Counting men, missing women: a qualitative exploration of barriers underlying sex disparity in death registration in selected districts of Bangladesh
Mrittika Barua, Protyasha Ghosh, Avijit Saha, Muhammad Abdul Mannan, Md Jahedul Islam, Shahrear Alam, Saima Mehjabeen, Syeda Tahmina Ahmed, Sayema Akter, Romain Santon, Anushka Mangharam, Moyeen Uddin, Nazrul Islam, Malabika SarkerIntroduction
Accurate and timely reporting of deaths and causes of death is crucial evidence for health policy and planning. However, in practice, there is a low level of completeness of the death registration process in low-income settings such as Bangladesh and more so among females than males. An in-depth exploration of the barriers to low registration among females is needed in Bangladesh, a country bound by unequal gender norms and practices.
Methods
The study relied on a qualitative approach and consisted of 33 key informant interviews with field-level implementers, policymakers and 13 focus group discussions among beneficiaries in eight subdistricts with low and high sex disparity.
Results
The findings show that poor awareness about the registration process, inheritance-driven need and missing accurate supporting information hinder and delay death registration. Deep-rooted male-dominated inheritance practices contribute to lower registration of female deaths. This is further compounded by complex registration procedures, including the requirement for a pre-existing birth certificate and difficulties in obtaining or verifying supporting documents. In addition, awareness activities often emphasise inheritance-related benefits, unintentionally reinforcing the perception that death registration is more important for men than for women.
Conclusions
Policies need to be strengthened and adapted to improve death registration completeness by addressing the barriers. More gender-sensitive, stronger and context-appropriate policy reforms, along with better implementation and oversight, are needed to improve the completeness of female death registration.