Background and Development
1. Birth Registration System under the Household Registration Act
2. Origin of Birth Reporting
Health care of women and children in the ROC was promoted through local health departments that provided health care services based on information regarding newborns obtained from the household registration office. However, as birth registration was often delayed, services such as vaccination, postnatal health care and birth control were not delivered in a timely manner. If an infant died before his/her birth was registered, the parents were often reluctant to register the birth and death, making it difficult to obtain accurate statistics on infant births and deaths.
To obtain accurate and comprehensive information regarding population dynamics in a timely manner, to raise the effectiveness of women’s and children’s health care, and to enhance accuracy of birth-related data, such as mortality rate at various times during pregnancy and mortality rates of newborns and infants, the DOH launched a birth reporting system in 1992. This system called for birthing facilities to spontaneously report new births and stillbirths. This system was first tested in Yilan County, Taichung County and Nantou County.
3. Implementation of the Birth Reporting System
TheChild Welfare Act was amended and promulgated on February 5, 1993. It stipulates that “The midwife shall communicate the birth information with household and health authorities within ten days of the childbirth.”
To fully carry out the birth reporting policy, the Ministry of Health and Welfare and its predecessor agency, Department of Health (DOH) prescribed the “birth reporting processing plan”. After a number of discussions with the MOI, the Child Welfare Act authority, the MOI finalized and promulgated the “birth reporting procedures” on September 13, 1994. On December 28 of the same year, the DOH promulgated the newly amended “birth certificate” and “stillbirth certificate”. In March 1995, the paper-form reporting procedures were implemented and remain in effect to now.
On May 28, 2003, The Child Welfare Act and The Youth Welfare Act were consolidated into The Child and Youth Welfare Act. Article 13 of the act stipulates that “The midwife shall communicate the birth information with household and health authorities within seven days of the childbirth.” Then the law amended to TheProtection of Children and Youth Welfare and Right Act on November 30, 2011. Article 14 of the act stipulates that “The identified person will report to the health authority the relevant birth information seven days after the delivery of the baby. If it was stillborn, the same applies.” For those who were not delivered in hospitals, clinics or midwife clinics, and cannot obtain a birth certificate, a DNA report identifying the parent-child relationship issued by a medical facility or a “birth report form” issued by a certified medical professional shall be presented to register a birth.
4. Current Differences between Birth Reporting and Birth Registration
According to TheProtection of Children and Youth Welfare and Right Act, medical facilities or midwives shall spontaneously inform the household registration office and health authorities concerned within 7 days of a birth. They shall also issue a live birth\stillbirth certificate to the mother of the newborn or her spouse to register the birth with the household registration office. Differences between birth reporting and birth registration are detailed in Table 1.
Table 1. Current Comparison of Birth Registration and Birth Reporting
5. Web-based Birth Reporting System
In 1995 when the preliminary stage of birth reporting was implemented, the annual number of reports ranged from 90,000 to 120,000, much lower than the birth registration figures. It drastically increased to more than 200,000 after 1999 when the plan for the improvement of birth reporting was carried out. However, the number of birth registrations was 60,000 more than the number of birth reports. Medical facilities, city/county health departments, and the Health Promotion Administration (HPA),Ministry of Health and Welfare and its predecessor Bureau of Health Promotion (BHP), Department of Health, Executive Yuan, often created repetitive records and compiled similar types of data. As medical facilities often postponed mailing or accidentally lost birth information, new birth data were not received until months later, making it impossible for medical administrators to provide timely health care to newborns. Thus, accuracy of birth reporting and women’s and children’s health care were negatively affected.
Birth reports contain much public health information. The practice of birth reporting is worth encouraging because the information acquired is valuable for women’s and children’s health policy formulation and academic research. In July 2001 when the BHP took over the task of handling birth reports, it looked into the practices of Kaohsiung City and Taichung City in online reporting and started planning an online reporting system. The BHP also built a central database for the collection of nationwide birth information that could be rapidly transmitted through the Internet. Access to the information can only be made with authorization by the appropriate level of administration. The information is also provided for the use of academic research on public health to strengthen health care for newborns and to fully carry out population policy. In May 2002, the BHP developed and completed a 24-hour Web-based Birth Reporting System and provided training to the personnel concerned. Testing and promotion of the system were completed by the end of 2003. In January 2004, the system was officially in use across the nation. In response to the exponential growth of the number of foreign spouses living in the ROC, the accessibility of the Internet and the database have enabled administrators to share information and fully understand conditions of mothers and newborns at the local level.
6. “Paperless” Birth Reporting
For better resource-sharing and in accordance with the “Birth Data Network Reporting Operational Terms” of the MOE implemented in April 2004 interface links were established between related agencies and the household registration information system for information transmission. In the initial stage, hard copies of documents were printed along with the use of the online network. The BHP divided birth reporting data by nationality and transmitted related files to the MOI, Immigration Bureau, Foreign Affairs Police and household registration offices. The ultimate goal was to reach paperless birth reporting before January 1, 2005.
In accordance with the organizational restructuring of the Executive Yuan, the Bureau of Health Promotion, Department of Health, was organizationally restructured to the Health Promotion Administration, Ministry of Health and Welfare on July 23, 2013. The Health Promotion Administration takes over and continues to conduct birth reporting system.
7. Web-based birth reporting system receives ISO27001 certification
To comply with the Personal Information Protection Act, the web-based birth reporting system can only be accessed with a medical certification identification card. The health care certification authority (HCA) mechanism has been applied to protect information since the beginning of 2004. In addition, an encryption mechanism has been installed to ensure the information security. This has decreased the possibility of hacking and information leaks.
In 2008 and 2011, the web-based birth reporting system received ISO27001 certification, and continuing assessment in 2012-2013. The certification pointed to the confidentiality, completeness and usability of birth data. This certification also symbolizes the excellence in service quality and sustainable management of this system.
The practice of birth reporting was officially implemented on a nationwide basis in 1995. In the beginning, the procedures and information required for reporting were determined by the Department of Health (DOH, the predecessor agency of the Ministry of Health and Welfare) and MOI, with each agency carrying out different responsibilities. The MOI was responsible for overseeing the local departments of civil affairs which in turn provided guidance and assistance to the household registration offices. For overdue birth registrations, notices were sent out to encourage registration or registration procedures were completed by the household registration office. The DOH was responsible for providing guidance and assistance to subordinate health agencies to ensure that medical facilities in which infants are born report all births according to related regulations. In 2001, due to restructuring and consolidation of central government agencies, birth reporting duties were transferred to the Bureau of Health Promotion (BHP, the predecessor agency of the Health Promotion Administration). The BHP found that there were a large number of omitted birth reports and overdue or incomplete birth registrations, making it impossible to understand the real nationwide birth statistics. Therefore, the BHP proactively guided the local health departments, and reiterated birth reporting responsibilities to all health authorities. It also enhanced oversight of medical facilities under its jurisdiction to ensure that they carried out birth reporting in accordance with the law.
1. Paper-form Birth Reporting Procedures (1995 - 2003)
For newborns delivered in hospitals, clinics or by midwives, including live births and stillbirths (weighing 500 grams or more and carried for 20 weeks or more), the medical facility in which the child was delivered or the midwife who delivered the newborn is to inform the household registration office and health authorities of the newborn’s information within 7 days of its birth. Failure to meet the deadline is subject to a penalty of not less than NT$6,000 and not more than NT$30,000.
Following a live birth, the medical facility or the person who delivered the infant shall issue a birth certificate in quadruplicate. The first of the four copies is given to the mother or her spouse as proof of a birth to be used in completing the birth registration. The second is for the medical facility to send to the Department of Civil Affairs of the city/county government, and this is then forwarded to the local household registration office in the district in which the infant’s mother has a registered residence. If birth registration procedures are not completed within 30 days (amended to 60 days in May 2008), this copy will be used to send a reminder or for the household registration office staff to complete the registration procedures on its own. The third is for the medical facility to send to the local health authority (department of health). The local department of health confirms receipt and makes a copy (or creates a file) to send to the health station in the jurisdiction in which the newborn’s mother’s residence is registered for follow-up health care. The health station also checks if the birth report was made within 7 days of the birth. Failure to meet the deadline is subject to a penalty. The fourth is for the medical facility to keep for its records.
The birth reporting form was drafted by the BHP in 2004 (the term birth reporting form was amended to birth report on January 1, 2009). It provides a means for medical staff to conduct birth registration for newborns not delivered in a medical facility and thus unable to obtain a birth certificate.
2. Online Birth Reporting Procedure (Starting from 2004)