For decades, the burden of fixing birth and death registries has rested mostly on health officials. When Macphilly joined the World Health Organization in 2021, he was surprised to discover how intractable the problem seemed. It's not just that health officials don't control the registries or the purse strings; it's that they are implicated in every aspect of state, public health,. local governance, basic human rights.
In the final days of Marleny Mesa’s pregnancy, she could not shake the feeling that something was wrong. She could barely breathe, for one thing. For another, her anxiety and physical discomfort were approaching what felt like an unbearable peak. A week or so later, she delivered a tiny, squirming boy with jet black hair and soft, curious eyes. She and her husband, Andrés Noscue, named him Eliad. Marleny thought he was perfect, but her mother, a retired midwife, insisted that the placenta contained a hint of trouble. It was far too big, she said, and Eliad was too small, probably because he did not have enough room in her womb to grow. His grandmother thought he might need an incubator. Marleny thought he was fine, but when the baby was a few days old, she and Andrés traveled from the Jerusalén-San Luis Alto Picudito Indigenous reservation in Putumayo, Colombia, to take him to Villagarzón for a checkup, just to be safe.
This proved harder than they expected. The baby could not be seen at the hospital there until he had a civil identification or registration number, which he could not get without a birth certificate, which the hospital could not provide because the baby was born at home. Go to the registrar’s office, the nurses told Marleny and Andrés. But the registrar’s office only sent Andrés back to the hospital, where a different nurse told them to try the notary’s office instead. By then it was almost noon. The only bus of the day would be heading back to San Luis soon; if Andrés and his family missed it, they would have to cough up more money for room and board in town than they normally spent in a week. So they went home.
The problem of inadequate registries is most pressing in the low-income nations of Africa and Southeast Asia. But it is not confined to those regions. In Colombia, birth and death registration is especially spotty in Indigenous and Afro-descendant communities, where the national government tends to have little presence and registrars and notaries tend to apply the rules arbitrarily. A program known as Colombia Rural Vital was created to simplify and democratize this process.
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