The Birth Certificate (Finally) Goes National

According to Joyce Martin, M.P.H., lead of the birth team in the Reproductive Statistics Branch, Division of Vital Statistics, a transition that began more than a decade-and-a-half ago will soon be completed, and a new era in national birth certificate data will begin. By the time we ring in 2015, all of America’s 50 states and the District of Columbia will have finally adopted the 2003 Revisions of the U.S. Standard Certificate of Live Birth, generally known as the standard birth certificate. And she, and her colleagues, couldn’t be more excited.

NCHS collects birth data electronically as part of the National Vital Statistics System (NVSS), administered by NCHS’s Division of Vital Statistics. NVSS data are provided through contracts between NCHS and the 57 independent vital records reporting areas; the 50 states; New York City and Washington, D.C.; and five territories (Puerto Rico, Virgin Islands, Guam, American Samoa, and Commonwealth of the Northern Mariana Islands). The jurisdictions are legally responsible for the registration of vital events, maintaining vital events registries, and issuing copies of birth, death and marriage, and divorce certificates.

The 2003 revision began in 1998, when NCHS convened a panel of experts to evaluate the 1989 standard birth certificate and recommend revisions. The panel included state vital registration and vital statistics executives; the National Association for Public Health Statistics and Information Systems (NAPHSIS), which represents state vital record departments; and representatives of organizations whose membership had an interest in vital records, such as the March of Dimes and the American College of Obstetricians and Gynecologists.

The standard certificates and reports are reviewed and revised periodically, normally on a 10- to 15-year cycle. The standard birth certificate had been revised 11 times prior to 2003. The 1998 panel, like previous panels, was charged with reviewing current certificates, identifying any unmet data needs, and making recommendations for the content, format, and standard definitions of the proposed 2003 standard certificates.

Unlike past panels, however, the latest birth certificate panel had a new and dramatically different mandate. It was to accomplish all this with the understanding that the certificate was no longer represented by a piece of paper. Instead, the certificate was to be viewed as a vital statistics database with a strong emphasis on electronic, automated data collection.

The panel recommended substantive changes to the birth certificate. Many items from the 1989 revision were changed, and new items were added, all to meet current data needs and improve data quality. In all, the size of the standard birth data file roughly doubled with the 2003 revision.

As the date for implementing the new standard across the nation loomed, however, it became clear that adoption would be a long, slow—and expensive—process.

“Although all jurisdictions follow the national standard certificate closely, jurisdictions often have somewhat different needs for their birth certificates. Usually, this means adding items,” says Martin. “And each jurisdiction develops its own electronic system to do so—there’s no electronic standard that everybody can just plug in.”

Most jurisdictions also had older legacy systems, and the scale of changes to the birth certificate went beyond mere tweaking of current systems. “So, each electronic birth reporting system had to be completely re-engineered—a costly endeavor,” Martin says. “There wasn’t a choice there. I think we didn’t fully anticipate the cost of all of the changes when we began the revision process.”

In 2003, the first year of implementation of the new national standards, only two states implemented the new birth certificate.

More than a decade later, with just about all systems “go” and a new era dawning, Martin looks forward to much timelier national data.

“The slow implementation left us with two entirely different reporting areas, which created huge complications in reviewing and publishing birth data,” she says. “We’re only as fast as our slowest reporting area, but we’re making a lot of headway. We released our 2012 data file  within 12 months of the close of the data year, and 2013 preliminary data within 6 months, a new record and a considerable improvement in timeliness. We expect to improve data timeliness even more in the coming months.

“And, finally, as of January 2015, all states are scheduled to be on the new birth certificate,” says Martin. “Soon, we will have national data on such key topics such as prenatal care and tobacco use, and on many new topics such as the mom’s body mass index, breastfeeding, and source of payment for the delivery.  Stay tuned!”