No official identity: a data linkage study of birth registration of Aboriginal children in Western Australia

Abstract

Objective: Evidence of identity, particularly a birth certificate, is essential to access many rights. However, the births of many Aboriginal Australians are not registered when they are infants. We examined factors related to birth registration among Western Australian children born to Aboriginal mothers. Methods:All births to Aboriginal mothers in the Midwives Notification System in Western Australia (WA) from 1980 to 2010 were linked to birth registrations. Associations between registration and maternal and child characteristics were examined for children aged under 16 years in 2012.Results: Among 49,694 births between 1980 and 2010, 18% of those aged under 16 years had unregistered births, compared to 3% of those aged 16-32 years. Unregistered births were most strongly associated with young maternal age at first birth (adjusted odds ratio [AOR] 5.22; 95%CI 3.07-8.86; for 16 years or younger vs 30 years or older, among non-smokers), remoteness (AOR 2.17; 95%CI 1.87-2.52; very remote vs major cities), mothers whose own birth was unregistered (AOR 3.00; 95%CI 1.78-5.07) and no private hospital insurance (AOR 0.19; insured vs uninsured).Conclusions: Unregistered births are common among WA Aboriginal children, particularly in disadvantaged families. Implications:Assistance before discharge from hospital may increase birth registrations.

Probabilistic linkage of national immunisation and state-based health records for a cohort of 1.9 million births to evaluate Australia’s childhood immunisation program

“…This led to certain differences between the perinatal data and our study cohort (Table 1). Similar differences have been reported in other studies linking the state birth registrations and perinatal data collections in WA (for Indigenous births only), NSW and Queensland [22,23,24] and should be kept in mind when generalising the data to all births. However, the study is representative of all registered births and includes a large cohort involving 97.5% of all live births (89.8% of all Indigenous births) in the NSW and WA perinatal data collection.…”

The real divide: the use of algorithm‐derived Indigenous status to measure disparities in sudden unexpected deaths in infancy in Queensland

“…Due to their young age at death, most infants have had limited contact with health and other administrative systems and lack the opportunity to have their Indigenous status captured in multiple presentations across a range of datasets. Consequently, studies of infant health outcomes rely heavily on birth registration and perinatal data collections 29,31,34 . A low rate of linkage of birth and death registration in the SUDI data was observed (77.6%; with only 3.1% explained by infants born outside Queensland), although the reasons for this are unclear.…”

“…It may relate to operational processes since this data (obtained from the Child Death Register) was linked by the Registry of Births Deaths and Marriages, which does not have a dedicated data linkage and statistical analysis team. Compounding this issue, Indigenous births are registered at a significantly lower rate than non‐Indigenous births 24,31,34 . A recent Queensland investigation found that 15–18% of births to Aboriginal mothers were not registered compared with an under‐registration rate of 1.8% for births to non‐Aboriginal mothers 35 .…”

The identification of Aboriginal and Torres Strait Islander people in official statistics and other data: Critical issues of international significance

“…Similar to the death registrations, the SIQ is used on the birth registration documents, however, there are known barriers to ensuring that births are registered, particularly for those who live remotely, including costs or perceived costs, a lack of online infrastructure and limitations in culturally appropriate services [60]. Reports from Queensland and Western Australia utilising data linkage to assess completeness of birth registrations describe that 17 percent and 18 percent, respectively, of Indigenous babies were not registered at birth [61,62]. While there has been some work undertaken to describe the extent of the under-registration of births in Australia, there is yet to be a comprehensive assessment of the impact that under-registrations and under-enumeration of Indigenous births can have on indicators, specifically infant and child mortality rates.…”