Structural, economic, and socio-cultural barriers to birth and death registration in Iran: a qualitative study

Civil Registration and Vital Statistics (CRVS) systems are fundamental to health governance, social protection, and evidence-based policymaking. Although Iran has made significant progress in expanding civil registration coverage, the incomplete and delayed registration of births and deaths remains a critical challenge. These gaps compromise the quality of national health data, distort resource allocation, and perpetuate inequalities. This study investigates the structural, economic, and socio-cultural barriers to the timely registration of births and deaths in Iran, with a specific focus on Sistan and Baluchestan Province. A qualitative study based on seven focus group discussions was conducted between January and February 2025. Thirty-four participants were purposively selected. Data were analyzed using conventional content analysis as outlined by Graneheim and Lundman. Three primary themes emerged from the analysis: (1) Legal and organizational barriers, including lack of foundational identity documents, unregistered marriages, undocumented migrants, home births and home deaths, absence of enclosed cemeteries, inaccessible registration centers, cumbersome death certification processes, and properties with unofficial documents; (2) Financial barriers, comprising poverty and financial exploitation; and (3) Socio-cultural barriers, such as lack of public awareness and poor community relations with health and registration organizations. The under-registration of vital events in Iran is rooted in interconnected structural, economic, and sociocultural barriers. Strengthening the CRVS system requires integrated strategies, such as linking registration with primary healthcare, decentralizing services, and launching community-based awareness campaigns. Ensuring comprehensive vital registration is not only an administrative imperative but also a critical public health priority, essential for evidence-based policymaking, equitable resource distribution, and upholding human rights.