Too precarious to walk: an integrated “three delays” framework for modeling barriers to maternal health care and birth registration among stateless persons and irregular migrants in Malaysia

Abstract

This study extends Thaddeus and Maine’s (1994) “three delays” framework to model the interrelated barriers to maternal health care and birth registration. We focus on stateless persons and irregular migrants, populations that are especially at risk of being “left behind” in United Nations member states’ efforts to “provide legal identity to all” as part of the 2030 Sustainable Development Agenda. Drawing on qualitative fieldwork conducted in Sabah, Malaysia, we model delays in accessing maternal health care and birth registration as an integrated, cyclical process. We identify the political and legal barriers that stateless or migrant families confront while deciding to make institutional contact (Phase I), identifying and reaching health or registering institutions (Phase II), and receiving adequate and appropriate treatment (Phase III). We find that exclusion from one system raises the risk of exclusion from the other, resulting in a range of negative consequences, including increased health risks, governments’ impaired ability to monitor population health, and the perpetuation of intergenerational cycles of legal exclusion.

Population perspectives and demographic methods to strengthen CRVS systems: introduction

“…This Genus thematic series highlights the gender dimensions of CRVS systems—through the study of sex-specific differentials in completeness of registration of vital events (Haider et al, 2021 ), and through the analysis of gender aspects that shape the laws, social norms, and bureaucratic processes related to civil registration systems (Cheong & Balthazar, 2021 ; Fall et al, 2021 ).…”

“…In the second paper of the thematic series, Cheong and Baltazar ( 2021 ) investigate the impediments to birth registration and maternal health access in Sabah among irregular migrants and stateless persons. The authors highlight the importance of unpacking the political economy of civil registration when seeking to understand barriers and factors impeding universal birth registration.…”

“…Cheong and Baltazar ( 2021 ) demonstrate the value of qualitative methods, such as the document inventory method, in assessing social and behavioral impediments to legal identity for foreign labor migrants in a subregion of Malaysia, a country that has reported universal birth registration for some time. The authors unpack the complex relationships between underregistration of births and impediments to maternal and child health using the “three delays model” (Thaddeus & Maine, 1994 ).…”

Residence registration to cope with homelessness: evidence from a qualitative research study in Milan

“…Evidence suggests the need to further explore the critical role of residence registration in improving the lives of homeless people in Italy and other countries. Indeed, increased barriers to legal identity access are not just an Italian phenomenon (Cheong and Balatazar 2021 ). Future research should consider the multidimensional factors involved in the residence registration process for homeless people at the country level.…”

“…Foreign nationals also lack social and economic support from a family network in Italy. Immigration policies and residence registration should consider and address difficulties experienced by foreign nationals in obtaining and maintaining their legal identities due to the denial, invalidation, and dispossession of official documentation (Cheong & Baltazar, 2021 ). Further research is needed to consider the particular requirements of foreign nationals and ease the specific difficulties they face in obtaining a residence permit.…”