Strengthening the link between civil registration and health services

is key to UNICEF strategy to improve birth registration rates in Senegal

UNICEF Senegal
15 July 2021

After checking baby Yatma’s heartbeat and going over family planning methods with Yatma’s young mother, midwife Oumy Thiam peeled off her medical gown and headed out the door, a pile of papers under her arm.

It was noon, but Oumy wasn’t heading on a break. Instead, she jumped on the back of a motorcycle taxi at the entrance of the health center and traversed the short distance to the town hall to deposit birth records.

As the head of the maternity ward at the Moricounda Health Center in Sédhiou, Oumy’s medical purpose went hand-in-hand with a whole other undertaking – that of ensuring babies like four-month old Yatma would exist in government registrars.

Oumy Thiam appointment with Yatma
Diabou Drame and her four-month-old baby Yatma attend an appointment with midwife Oumy Thiam at the Moricounda Health Center in Sédhiou. During the appointment, Oumy went over family planning methods with the 22-year old mother of four, and Diabou showed Oumy the birth certificate she obtained a week ago. Health and social action authorities in Sédhiou are collaborating on initiatives like ‘’Le Premier Cadeau’’ to improve birth registration rates.

According to UNICEF, West and Central Africa has the lowest birth registration rates in the world[1], and throughout Sub-Saharan Africa possession of a birth certificate is even less common.[2] Registration is ideally done as soon as possible after the birth has occurred, and preferably within the first year. Whereas Senegal has mechanisms in place for registering births, systematic and timely birth declarations remain a challenge.

Dr. Amadou Yedi Camara, the District Chief Doctor of Sédhiou, alleges that ‘’Registration is a cultural frame of mind. If you’re baptized, then you exist in African culture. In this rural zone, lack of knowledge on how to register a child’s birth is another barrier.’’

UNICEF recognizes birth registration as a first step in securing children’s recognition before the law, safeguarding their rights and ensuring that any violation of those rights does not go unnoticed. Without proof of age, children can be exposed to precarious marriage, barred from taking school exams, and miss out on exercising lifelong civic rights.


[2] A Snapshot of Civil Registration in Sub-Saharan Africa. UNICEF []

Birth Records
Oumy Thiam, a midwife and head of the maternity ward of the Moricounda Health Center in Sédhiou, consults the birth records of a baby she delivered in the ward four months ago. The mother understands the benefits of registering her children and is in the process of registering her newborn.

In the southern Casamance region of Senegal where births are not systematically registered, health services are rapidly accelerating change. ‘’Parents don’t always recognize the use of registering their babies, but when the mother gives birth in a health center, we get her contact and can invite her to a postnatal checkup’’, details Oumy.

Baby Ramatoulaye at Marsassoum Health Center
Two-week old Ramatoulaye waits with her mother at the Marsassoum Health Center in rural Sédhiou for a checkup. The mother says that she is her first child to be registered, thanks to the midwife of this rural health center who has been implementing the ‘’Le Premier Cadeau’’ project in her clinic.

‘’The contribution of the health sector to civil registration in Senegal has been phenomenal,’’ explains Mamadou Ibrahim Ndiaye, the District Head of Social Action in Sédhiou who oversees an initiative called ‘’Le Premier Cadeau.’’ Co-launched by the regional medical and social action authorities in Sédhiou, it’s a collaboration that informs mothers that the ‘’first gift’’ they can give their children is identity and recognition before the law and ensures that all children coming into contact with the health system are declared. With donations of hygiene products, healthcare providers incentivize mothers to attend three postnatal consultations in the weeks following birth. Strategically, the second postnatal appointment is set on the 9th day postpartum as in Senegal a baby’s name is traditionally given seven day after birth. On the day of their second appointment, midwives can therefore record the baby’s name and accompany parents in the civil registration process.

Fatimata Seydi in rural Sedhiou
A young mother stands in front of her homestead in rural Sédhiou surrounded by her children, including two-week-old Ramatoulaye cradled in her arms. Fatimata has recently completed registering her newborn’s birth thanks to the ‘’Le Premier Cadeau’’ initiative. She describes the challenges her eldest, who is seven and not registered, faced when he became of school-age.

Strengthening and systematizing linkages between civil registration and the delivery platforms of other social services is a key UNICEF strategy in improving birth registration rates in Senegal. Coupling birth registration with maternal health services has been particularly successful. ‘’I’ve been working in this facility since 2014, and this is the first time that birth registration has been functional, since March 2020. Ever since ‘’Le Premier Cadeau’’ began, I’ve been seeing women come for all three appointments and getting their babies’ birth certificates done. It used to be just under 50% and then it went to 81%’’, says midwife Oumy Thiam from the Moricounda Health Center in Sédhiou.

Mamadou Ibrahim Ndiaye
Mamadou Ibrahim Ndiaye, the District Head of Social Action in Sédhiou, stands in front of his office that oversees the latest initiative strengthening the linkage between health services and civil registration called ‘’Le Premier Cadeau.’’

‘’We work directly with the midwife because she is aware of every birth. When a midwife is involved, registration levels increase significantly’’, adds Mamadou Ibrahim Ndiaye. In the meantime, midwives like Oumy will continue to embody the remarkable partnership between civil registration and health services, ensuring the 60 to 80 babies she delivers each month have their first gift.