Introduction
Civil registration and vital statistics (CRVS) systems comprise two interdependent components: civil registration (CR) and vital statistics (VS). Civil registration records the occurrence and characteristics of vital events in a population, including births, deaths, fetal deaths, and cause of death information.Footnote 1 Vital statistics compile and process the data derived from civil registration to analyze mortality trends, and track demographic patterns, such as birth and death rates.Footnote 2
When operating effectively, CRVS systems perform two critical functions.Footnote 3 First, birth registration is the principal means of establishing a person’s legal identity. Legal identity is a foundational right recognized under Article 7 of the Convention on the Rights of the Child (CRC)Footnote 4 and Article 24(2) of the International Covenant on Civil and Political Rights.Footnote 5 ,Footnote 6 It is essential for exercising a range of other human rights, including socioeconomic rights such as access to healthcare and education.Footnote 7 The lack of birth registration can seriously impact individuals’ life outcomes.Footnote 8
Second, effective CRVS systems act as a source of continuous, up to date population data, supporting evidence-based policymaking, efficient resource allocation, and monitoring of national policy progress.Footnote 9 When countries fail to register these vital events consistently, policymakers lack basic population data needed to design, implement, and evaluate health interventions due to statistical invisibility.Footnote 10 An example of such a failure was demonstrated by COVID-19, where inaccuracies in collecting mortality data led to an estimated 14.9 million deaths being uncounted, and eighty-four countries lacking capacity to contribute to the estimation of mortality data.Footnote 11
For all these reasons, strengthening CRVS systems is key to making progress toward the realization of the Sustainable Development Goals (SDGs). Achieving universal birth registration is part of Target 16.9, which aims to provide legal identity for all, “including birth registration.”Footnote 12 This target is measured through the achievement of universal (100 percent) birth registration for children under five. Achieving universal birth registration and at least 80 percent death registration is also used as an indicator under Target 17.19, which calls for the development of data collection and statistical capacity for measuring progress toward sustainable development.Footnote 13 Despite not being explicitly recognized as a target, seven of seventeen SDG targets and their seventeen corresponding indicators require cause-specific mortality data, which only a well-functioning CRVS system can provide.Footnote 14 Sixteen targets and twenty-four indicators require data that is best generated from a CRVS system.Footnote 15
The latest available estimates indicate that some progress on birth registration rates has been achieved: globally in 2024, 77 percent of children under the age of five were registered,Footnote 16 marking an increase from 71 percent in 2016.Footnote 17 Yet progress has been slow and is not on track to meet the goal of 100 percent registration by 2030,Footnote 18 with approximately 150 million children remaining unregistered. The geographical disparities are especially stark: while Europe and North America achieve virtually 100 percent birth registration, sub-Saharan Africa is reported at 51 percent. Death registration rates are more concerning with approximately only 60 percent of deaths being registered worldwide.Footnote 19 In low-income countries, as many as 80 percent of deaths occur outside health facilities, and often go unregistered.Footnote 20 In these countries, it is estimated that only 8 percent of reported deaths have a documented cause of death.Footnote 21
As the deadline for the realization of the 2030 Agenda for Sustainable Development (UNSDGs) approaches in four years, it is critical to reflect on the role of law in strengthening CRVS systems that ultimately accelerate progress toward the SDGs. Law is a determinant of global health and a powerful tool, often underutilized, to combine achievement of public health goals with effective, evidence-based laws.Footnote 22 Research proves that there is a strong relationship between public health law and health-related SDGs, especially for indicators on maternal mortality rate, neonatal deaths, and adolescent birth rate.Footnote 23
Against this backdrop, this essay illustrates the role of legal reform in strengthening CRVS systems and presents the newly adopted CRVS legislation in Cambodia and Cameroon as case studies. We argue that these legal reforms for digitalized CRVS systems that respond to a country’s specific circumstances, are an integral step toward realizing the SDGs. We further argue that beyond 2030, CRVS ought to become a central element of the global health law agenda to build an equitable global health law regime.
Legal Frameworks for CRVS Systems
CRVS systems received international attention to assist with good governance and health policy, in conjunction with the UNSDGs for 2030 at the time of their adoption in 2015. This led to initiatives launched by the World Bank, UNSD, the World Health Organization (WHO), the United Nations Economic Commissions for the African and Asia-Pacific regions and other international partnershipsFootnote 24 that called for scaling up investment in CRVS with an implementation timeline of 2015 to 2030. However, despite its relevance to health systems, CRVS systems have not been adequately prioritized in the field of global health law.
Although the WHO programmatically supports CRVS strengthening through guidelines and strategic plans,Footnote 25 this work is often institutionally siloed and not integrated into the main legal frameworks for global health. A clear illustration is provided by the recently adopted Amendments to the International Health Regulations (IHR). The amendments require states to develop, strengthen and maintain the “core capacities” to carry out “surveillance” for the international spread of disease.Footnote 26 CRVS systems are a fundamental tool that track cause-specific mortality data, but the IHR are silent on their inclusion in obligations to strengthen core capacities for surveillance.Footnote 27
The role of a CRVS legal framework is to establish mandates and procedures to ensure the standardization, consistency, and universality of civil registration, as well as the generation of timely population data. Conversely, outdated, or weak CRVS rules can result in systems that are bureaucratically fragmented, inefficient, and expensive, ultimately depressing registration rates and leading to inaccuracies in collected data. Many low- and middle-income countries have laws mandating birth and death registration. However, laws in many of these countries are outdated, with some dating back a century to periods of colonial rule. Updating and strengthening legal frameworks for CRVS systems means reforming the applicable laws and regulations to create effective governance structures, eliminate barriers to access civil registration services, facilitate digitalization of systems, define roles across multiple agencies and ministries, provide for data sharing, and protect privacy.Footnote 28
In an era of growing fragmentation in multilateralism and international law-making, a pathway to use law as tool to strengthen the fundamental bedrock of global health governance lies in domestic legal reform. Over the past two decades, many countries have initiated CRVS improvement efforts. Countries like India, Pakistan, and the Philippines have used law and policy change as tools to implement improvements in their civil registration rates.Footnote 29 Most recently, Cameroon and Cambodia have adopted new CRVS legislations that have strengthened their ability to meet SDG Targets.
Cambodia
Prior to 2023, Cambodia lacked any national CRVS and identity management (ID) legislation.Footnote 30 The Khmer Rouge regime in Cambodia destroyed civil registration records, leaving generations without access to legal identification.Footnote 31 In July 2023, after years of consultation and drafting, the Cambodian government adopted a new CRVS law. The Law on Civil Registration, Vital Statistics and Identification came into force in 2024 guaranteeing legal identity for all residents of Cambodia and mandating registration of births, deaths, and other vital events regardless of the person’s citizenship, nationality, ethnicity, or geographic location.Footnote 32 This law integrated birth and death registrations to a newly created population register, and a new digital identity system. To make registration easily accessible, the civil registration system is decentralized, with district and provincial level civil registrars, to improve local access to civil registration services. It also addressed barriers and disincentives to registrations by making registration free of charge, extending the time-period to register a birth to ninety days, and simplifying the processes for late and delayed registrations.
The law enabled the issuance of a Unique Identification Code (UIC), issued at birth to all citizens that facilitates participation in the economy and access to public services.Footnote 33 As the UN Economic and Social Commission for Asia and Pacific described it, Cambodia’s new CRVS system “highlights the interoperability of CRVS systems as the foundation of digital public infrastructure,” seamlessly integrating health, social protection and education with secure digital identity verification.Footnote 34
Since Cambodia began its work on drafting a new law, death registrations rates have more than doubled to 70 percent in 2023 and birth registration rates have improved by 30 percentage points.Footnote 35 With its commitment to strengthening the legal frameworks that facilitate access to CRVS systems, Cambodia is well-positioned to meet its Sustainable Development Goal target 16.9, which aims at 100 percent of births and 80 percent of deaths being registered globally by 2030.Footnote 36
Cameroon
In Cameroon, CRVS legal reform took place in several steps. Its post-colonial law was first modified by Law No. 2011/011 of 2011.Footnote 37 This law improved Cameroon’s civil registration system by instituting the National Civil Status Registration Office, and made birth, death, and marriage registration compulsory and universal for all residents of Cameroon, regardless of citizenship status.
In 2016, civil conflict broke out in Cameroon, which resulted in high numbers of internally displaced persons, amounting to 900,000 since the conflict began.Footnote 38 Under the 2011 law, reproducing lost birth certificates required traveling to a high court with jurisdiction over the location where the birth certificate was lost. This negatively impacted many internally displaced persons, who lost access to their civil identification documents.
To overcome these and other challenges, in December 2024, Cameroon adopted a new piece of CRVS legislation. Law No. 2024/016 directly introduced digital civil registration certificates called electronic civil status certificates.Footnote 39 These electronic certificates have, by law, the same legal force and evidentiary validity as paper certificates. Among the other innovations of the law, the registration time-period for births and deaths increased from sixty days to ninety days, thus addressing a barrier to registration. Simultaneously, the law created a national civil status database that automatically generates all vital statistics. Similarly to Cambodia’s CRVS legislation, Cameroon’s new law mandates the generation of a Unique Personal Identification Number (UPIN) that is assigned to each person when their birth is recorded in the national civil status database. This unique identifier is expected to ease communication between individuals and government agencies, reducing double identifications and decreasing administrative bottlenecks in service delivery.
In early 2024, Cameroon’s birth registration rate was 54 percent, which has improved to 62 percent in June 2025, within six months of adopting a new CRVS law.Footnote 40 The Cameroonian government has stated that the new law positions the country to meet its SDG target 16.9 of 100 percent birth registration rate.Footnote 41
Placing Civil Registration and Vital Statistics at the Core of the Global Health Law Agenda
While legal reform alone is not sufficient to strengthen CRVS systems and needs to be complemented by budget, communication, capacity building, and infrastructure investments,Footnote 42 Cameroon and Cambodia’s new CRVS laws demonstrate that legal reform can play a critical role in improving birth and death registration rates. Laws can remove barriers to registration (like registration fees or short time-periods for registration), support the digitalization of registration services, and improve inter-agency coordination. At a national level, legal reform of outdated CRVS laws or adoption of new laws, offer a clear pathway to progress toward the SDGs in the next four years.
At an international level, despite the lack of prioritization of CRVS systems in global health law instruments, and the fragmented nature of global health law as a field,Footnote 43 the experience of other sub-fields of global health law demonstrates that strategic actions by civil society organizations can help bridge the disconnect between the sub-fields of global health law and within international law more broadly.Footnote 44 The global health legal community ought to recognize the central role of CRVS systems reforms in the global health agenda, both in the round-up to 2030, and in shaping the post-2030 agenda. CRVS systems determine who becomes visible to legal institutions and whose health needs are recognized. Without complete and equitable registration of births and deaths, core legal commitments in international human rights law, including the rights to legal identity, non-discrimination, and the highest attainable standard of health, cannot be operationalized. Gaps in CRVS coverage systematically mirror and reinforce inequities: children born in marginalized, rural, conflict affected, or economically excluded communities are less likely to be registered, which in turn makes them less likely to be counted in health surveillance, less likely to benefit from resource allocation, and less likely to have their deaths investigated or prevented. As the maxim goes, “For everyone to count, everyone must be counted.”
Conclusion
The realization of UNSDGs 2030 is fundamentally intertwined with strengthening CRVS systems. To achieve the Sustainable Development Agenda in the next four years, countries need to reform outdated CRVS laws, addressing barriers to birth and death registrations. While achieving 100 percent birth registration may not be possible by 2030, global health law must reimagine its role in creating a post-2030 global health agenda that places the bedrock of health systems—CRVS systems—at its core.
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