title: Thriving beyond survival: understanding utilization of perinatal health services as predictors of birth registration: a cross-sectional study.
abstract: BACKGROUND
  There are an estimated 35 million unregistered children in Indonesia. To understand ways to best leverage existing health system-related resources and ensure greater protective measures for these vulnerable children, this study explores the predictive relationship between the utilization of perinatal health services and birth certificate ownership in two Indonesian provinces.
  
  
  METHODS
  This study employed a cross-sectional design with interviewer-administered household surveys to heads of households in West Nusa Tenggara and East Nusa Tenggara from May to July of 2013. The primary outcome of interest was birth certificate ownership among children under the age of 5 years old. Bivariate and multivariable regression analyses using Generalized Estimating Equations (GEE) considered a set of covariates that represented child and household socio-demographic characteristics along with health services utilization variables during pregnancy and post-pregnancy periods.
  
  
  RESULTS
  389 heads of households were interviewed, yielding data on a sample of 451 children under the age of 5. Fewer than 28% of children in this sample possessed a birth certificate. Nearly 57% (n = 259) of children were delivered in a clinical facility, though only 36% (n = 93) of these were legally registered. Of children born in the home (n = 194), registration dropped to 16% (n = 31). Adjusted analyses accounting for socio-demographic factors suggest that children born in a clinic facility (AOR = 2.33, 95% CI: 1.27, 4.33), hospital (AOR = 2.38, 95% CI: 1.12, 5.09), or in the presence of a skilled birth attendant (AOR = 2.35, 95% CI: 1.31, 4.23) were significantly more likely to be registered. Children whose mothers sought post-natal care were 2.99 times more likely to possess a birth certificate (AOR = 2.99, 95% CI: 1.1, 7.57). Pre-natal care was not associated with birth registration.
  
  
  CONCLUSIONS
  These findings suggest that use of perinatal health services increases the likelihood of registering a child's birth despite a lack of formal integration of vital registration with the health sector. Formally leveraging existing community-based health workers and perinatal services may serve to further increase registration rates in hard to reach areas of Indonesia.
authors.affiliation: Program on Forced Migration and Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, 10032, NY, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Jackson
authors.affiliation: School of Population and Public Health, University of British Columbia, 608-1081 Burrard St, Vancouver, V5N 1P5, BC, Canada.
authors.forename: Putu
authors.initials: P
authors.lastname: Duff
authors.affiliation: Center on Child Protection at the University of Indonesia, Gedung Nusantara II (Ex PAU Ekonomi) FISIP, Lantai 1, Kampus UI, Depok, 16424, Indonesia.
authors.forename: Santi
authors.initials: S
authors.lastname: Kusumaningrum
authors.affiliation: Program on Forced Migration and Health, Columbia University Mailman School of Public Health, 60 Haven Ave B-4 Suite 432, New York, 10032, NY, USA. ls2302@columbia.edu.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Stark
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001719:Birth Certificates; D002675:Child, Preschool; D003150:Community Health Workers; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric; D005191:Family Characteristics; D005260:Female; D006700:Home Childbirth; D006761:Hospitals; D006801:Humans; D007214:Indonesia; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery; D010342:Patient Acceptance of Health Care; D018743:Perinatal Care / Q000706:statistics & numerical data; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D012111:Residence Characteristics