Appendix IV

Note on the Death Registration and Notification System in India

The Registration of Births and Deaths Act, 1969, creates a hierarchical structure of registrars of births and deaths. At the highest end of the spectrum is the Registrar General of India and at the lowest end or local village council level is the sub-registrar or registrar.

Notifiers and registrars are in charge of reporting and registering deaths. The law identifies "notifiers" of births and deaths and obliges them to give information about a death to the nearest registrar. Midwives or health attendants present at death irrespective of its place of occurrence, medical officers in charge of hospitals, and owners or keepers of crematoriums or burial grounds are obliged to give information to registrars about deaths.[517]  Doctors, staff nurses, nurse-midwives, ASHAs, and trained traditional birth attendants who are present at the time of delivery are notifiers and should report all deaths to the nearest registrar.[518] In addition, where a death occurs at home, the head of the household should notify the death. And where a death occurs at in any other public place, the person in charge is supposed to notify such deaths.[519]

The Uttar Pradesh government has developed separate notification forms called "death report forms." These forms have a column asking the cause of death. But they also ask whether the death is pregnancy-related, that is, whether the woman died during, at the time of, or six weeks after the termination of pregnancy.[520] So even if notifiers do not know the cause of death, all pregnancy-related deaths can be notified where they have information about the pregnancy. 

Registrars should, as soon as the information of a birth or death is given to them, note the details in a register.[521] They should provide an extract of the information (birth or death certificate) recorded by them to the person giving such information. The Uttar Pradesh government has prescribed formats for maintaining and issuing death certificates.[522]

The Uttar Pradesh government has issued government orders asking ANMs, medical officers in charge of primary health centers, and superintendents of community health centers to discharge the functions of birth and death registrars.[523] Village development officers or gram vikas adhikaris are also appointed as registrars.[524] Where a pregnant woman dies in the presence of an ANM during or after delivery, by virtue of being present at the time of delivery, the ANM can automatically register the death and issue a death certificate. Alternatively, if the ANM receives information about a death through the ASHA, she should record it and issue a death certificate. This is also true for medical officers of primary health centers and superintendents of community health centers.

This general registration process is supplemented by a special medical cause of death certification process. The Government of India through the Registrar General's Office has launched the Medical Cause of Death Certification scheme which is implemented in many hospitals of Uttar Pradesh. Under this scheme, the Indian government provides financial and technical support for governments to train and ensure that causes of death are medically certified in hospitals.