ArticleFrontiers in public health2026
From delivery to identity: applying transaction cost economics to health-enabled civil registration in India.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: This study demonstrates that achieving Sustainable Development Goal (SDG) 16.9-universal legal identity through timely birth and death registration necessitates institutional redesign, best analyzed through the framework of Transaction Cost Economics (TCE). In India, civil registration faces high, uneven transaction costs-travel, documentation, procedural complexity, and information gaps-that disproportionately affect marginalized groups. TCE explains how current systems shift the registration burden onto individuals instead of leveraging health facilities as accessible service platforms. Methods: The study employed a mixed-methods approach combining conceptual inquiry, policy analysis and field data collection using key-informant interviews in Uttar Pradesh using three separate modules for general public, registrars and executive magistrates, with an aim to capture the diverse perspectives on the barriers of timely birth and death registration. Results: Drawing on data collected the study shows that delays in birth and death registration were driven by systemic barriers and transaction costs rather than disinterest. Among 142 general public respondents, 55% registered within 21 days, while 20% delayed over 30 days mainly due to low awareness (81%), absent hospital certificates (30%), and access challenges (20%). Timeliness of registration improved in health facilities (~80%) with Auxiliary Nurse Midwives (ANM)/Accredited Social Health Activists (ASHA) support. Registrars and magistrates reported workload pressures, verification challenges, and inconsistent procedures, underscoring the need for institutional reforms to streamline registration in case of delayed registration under section 13(3) of the Registration of Births and Deaths (RBD) Act. Discussion: The results of the study highlight that integrating civil registration into health facilities can reduce transaction costs, improve equity, and ensure timely coverage. Health institutions are accessible, trusted, and already collect essential data. Supported by digital infrastructure and clear roles, proactive, health-based registration offers a scalable, cost-effective, and inclusive strategy for universal legal identity and strengthened governance.
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