For the study, published in the ‘International Journal for Equity in Health’ by BioMed Central on August 31, the researchers compiled death registration data from Civil Registration Reports between 2000 and 2018, and used statistical analysis — the empirical completeness method — to estimate how far deaths were registered and if inequalities between states and sexes have narrowed or widened.
They found that estimated completeness of death registration went up from 58% in 2000 to 81% in 2018. Data categorised on the basis of sex was only available 2009 onwards which, the researchers said, was dependent on how well the states compiled data. Since then, completeness of male death records rose from 60% to 85% but that of female death records from 54% to only 74%.
“It is significant difference and is important for two reasons. Firstly, it means that the official registration of female deaths is less common than for male deaths, despite registration of deaths being compulsory. This means the families are less likely to receive an official death certificate for a female death,” corresponding author Dr Timothy Adair told TOI.
“Secondly, it means that a higher proportion of female deaths are unreported and so we know less about female mortality patterns compared to male mortality. Accurate measurement of mortality is important to monitor trends in population health, including measurement of excess mortality during the COVID-19 pandemic. If mortality of females during the pandemic is under-reported compared with male mortality, then the impact of the pandemic on female mortality would be under-estimated.”
The differences among states are stark. In Rajasthan, the latest estimates in the study show, male completeness was 87% while female was just 62% — a 25-percentage point difference, the highest in the country. Arunachal Pradesh came next (22-percentage point difference), followed by Madhya Pradesh (17), Assam (14), Mizoram (13) and Uttarakhand (12).
There were some outliers. In Sikkim, female completeness (95%) surpassed that of male records (87%), an 8-percentage point difference. Nagaland came next (4-point difference), then Jammu & Kashmir (2), Meghalaya (2) and Odisha (1). “Social and cultural factors can interact with characteristics of the national death registration system to create barriers to female death registration. A death needs to be registered so that a death certificate can be issued. A death certificate is required for property-related inheritance and social security/insurance issues,” said Adair.
“Another issue is higher proportion of male than female deaths occur in hospitals, where deaths are more likely to be registered than if occurring at home. The attainment of more equitable levels of death registration between males and females requires the reduction in barriers to death registration.”