Fisher: Citizenship, Federalism, and Delayed Birth Registration 2024] C ITIZENSHIP, F EDERALISM, AND DELAYED BIRTH R EGISTRATION 57 Systems (NAPHSIS). 43 Despite the coordinating role of the federal government, a revised model birth certificate form issued in 2003 was not adopted nationwide until 2016, after which a few states continued to omit a handful of data fields from the 2003 revised form. 44 Requirements to register a birth certificate, and the process by which registration is done, vary widely among U.S. states and territories. Despite the robust literature on civil registration in many developing countries, 45 recent literature is sparse about the prevalence and adequacy of birth registration in the United States. Academic studies from decades ago evaluated the completeness of birth registration in the United States but have not been repeated in nearly 75 years. 46 Studies on the prevalence of at-home births draw their data from birth registration records, meaning that they do not account for births that go unregistered. 47 The Committee on the Rights of the Child frequently examines state parties’ compliance with birth registration-related mandates in its periodic reviews. 48 However, the United States occupies the unique status of being the only United Nations member state that has not ratified the Convention on the Rights of the Child, 49 and is thus not subject to review of the adequacy of its birth registration systems. 50 Without nationwide studies or mandatory 43. NRC, “Vital Statistics”, supra note 35, “The U.S. Vital Statistics System: The Role of State and Local Health Departments,�� at 78. 44. Marian F. MacDorman & E. Declercq, Trends and State Variations in Out-of-Hospital Births in the United States, 2004–2017, 46 B IRTH 279, 279 (2019) (“The slow adoption by states of the 2003 revised birth certificate has meant that a number of key variables . . . were not available nationally until 2016.”). 45. See, e.g., Amiya Bhatia, Nancy Krieger, Jason Becfield, Aluisio Barros, and Cesar Victora, Are Inequities Decreasing? Birth Registration for Children under Five in Low-Income and MiddleIncome Countries, 1999–2016, BMJ GLOBAL HEALTH 4:e00192 (2019) https://gh.bmj.com/content/bmjgh/4/6/e001926.full.pdf [https://perma.cc/MU2J-5WDG]; Andrea Wendt, Franciele Hellwig, Ghada E. Saad, Cheikh Fate, Ties Boerma, Aluisio J.D. Barros, and Cesar G. Victora, Birth Registration Coverage According to the Sex of the Head of Household: An Analysis of National Surveys from 93 Low- and Middle-income Countries, 22 BMC P UBLIC HEALTH, 1942 (2022), https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14325-z [https:// perma.cc/89YQ-NZVG]. 46. Sam Shapiro & Joseph Schachter, Birth Registration Completeness United States, 1950, 67 P UBLIC HEALTH R EPS. (1896-1970) 51351Cooperative Federalism and SIJS, 61 B.C. L. R EV. 2869A3 (1952), https://doi.org/10.2307/4588130; P. K. Whelpton, The Completeness of Birth Registration in the United States, 29 J. AM. S TAT. ASS’N 125, 125 (1934). 47. See MacDorman & Declercq, supra note 45, at 280 (noting that data from out-of-hospital births is drawn from birth certificates). 48. C OMM. ON THE R TS. OF THE C HILD, R EPORTING GUIDELINES, https://www.ohchr.org/ en/treaty-bodies/crc/reporting-guidelines [https://perma.cc/HEA8-NQ7X] (last visited July 4, 2023). 49. U.N. TREATY B ODY DATABASE, R ATIFICATION S TATUS FOR CRC - C ONVENTION ON THE R IGHTS OF THE C HILD, https://tbinternet.ohchr.org/layouts/15/TreatyBodyExternal/Treaty.aspx? Treaty=CRC&Lang=en/ [https://perma.cc/69HM-G5SZ] (last visited Apr. 2, 2023). 50. The United States likewise has not ratified the Convention on the Reduction of Statelessness. See U.N. TREATY C OLLECTION, C ONVENTION ON THE REDUCTION OF STATELESSNESS, Published by IdeaExchange@UAkron, 2025 9