Competing discourses of vital registration and personhood: perspectives from rural South Africa.

Whilst birth and death data derived from civil registration systems are regarded as essential indicators of health status and important for population planning, in developing countries they are usually perceived by civil servants and researchers to be very incomplete. In South Africa in 1994 only 50% of deaths were registered and 18% of births in the first year of life. A rapid qualitative study was undertaken in a rural district of South Africa to ascertain why registration levels of births, still-births and infant deaths are so low. Fifty-five semi-structured interviews were conducted with 22 local Xhosa women and 33 "professional" key informants, ranging from local civil servants to hospital staff and grave diggers. The study found that local people had complex notions of personhood, before birth and in the years following. Personhood was viewed as a process rather than a stage which is achieved through live birth, as is implied in discourses of vital registration. The women interviewed knew about birth registration although most had registered some or none of their children; they did not know of death registration. There was little knowledge of why registration was necessary and perceptions of this among all informant groups mostly related to the need for a certificate to achieve something else, such as an identity document or welfare payment. Confusion about the procedures to be followed was found among both women and professionals, who advised them. In circumstances in which certificates were officially required, for school entry and burial, other documentation were reported to be accepted. This suggests that the dominance of vital registration as a means of establishing official identity was not recognized. Registration was regarded as a means of achieving something else rather than and end in itself, which discourses of statistical and juridical importance imply. In the light of this we suggest that the present system be replaced by one based on "passive" registration in health care settings if substantially greater levels of completeness are to be achieved.