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Objectives: Official data on birth is important to monitor the specific targets of SDGs. About 2.7 million children under age five years do not have official birth registration document in India. Unavailability of birth registration document may deprive the children from access to government-aided essential services such as fixed years of formal education, healthcare, and legal protection. This study examines the effect of socioeconomic, demographic and health care factors on birth registration in India. We also examined the spatial pattern of completeness of birth registration that could be useful for district level intervention., Methods: We used data from the National Family Health Survey (NFHS-4), 2015-16. We carried out the descriptive statistics and bivariate analysis. Besides, we used multilevel binary logistic regression to identify significant covariates of birth registration at the individual, district, and state levels. We used GIS software to do spatial mapping of completeness of birth registration at district level., Results: The birth registration level was lower than national average (80.21%) in the 254 districts. In Uttar Pradesh, 12 out of 71 districts recorded lower than 50% birth registration. Also, some districts from Arunachal Pradesh, J&K, and Rajasthan recorded lower than 50% birth registration. We also found a lower proportion of children are registered among children of birth order three and above (62.83%) and rural resident (76.62%). Children of mothers with no formal education, no media exposure, poorest wealth quintile, OBC and muslims religion have lower level of birth registration. Multilevel regression result showed 25 percent variation in birth registration lie between states while the remaining 75 percent variation lie within states. Moreover, children among illiterate mother (AOR = 0.57, CI [0.54, 0.61], p<0.001), Muslims households (AOR = 0.90, CI [0.87, 0.94], p<0.001), and poorest wealth quintile (AOR = 0.38, CI [0.36, 0.41], p<0.001) showed lower odds for child's birth registration., Conclusion: We strongly suggest linking the birth registration facilities with health institutions., Competing Interests: The authors have declared that no competing interests exist.

In R (McConnell and YY) v Registrar General for England and Wales [2020] EWCA Civ 559, the Court of Appeal held the Registrar General was correct to register a trans man, who had given birth after the issuing of his gender recognition certificate, as 'mother' on his son's birth certificate. In their judgement, the court rejected the appellants' contention that the Gender Recognition Act 2004 should be construed to allow registration as either 'father' or 'parent'. The court further held that the interference with the appellants' Article 8 rights which resulted from the registration as 'mother' was proportionate and justified., (© The Author(s) 2021. Published by Oxford University Press; All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Transgender individuals smoke tobacco at disproportionately higher rates than the general U.S. population, and concurrent use of gender-affirming hormones (estrogen or testosterone) and tobacco confers greater cardiovascular (CV) risk. This study examines the relationship between tobacco use and legal document gender-marker change, and medical/surgical interventions for gender transition., Methods: Data came from an Internet-based survey of U.S. trans-feminine (n = 631) and trans-masculine (n = 473) individuals. We used multivariable logistic regression to investigate the relationship between past 3-month tobacco use and legal document gender-marker change, hormone use, and gender-affirming surgery controlling for demographic covariates and enacted and felt stigma., Results: Compared to trans-feminine participants, trans-masculine individuals reported significantly higher rates of lifetime (74.4% vs. 63.5%) and past 3-month tobacco use (47.8% vs. 36.1%), and began smoking at an earlier age (14.5 vs. 15.5 years). Trans-feminine smokers reported significantly more frequent and heavier use. Adjusting for demographic covariates and enacted and felt stigma, legal document gender-marker change was associated with lower tobacco-use odds among trans-feminine individuals, whereas gender-affirming surgery predicted lower smoking odds among trans-masculine individuals. There were no significant differences in tobacco use by hormone use status., Conclusion: In this study, trans-masculine individuals were more likely to smoke and trans-feminine individuals reported heavier use. It is concerning that individuals receiving hormones did not report lower smoking rates, given the elevated CV risk of this combination. This is a missed opportunity to intervene on a major public health issue and highlights the need for smoking cessation interventions in this population.

Background: The birth of a child is a vital event that needs to be registered but this is not always the case as an estimated 40 million births go unregistered annually. Birth registration safeguards the basic rights of children and gives them an identity, citizenship/nationality and legal protection against violence, abuse and human rights violations. It is therefore necessary that all births are registered and even more critical that the registration of a birth is followed by the issuance of a birth certificate. But sadly, birth registration in many African countries continues to remain below acceptable international standards and not all registered births are certified. This paper examined birth registration and certification in Ghana. Differentials in the characteristics of children and mothers of children whose births are registered and certified, children whose births are registered but not certified and children whose births are not registered were examined., Methods: This paper analysed data from the 2014 Ghana Demographic and Health Survey drawing on variables from the household and children's data files. Descriptive analytical tools (frequencies, percentage and cross tabulations) and multinomial logistic regression analysis were used to examine differentials in birth registration status among an analytical sample of 3880 (weighted) children aged 0-4 years., Results: The birth of about every 1 in 4 (28.89%) children in Ghana have never been registered. Birth registration and certification was lowest among children born to young mothers (15-19 years), children whose mothers have no formal education, mothers who reside in rural areas and mothers in the poorest wealth quintile. Additionally, home births and births that were not assisted by a medical professional were observed to have the lowest proportion of registered and certified births. Furthermore, the birth of children who are less than a year old was significantly more likely not to be registered or issued with a birth certificate., Conclusion: Efforts aimed at improving birth registration and certification in Ghana need to target groups of children and mothers with low levels of registration and certification particularly children who are born at home, children born to young mothers and children whose mothers are poor and or reside in rural areas.

This article marks the 30 th anniversary of the Supreme Court of New Jersey's Baby M decision by offering a critical analysis of surrogacy policy in the United States. Despite fundamental changes in both science and society since the case was decided, state courts and legislatures remain bitterly divided on the legality of surrogacy. In arguing for a more uniform, permissive legal posture toward surrogacy, the article addresses five central debates in the surrogacy literature. First, should the legal system accommodate those seeking conception through surrogacy, or should it prohibit such arrangements? Second, if surrogacy is permitted, what steps can be taken to minimize the potential exploitation of women who are willing to rent their wombs for income? Third, what criteria should govern the eligibility to serve as a surrogate mother and an intended parent? Fourth, what principle(s) should serve as the basis for determining the parentage of children born through surrogacy? Fifth, is regulatory uniformity in the surrogacy realm desirable? Is it achievable? The article concludes that courts and legislatures should accept the validity of surrogacy contracts, determine parentage according to intent, and identify transparent criteria for the eligibility of both surrogates and intended parents.

Purpose: In 1971, the New York City (NYC) Department of Health and Mental Hygiene amended Section 207.05 of the NYC Health Code to allow individuals who had undergone "convertive surgery" (interpreted by the code to mean genital surgery) to amend the gender on their birth certificates. This surgery requirement was removed in 2015. In a survey evaluating the regulation change, we sought to characterize the transgender population newly eligible to obtain a gender-congruent NYC birth certificate by comparing respondents with and without genital surgery., Methods: We mailed a 42-question survey with each newly issued birth certificate. We compared respondents across current gender identity, race, Hispanic ethnicity, age, insurance status, income, current general health status, other transition-related care obtained, and healthcare access, stigma, and discrimination., Results: Of 642 applicants, 219 responded and were thus enrolled in our 5-year study (34.1%). Most (n = 158 out of 203 who answered, 77.8%) had not received genital surgery. Compared to respondents with genital surgery, respondents without surgery were significantly more likely to be transgender men (50.0% vs. 20.0%); younger (median age 32 vs. 56.5); on Medicaid (31.6% vs. 11.1%); identify as Hispanic (28.5% vs. 8.9%); and live in households making <$20,000 annually (35.3% vs. 12.8%)., Conclusions: Removing a genital surgery requirement more equitably enables transgender men and those with limited resources to obtain a gender-congruent birth certificate. Jurisdictions with such requirements should consider similar regulation changes to address the inequities that this requirement likely imposes in accessing birth certificates.

Birth registration and obtaining physical birth certificates impose major challenges in developing countries, with impact on child and community health, education, planning, and all levels of development. However despite initiatives, universal registration is elusive, leading to calls for new approaches to understanding the decisions of parents. In this paper, we report results of a survey of students in grades six to eight (age ~12-16) in an under-registered area of Kenya regarding their own understanding of registration issues and their suggestions for improvement. These students were selected because they themselves were also nearing the age for high school enrollment/entrance examinations, which specifically requires possession of a birth certificate. This assessment was also a companion to our previous representative survey of adults in the same Kenyan region, allowing for parent-child comparison. Results supported previous research, showing that only 43% had birth certificates. At the same time, despite these low totals, students were themselves quite aware of registration factors and purposes. The students also made quite prescient sources for understanding their households' motivations, with many of their suggestions-for focus on communication of pragmatic benefits, or automatic measures shifting responsibility from parents-mirroring our own previous suggestions, and showing a level of pragmatism not witnessed when surveying their parents. This paper therefore adds evidence to the discussion of registration policy planning. More generally, it also builds on an important trend regarding the treatment of children as stakeholders and important sources of information, and raising an intriguing new avenue for future research.

Introduction: Early birth registration, childhood care, and education are essential rights for children and are important for their development and education. This study investigates changes and socioeconomic inequalities in early birth registration and indicators of care and education in children aged under 5 years in Vietnam., Design: The analyses reported here used data from the Vietnam Multiple Indicator Cluster Surveys (MICS) in 2006 and 2011. The sample sizes in 2006 and 2011 were 2,680 and 3,678 for children under 5 years of age. Four indicators of childcare and preschool education were measured: birth registration, possession of books, preschool education attendance, and parental support for early childhood education. The concentration index (CI) was used to measure inequalities in gender, maternal education, geographical area, place of residence, ethnicity, and household wealth., Results: There were some improvements in birth registration (86.4% in 2006; 93.8% in 2011), preschool education attendance (57.1% in 2006; 71.9% in 2011), and parental support for early childhood education (68.9 and 76.8%, respectively). However, the possession of books was lower (24.7% in 2006; 19.6% in 2011) and became more unequal over time (i.e. CI=0.370 in 2006; CI=0.443 in 2011 in wealth inequality). Inequalities in the care and education of children were still persistent. The largest inequalities were for household wealth and rural versus urban areas., Conclusion: Although there have been some improvements in this area, inequalities still exist. Policy efforts in Vietnam should be directed towards closing the gap between different socioeconomic groups for the care and education of children under 5 years old.

An Irish surrogacy case from 2013 illustrates how negotiations of the mother's identity in a given national and legal context are drawing on novel scientific perspectives, at a time when the use of new biotechnological possibilities (such as IVF) is becoming more widespread and commonplace. The Roman dictum, 'Mater Semper Certa Est' (the mother is always certain, i.e. proven by giving birth) is contested by the finding of this Irish court, in which the judge made a declaration of parentage stating that the genetic parents of twins born using a surrogate (the mother's sister) were the parents. This article critically examines the normative background assumptions involved in this ruling. It will argue that the particular deployment of arguments from genetics and epigenetics in this court case produces a naturalization of the mother's identity that is inherently reductive. A second surrogacy case is also examined, this time regarding the rights of a woman of Irish nationality to receive paid maternity leave or paid leave similar to adoptive leave after the birth of her daughter to a surrogate mother in the US state of California. This case, which was brought to the Equality Tribunal in Ireland and decided by the Court of Justice of the European Union, is used to illustrate the possible ramifications of conflicting definitions of motherhood in the legal system. In concluding, this article argues for the development and deployment of a more complex understanding of the evolving state of motherhood within the courts, in keeping with developments in the IVF industry and the various new mother-relations it makes possible.

Objective: This study compared maternal smoking during pregnancy between the new Patient Protection and Affordable Care Act (ACA) data collection standards and Federal Office of Management and Budget (OMB) standards., Method: Data were from the Massachusetts Standard Certificate of Live Births on 1,156,472 babies from 1996 to 2010. A parent reported whether the mother smoked during pregnancy (yes/no), her race (5 options) and, separately, her ethnicity (39 categories). Prenatal smoking rates were compared between the ACA and OMB standards. Detailed ethnicity from the birth certificate was then examined within all broad categories of the ACA standards: White, Black/African American, Other Hispanic, Other Asian/Pacific Islander, and Other categories., Results: For Hispanic/Latina and Asian mothers, the ACA standards captured the variability in smoking across and within racial/ethnic groups more than the OMB standards. However, for White and Black/African American mothers, the broad ACA categories masked striking differences in prenatal smoking. While the overall prevalence among Whites was 10.2%, this ranged from 0.8% for Iranians to 21.0% for Cape Verdeans. Among Black/African Americans (7.6%), this ranged from 0.5% for Nigerians to 12.9% for African Americans. The ACA standards also combined ethnic groups with sizeable populations into Other Hispanics and Other Asian/Pacific Islanders., Conclusion: When population health surveys and other reporting tools are being revised, state and federal agencies should consider expanding all race/ethnicity categories to capture detailed ethnicity on everyone., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: The partogram is a central record in everyday practice for midwifes and obstetricians. For legal enquiries it is one of the most important documents, however, so far there is no standardised partogram in use in Germany. This study explores the current requirements and develops a standardised partogram., Material and Methods: In Germany 95 hospitals with a focus on tertiary referral centres were randomly selected to be questioned. Obstetricians and midwifes were asked to answer a questionnaire, which was based on a current literature search and expert interviews., Results: 49 obstetricians (51.6%) and 24 midwives (25.3%) returned the questionnaires. 80% of those regularly cooperate with the other specialty with a partogram. 75% are using a standardised partogram, 8% an empty page and 6% computerised obstetric records. Most responders are using parameters which are defined in the current guidelines of the German Society of Obstetrics and Gynaecology. Variations were especially pronounced in the scoring system of the cardiotocogram and on legal issues. Room for improvement of the current documentation was documented in half of the cases., Discussion: There is a need for optimising the current birth documentation. With the results of the questionnaire a standardised model for a partogram was developed., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: We provide background information/education for national recommendations to include initial newborn screening dried bloodspot serial numbers in electronic birth registrations. Mutual data linking would provide quality checks for each data source, determinations of percentages of newborns screened, and identification of locations where screening is lacking., Methods: State newborn screening dried bloodspot programs were surveyed to determine the extent of newborn screening dried bloodspot and electronic birth registration linking and the states' level of interest in such linkages. These data were reviewed with federal and state policy makers and presented to the Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children for national policy recommendations., Results: Only 40% of state newborn screening dried bloodspot programs reported comparing births with screens. All states use serially numbered newborn screening dried bloodspot collection cards, and electronic birth registrations exist in almost all states. Newborn screening dried bloodspot serial number data fields currently exist in only 24% of state electronic birth registrations., Conclusion: The Secretary of Health and Human Services' Advisory Committee on Heritable Disorders in Newborns and Children recommends the universal use of the newborn screening dried bloodspot serial number in a standardized format as part of state birth registration; consideration of including the initial newborn screening dried bloodspot serial number as a required data field; and, once established, using these data linkages to monitor completeness of newborn screening and to validate demographic information in both systems.

Background: Birthweight and gestational age are key indicators for perinatal health obtained through the birth certificate. Knowing the validity of birth certificate data is crucial when identifying needs and evaluating birth outcomes. In Spain, vital information is reported by parents and is not checked for consistency with any hospital document. Therefore, to perform a validation study and describe the variables associated with misreporting is essential to improve the quality of birth certificates., Methods: A database was created using birth information from hospital medical records that were individually linked with the Spanish National Institute of Statistics (INE) birth certificate files. Measures of reliability and validity were used to compare the data from the two sources. Logistic regression models were adjusted to model the odds of being misreported in birthweight and gestational age, controlling for relevant variables., Results: INE overestimated the prevalence of birthweight and gestational age. The degree of agreement between the two sources was good for most gestational age groups (Kappa = 0.74), very good for the very preterm (Kappa = 0.85) and very good also for all categories of birthweight (Kappa = 0.88). Misreporting was significantly higher among immigrants, unmarried mothers and girls. Being a preterm birth increased the odds of being declared with errors in gestational age; having low birthweight and missing information on gestational age were associated with misreporting birthweight., Conclusions: The reliability of INE information could be greatly improved if hospitals included birthweight and gestational age on the document provided to parents for registering the birth., (© 2012 Blackwell Publishing Ltd.)

Whereas hormonal and surgical sex change have been increasingly refined and accepted medically during the past 40 years, legal protections have only recently received attention. This overview focuses on employment, medical treatment, and civil status as male or female in the United States and the United Kingdom. Employment protection in the UK is assured since a court decision in 1994, but in the U.S. is generally uncertain and inconsistent between states. Health care, including surgery, under the UK National Health Service, is assured since a court decision in 1996. In the U.S., the absence of a national insurance program and the reluctance of private insurers to fund treatment remains an obstacle. Military personnel and prisoners are provided treatment in the UK but there is no military-provided treatment in the U.S. and prison treatment is limited. Change in birth certificate sex status is available in the UK since 2004. This permits heterosexual marriage as a person of the reassigned sex. In the U.S., whereas nearly all states permit birth certificate modification, obstacles remain to recognition across state jurisdictions. Some states forbid marriage for a transsexual as a person of their reassigned sex. This can impact on transsexuals as parents.

All longitudinal birth cohorts should be undertaken with a detailed ethical strategy and policy on governance. Here we outline the various factors that should be taken into consideration and describe ways in which these issues may be addressed.

The Millennium Cohort Study of 18,818 UK babies born in 2000-02 interviewed parents when the baby was 9 months old. Time constraints on the interview limited the amount of health-related questions that could be included. The aim of this study was to augment interview data with information from birth registrations and hospital records. It also provided an opportunity to assess the accuracy of the data acquired and parents' recall of the information on pregnancy and delivery. Deterministic and probabilistic matching were used to obtain information from birth registration and hospital records. Investigation into the accuracy of the matches obtained was undertaken. The records received were checked for range, consistency and completion. Birth registration data were obtained for 99% of those who gave consent. The number of additional variables gained ranged from six in Northern Ireland to 16 in Scotland. Hospital record data were obtained for 83% of those who gave consent. The additional general and maternity-related variables gained ranged from 55 in Scotland to 76 in England. Completion of available health record variables ranged from 28% to 100% across all UK countries. Linkage to birth registration and hospital records in order to augment Millennium Cohort Study data with routinely collected data was successful. The variables gained by linkage have added considerable value to the cohort study and validated some of the mother's responses.

No standards exist for reporting the accuracy and completeness of pregnancy histories created by linking the birth and fetal death certificates for all the deliveries occurring to one woman. To link certificates, analysts use deterministic and/or probabilistic approaches. Errors in linkage occur randomly and non-randomly. Any type of error can cause incorrect estimation of the magnitude of relationships. Methods for assessing linkage correctness are proposed. Analysts can detect errors in linkage by comparing the linkage results with the pregnancy history reported by the mother. The analyst interviews a random sample of women, ascertaining the dates and outcomes (stillbirth or live birth) for their births and, if the linkage used certificates from one state, the state where they occurred. For each woman, he/she then assesses the accuracy and completeness of this linkage by comparing it with her reported pregnancy history. An alternative approach is to chronologically sequence each woman's births. The parity for the most recent birth shows the number of babies born to the same woman and should equal the number of births that the analyst linked. In the absence of maternally reported pregnancy histories, an analyst can use data on the certificates to assess linkage correctness. Although this will show whether the correct number of births have been linked, it provides no information concerning the accuracy of linkages. It may be, however, the most universally applicable way of reporting the completeness of the linkage of deliveries.

Numerous researchers have expressed concern over the impacts on medical records availability of the newly effective Medical Information Privacy rule, as authorized by the Health Insurance Portability and Accountability Act (HIPAA). The increased costs associated with compliance with the rule, and the increased potential for financial liability, raises the possibility that hospitals may be less likely to participate in such research, resulting in a decrease of the validity of multisite studies designed to represent an entire population. Our multisite medical record validation study, designed to assess the accuracy of maternally linked birth records, provides an overview of a number of HIPAA implementation challenges. We found that the new HIPAA rule presents new challenges for those who rely on the release of medical record information for epidemiologic research. At the very minimum, increased compliance costs associated with human subjects protection and increased administrative burden for researchers would seem to be inevitable as medical institutions address the requirements of the new HIPAA rule by instituting more complex and thus more cumbersome procedures. Researchers should anticipate increased costs and plan accordingly when budgeting for human subjects review processes.

This article challenges the distinction the law draws between male and female. It focuses on the legal and medical treatment of intersexual people. Analysing the nature and rate of intersexuality it argues that there is a significant number of people who cannot be described as either male or female and instead exhibit a range of sexual characteristics. Until recently the law and medicine have insisted that intersexual people should be categorized as either male or female. Surgery was performed to ensure that they had the appearance assumed to be the 'norm' for a man or woman and the law followed this medical assignment of sex. Over the last couple of years the established medical practice and the legal treatment have been challenged. This article discusses the nature of these challenges and argues that there is a strong case for rejecting the traditional legal and medical approach to intersexual people. Cosmetic surgery on intersexual babies should be delayed until the individual is old enough to be able to choose their own sexual identity, which may be neither male nor female. The insistence that every person must either be male or female is no longer supportable in medical or social terms and a much wider range of sexual identities must be recognized by the law.

Objective: In November 1998, Oregon voters passed Ballot Measure 58, which allowed Oregon adoptees > or = 21 years of age access to their original birth records, which are sealed at adoption. The objective of this study was to evaluate the impact of the measure on the Oregon Health Division (since renamed Oregon Health Services) by assessing procedures used and resources needed after implementation of Measure 58., Methods: Vital records employees were interviewed about processing, storage, and archive retrieval procedures for pre-adoption birth records before, during, and after the implementation of Measure 58 and the effect on their usual workload. Personnel time, space, and fiscal resources used to process requests for pre-adoption records were also calculated., Results: The Oregon Health Division began to receive requests from adoptees immediately following the passage of Measure 58 in November 1998, but due to legal challenges, they could not be processed until May 31, 2000. From June 2, 2000, through October 20, 2000, 12 staff members and two supervisors issued more than 4,700 pre-adoption birth records while also processing their normal workload, which averages more than 135,400 vital record orders annually. Due to the need for retrieval from archives, requests for pre-adoption birth records were estimated to take 75 hours to process vs. 2-3 minutes for standard requests. Each batch of approximately 75 pre-adoption birth records required approximately 12.5 person-hours from vital records staff and 3-4 person-hours from archive personnel; in addition, supervisors spent time responding to incomplete orders, informing the public and the media, and responding to concerns of adoptees, birth parents, and adoptive parents. Fewer than 1% of requests went unfilled., Conclusions: Implementation of Measure 58 utilized substantial resources of the Oregon Health Division. States contemplating similar legislation should consider increasing personnel and resources, preparing for intense public and media interest, and reorganizing the storage of adoptees' original birth records so they are easily retrieved.

Objective: In June 2000, Oregon implemented a citizen-initiated ballot measure that grants adult adoptees access to their birth records, which contain their birth parents' identifying information. Because other states are considering similar policy changes, the authors explored whether Oregon's new law is meeting the information needs of adoptees., Methods: Birth records were abstracted for a 9% (221/2,529) random sample of adoptees who obtained their records from June 20, 2000, to July 20, 2000, to describe the population and the information they obtained. Telephone interviews documented their motivations, expectations, and whether they considered the birth record useful., Results: The mean age of the adoptees was 41 years, 64% were female, and 97% were white. Virtually all received information about their birth mother; however, only one-third received information about their birth father. Of the 221 sampled, 123 (59%) participated in the telephone survey, 12 were ineligible, 84 could not be reached, and 2 refused. The most common motivations for requesting records were to find birth parents (29%) and to obtain medical information (29%). Twenty-nine percent received less information than they expected, with many expecting, but not receiving, birth father information. Thirty-three (47%) of the 70 adoptees who tried to find their birth mother were successful. The records were considered "very" useful by 52% of respondents, "somewhat" or "a little" useful by 42%, and "not at all" useful by 6%., Conclusions: The results indicate that many adoptees received less information than they expected, and many did not meet their goals of finding birth parents or obtaining medical information. Nonetheless, the majority considered their birth records useful and important.

The authors studied the incidence and the determinants of cesarean section in ASL Naples 4. In addition while they analysed the reliability and completeness of birth certificates in order to verify their accuracy for statistical and epidemiological purposes. The results show an increase of cesarean section higher than national mean (from 1997 to 2000: 44.5-54.9%), rarely justified by real risk conditions. 41.1% of vertex deliveries required cesarean section. The most frequent indications were repeated cesarean section (40.6%) and fetal problems (39.3%) in the multiparous; fetal dystocia (27.8%) and fetal distress (17.1%) in the primiparous. The quality of the compilation of the certificates was unsatisfactory for completeness and reliability. Indeed, 14.9% of 1997 birth certificates and more than 70% in the following years did not reach the epidemiological services of ASL; moreover, the comparison with clinical records proved that 46.9% of presentations resulted abnormal on clinical records were vertex on the birth certificates.

This proposed rule would implement part of the paternity establishment provisions contained in section 331 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) and amended by section 5539 of Pub. L. 105-33, which impose new statutory requirements for a State's voluntary paternity acknowledgement process and require the Secretary to promulgate regulations governing voluntary paternity establishment services and identifying the types of entities other than hospitals and birth record agencies that may be allowed to offer voluntary paternity establishment services. States will be required to adopt laws and procedures that are in accordance with the statutory and regulatory provisions. These proposed regulations will address these procedures and related provisions.

Live births which occurred in the period from April to September of 1994 were analysed, using the two copies of the Birth Declaration-BD-(the white copy coming from the hospital where the child was born and the yellow copy sent by the Legal Registry Office where the birth was registered) received by the Londrina Municipal Health Service. After the "cross matching" of both copies (for each child), household interviews were performed in cases without matched pairs (only a white or only a yellow copy indicating possible unregistered or home deliveries). Results showed that the proportion of births not legally registered was of from 5.3 to 6.6% of the hospital births. Cost, negligence and legitimacy were the main reasons given for not registering births legally. The average time taken to make the registration was 26.5 days (standard deviation of 52 days) and 88.7% of the families did it by the 60th day from the date of the birth. A statistical association was detected between the act of registration and the period within which registration is required (within 60 days from birth) and type of delivery, maternal age and education. The official proportion of home deliveries was 0.5%; however, after the research the value was found to be somewhere between 0.13 and 0.3% of all the registered births--only 36.8% were really born at home. Reasons for home deliveries were: option, "there wasn't a means of transport to take the pregnant woman to hospital" and "there wasn't enough time to get to a hospital".

The requisites for filling up birth certificates in France (> or = 180 days of pregnancy and vitality at the registration of birth) are different from the criteria recommended by the World Health Organisation (WHO) (at least 500 g) for national statistics. The number of stillborn babies and neonatal deaths known from two different sources in the Nord-Pas de Calais Region in 1988-1989 have been compared ie: the vital statistics published by INSEE and the data of a survey carried out in hospitals according to the WHO criteria. Among the 808 known perinatal deaths in the survey, 305 (37.7%) were ignored or were not classified in the same categories by the registration services for vital statistics. 230 children including 29 born alive had not been registered and 75 children born alive had been registered as still born. The disparity in these definitions between INSEE and the WHO has serious consequences: the perinatal mortality measured by INSEE is underestimated by 28%, in comparison with mortality registered according to the WHO criteria. The 180 day threshold of viability reduces the social rights of employed women and makes it more difficult for them to have the money they spent on medical care refunded. Finally, as it is impossible to find a trace of these children who were not legally registered since they were under the threshold of viability, the mourning response of parents to perinatal deaths is all the more difficult. Current evolution in the threshold of viability observed in maternity units, makes it necessary to change the criteria which are applied for the legal registration of births.