s had those strikes against her. Then as she gets older, she could be at greater risk of child marriage because we don’t know her birth date.”

Without proof of age, an undocumented child may also be conscripted into army service before the legal age, or maybe be prosecuted for a crime as an adult, UNICEF warns in its report. As they grow up, the lack of a birth certificate may make it impossible for that child to get a job, buy a home, vote or obtain a passport.

Civil registration of both births and deaths also serves “a statistical purpose,” UNICEF says. The data is crucial for governments, non-governmental organizations and other stakeholders to plan and implement programs on everything ranging from health care to education to water sanitation to housing.

“Right now we don’t count every baby that’s born, and we don’t know who’s dying or why they died in the majority of cases,” Gates said in a keynote address to the summit.

That leaves stakeholders to estimate birth and death rates, as well as causes, “and then they’re implementing and making policy decisions. That’s not good enough.”

She noted that reliable cause of death information is not available for some six billion people.

“In other words, we don’t know how three-quarters of the global population dies, which makes it really hard to allocate our investments and our resources.”

'You’ve got to engage the community'

With stakeholders making documenting every birth and death around the world a priority, Morley says it starts with one of the basic tenets of development: “You’ve got to engage the community.”

The first challenge is to get the word out to each child’s family.

Basic education on how to register a child, the process it entails, and the benefits it offers can begin with simple radio ads, posters around a community, and even street theatre, which can dramatize some of the risks of not having a birth certificate.

“As people start to really understand that this is what this piece of paper can mean, they’ll want it and they’ll want to get the services as well,” Morley said.

As an example, he told of working at a refugee camp just inside the border of Zambia years ago, when streams of people were flooding in to escape the war in Angola.

Refugees arrived wearing rags and carrying little, if any, personal items.

“I remember a woman reaching inside those rags and pulling out, in a baggie, a birth registration for her child. She had nothing, but she had this piece of paper,” Morley said.

“So when people know how important it is, they treasure it. We have to help people know about doing that through public education.”

Once citizens start demanding registration, governments with inadequate record-keeping mechanisms need help establishing registry offices to collect and maintain all of the data.

Finally, a system connecting the two must be put in place to remove barriers to registration and make it easier for parents in even the most remote communities.

Last month, Canada provided $20 million to a UNICEF birth registration project in sub-Saharan Africa. Initiatives include an SMS-based system that allows a health worker to register a newborn with a simple text message from a cellphone.

“Birth registration is not only a fundamental right in itself,” UNICEF says, “but also a key to ensuring the fulfillment of other rights.”