BMJ Global Health (figure 3B). Among the 53 countries, which did not have complete birth registration, 39 countries successfully decreased the percentage of children without birth registration. However, in most of these countries, statistically significant reductions in wealth inequalities were not observed: 10 out of 39 countries achieved significant reductions in wealth inequalities, and in 9 countries significant increases in wealth inequalities were observed. Similarly, in most of the 39 countries where non-­registration decreased, urban/rural inequalities did not decline: 9 countries achieved significant reductions in urban/rural inequalities in 4 countries significant increases in urban/rural inequalities were observed. Figure 3 also shows that among the 14 countries where the percentage of children without birth registration increased between the first and most recent survey, there were concurrent and significant increases in wealth inequalities in 5 countries and in urban/rural inequalities in 4 countries. None of the 14 countries where non-­registration increased were able to achieve significant reductions in wealth and urban/rural inequalities. Online supplementary tables S2 and S3 show the magnitude and direction of total change in the SII and urban/ Bhatia A, et al. BMJ Global Health 2019;4:e001926. doi:10.1136/bmjgh-2019-001926 rural inequalities, annual change and changes between survey wave in all 67 countries. Figure 4 shows the magnitude of annual change in inequalities for each of the groups in figure 3. Among the countries where non-­ registration increased, the largest increase in wealth inequalities was in Lesotho. Between 2006 and 2014, non-­registration increased by 1.8 percentage points (0.36 percentage points per year) and wealth inequalities increased by 20.7 percentage points (4.1 percentage points per year), indicating that children in the poorest households faced the largest increase in non-­ registration. Among countries where non-­registration decreased, the largest annual decline in wealth inequalities (5.5 percentage points) and urban/rural inequalities (2.9 percentage points) was in Namibia, while in Pakistan the on-­average decline in non-­ registration was paired with the largest annual increase in wealth inequalities (7.8 percentage points) and urban/ rural inequalities (4.7 percentage points). Countries with complete birth registration reduced any remaining wealth and urban/rural inequalities. Notably, there was significant correlation between annual change in wealth and urban/rural inequalities (correlation coefficient=0.82). 7 BMJ Global Health: first published as 10.1136/bmjgh-2019-001926 on 16 December 2019. Downloaded from https://gh.bmj.com on 21 July 2025 by guest. Protected by copyright, including for uses related to text and data mining, AI training, and similar technologies. Figure 1 Wealth, urban/rural and sex inequalities in the % of children without birth registration in 173 national surveys stratified by region. Each dot is a survey (n=173) in a country. Zero is the null value and positive values in the shaded area represent inequalities. Wealth inequalities were estimated using the Slope Index of Inequality and five wealth quintiles. Urban/ rural and sex inequalities were estimated by calculating the absolute difference in the % of children without birth registration residing in rural areas compared to urban areas, and among girls compared to boys.