Socioeconomic and Demographic Factors Associated With Birth and Death Registration in India: A Secondary Analysis of the National Family Health Survey-5 (2019-21)

Background: Complete registration of births and deaths underpins legal identity, demographic analysis, and health planning.Despite a legal mandate in India, under-registration persists, particularly among socioeconomically disadvantaged groups.This study examines socioeconomic and demographic factors associated with reported birth and death registration in India, with particular attention to absolute poverty.Methods: This is a secondary cross-sectional analysis of the National Family Health Survey-5 (NFHS-5, 2019-21).The birth-registration sample comprised de jure children under five years (N = 224,226).The death-registration sample comprised (N = 79,449) deaths occurring in the three years preceding the survey.Individuals were ranked by the continuous NFHS asset-based wealth score, and World Bank poverty headcount ratios for India (2021 purchasing-power parity, PPP) were used to assign households to four mutually exclusive categories: extremely poor (<$3.00 per person per day), poor ($3.00 to <$4.20), middle ($4.20 to <$8.30), and non-poor (≥$8.30).Associations were estimated with multivariable logistic regression.All estimates were weighted with the NFHS-5 household sampling weight.Results: Reported birth registration was 89.1%, and reported death registration was 70.6%.Registration was lower in poorer categories for both outcomes.Compared with the extremely poor, the adjusted odds of birth registration were higher among the poor (adjusted odds ratio (AOR) 1.44, 95% confidence interval (CI) 1.38-1.51),middle (AOR 2.48, 95% CI 2.37-2.60),and non-poor (AOR 4.36, 95% CI 4.01-4.73)categories.For death registration, the corresponding AORs were 1.36 (95% CI 1.28-1.46),2.64 (95% CI 2.47-2.82),and 5.28 (95% CI 4.82-5.78).Rural residence was associated with lower adjusted odds of birth (AOR 0.82, 95% CI 0.78-0.86)and death (AOR 0.67, 95% CI 0.64-0.70)registration, and higher education was associated with higher odds of both.Conclusions: In this secondary analysis of NFHS-5, reported birth and death registration varied by household economic position, education, and residence.Lower economic position and rural residence were associated with lower registration after covariate adjustment.These are associations, not causal effects, and should be interpreted in light of the cross-sectional design, self-reported outcomes, and uncertainty in translating an asset index into absolute poverty categories.