The right start in life
In Mali, health services are now working hand in hand with protection services to make sure new births are registered and children benefit from their first right – the right to an identity
Fatouma Traore’s size belies her age. The petite-sized woman of 43 years is mother of four, and still breastfeeds her youngest infant Drissa, now almost one year old. During her first pregnancy, Fatouma made time away from her chores and petty trading to participate in the community discussions with the outreach staff who came to her village from Kaboïla Community health center (CSCom).
''I followed their advice …. all my children were born at the Kaboïla Community Health centre without any difficulties, and they are all alive today''
The Kaboïla community health center is situated 12 kilometers away from the bustling commercial town of Sikasso, which also gives its name to the region that lies south-east of Mali. The health center is managed by Oumar Doumbia, the Senior Health Technician who has been working there since 2009. The outreach personnel encourage expectant mothers to visit the health center. “Our population coverage is about 9,980, so we expect to get about 42 new pregnant women each month, that is, women attending their first pre-natal consultation. Last month in May, we had only 17 new pregnant attendees. In April, just the month before, they were as many as 47.”
Fatouma now visits the Kaboïla Community Health Centre regularly for the vaccines that Drissa needs to protect him against diseases like diphtheria and polio, and to monitor his growth. The data from the health center helped her husband to kick-start the process for Drissa’s birth registration a few weeks later.
Local tradition in Mali prescribes rest for women after they deliver, so most stay within their compounds for the first 40 days after delivering. Families wait seven days, during the baptism of the child, to receive the name the father has chosen for the baby. Oumar Doumbia explains that when compiling the family records, they leave that space unfilled. “The birth declaration that we do here is totally free of charge. The father of the child or any adult male relative, comes back here to us to give us the name after the baptism. That is when we fill in the blank space. We then give them the declaration paper, which they take to the town hall (Mayor’s office) to apply for the birth certificate.”
There is no record or trace of children who die outside the community health center because the families do not report the deaths.
Similarly, most families do not return to the health center to report when the new-born child does not survive the first week of life. The blank space in the health center’s record book stays unfilled.
The Cercle of Sikasso is the lowest administrative unit in the region. As far as they are concerned, these children never existed.
Oumar says that the health center refers to the details provided on the declaration form to determine the age of the child when the parents are unsure. This is critical for the health team when they monitor the individual vaccination schedules to protect each child against preventable childhood diseases. They also use the information to do their own forward planning. On the importance of the birth declaration and registration, Fatouma Traore explains: “This administrative paper can speak for the child anywhere. We need it to enroll the child in school, and even later when they grow up and are ready to marry. Without it, a child is lost in their own country,” she concludes emphatically.
This administrative paper can speak for the child anywhere. Without it, a child is lost in their own country
Mali recorded 87.2% of children registered at birth in 2015. At the time, the bottlenecks included lack of knowledge about the importance of registering children. Children without birth registration documents are potentially unprotected from violations such as inability to access education, marriage of girls, or sometimes enrolment into armed
''This administrative paper can speak for the child anywhere. Without it, a child is lost in their own country''
There is no charge for a child’s birth certificate at the Mayor’s office if the process is completed within 30 days of birth. Parents however need to pay a processing fee of CFA100 (approximately 18 cents).
It is therefore important for the ministries of Health and Justice to work together as is being done in Sikasso, with each playing their respective roles in promoting and facilitating birth registration at the local level for all children.
With support provided by Global Affairs of Canada to UNICEF in Mali, 6,761 community health workers and mobilizers, village registrars and matrons from six locations including Sikasso health district were trained in birth registration. Additional funding received from the Swedish government was used to train registration agents and equip 1,251 offices in Sikasso district with solar panels, computers and registers. The collaboration between community health facilities like the Kaboïla health center and civil registration officers is making it possible to reach out to approximately 202,830 children under five years living in rural areas within the Cercle de Sikasso and offer them prompt birth registration services.