Birth Certificate

Birth certificates provide important data about a newborn's status, the child's parents, the mother's use of prenatal care, and complications and events during pregnancy. As such, they are a key resource for maternal and child health epidemiology. They also serve as the basis for legal identity. The history, organization, availability, content, uses, and accuracy of birth certificates are summarized in this entry.

In the United States, the annual collection of birth statistics on a national basis began in 1915, with 10 reporting states and the District of Colombia; by 1933, it included the entire country with at least 90% coverage in each state. The standard certificate of live birth was developed in 1900 and has since undergone 12 revisions, with the 1989 and 2003 revisions expanding the content of medical information. National statistics on fetal deaths have been compiled annually since 1922.

The National Center for Health Statistics (NCHS) collates national and state data on live births, deaths, and fetal deaths based on vital records filed in state registration offices. States generally adhere to the standard certificates developed by the NCHS but can choose to add or delete items. The NCHS regularly publishes reports on birth certificate statistics and prepares public use data sets for further analysis. These include a Linked Birth/Infant Death File (linking live birth and infant death [0 to 365 days] certificates for all infants born during a cohort year) that may be used to help explain trends in infant heath and mortality. Technological advances further allow linkages with data for Medicaid enrollment and other publicly funded health programs to assess quality of perinatal outcomes.

Birth certificates have two parts. The first provides demographic data on the parents and infant; the second, completed from hospital records, gives data on maternal and infant health. Birth certificates offer useful information for researchers, policymakers, and state officials to evaluate trends in maternal and infant health and the quality of care delivered to pregnant women. Birth certificate data allow for the creation of many potential health status outcome and health risk indicators.

The reliability and validity of birth certificate data vary considerably by item, but their quality and completeness are reasonable for population-based analyses. Basic demographic characteristics (e.g., maternal age) and maternal data tend to be more accurately and completely reported than those for fathers or social traits (e.g., education). Medical information about the birth or the newborn is typically least adequately reported. Data are more likely to be missing for very low birthweight infants, teenage and unwed mothers, and those with less than a high school education. Absent accurate data, however, high-risk groups are less likely to be understood or helped, and inaccurate conclusions may be drawn about underlying variables of interest, such as substance abuse during pregnancy.