Lieu d’accouchement et enregistrement à l’état civil des naissances chez les enfants de moins de 5 ans en République démocratique du Congo : une analyse multiniveau
Abstract
En Afrique subsaharienne (ASS), l’enregistrement des naissances demeure incomplet, avec des niveaux particulièrement faibles en République démocratique du Congo (RDC), où seuls 34 % des enfants de moins de cinq ans sont enregistrés. Si de nombreux travaux ont identifié les déterminants socioéconomiques de ce phénomène, le rôle du lieu d’accouchement reste peu exploré comme facteur explicatif principal. Cette étude examine l’effet du lieu d’accouchement sur l’enregistrement des naissances en RDC et analyse la variation de cet effet selon les contextes communautaires. Elle s’appuie sur les données de l’Enquête Démographique et de Santé (EDS-RDC III) réalisée en 2023-2024 et utilise un modèle de régression logistique multiniveau. Les résultats montrent que le lieu d’accouchement a un effet significatif sur l’enregistrement des naissances. Les enfants nés en structure de santé ont une probabilité significativement plus élevée d’être enregistrés que ceux nés à domicile. Toutefois, cet effet diminue après prise en compte des caractéristiques individuelles, du ménage et du contexte. Par ailleurs, son ampleur varie selon les contextes communautaires, étant plus marquée dans ceux où le niveau d’enregistrement est faible. Ce résultat indique que les structures de santé jouent un rôle de substitution lorsque les autres canaux d’accès à l’état civil sont limités. Si l’accouchement en structure de santé favorise l’enregistrement des naissances, son effet dépend des conditions dans lesquelles il s’inscrit. Le recours aux structures de santé constitue un levier important mais insuffisant à lui seul, l’enregistrement des naissances dépendant également des conditions socioéconomiques des ménages et de l’organisation des services au niveau communautaire. À cet égard, le renforcement de l’intégration des services d’état civil au sein des structures de santé, combiné à des interventions ciblées dans les contextes communautaires où le niveau d’enregistrement demeure faible, apparaît souhaitable pour réduire les inégalités d’enregistrement des naissances.
In Sub-Saharan Africa (SSA), birth registration remains incomplete, with particularly low levels in the Democratic Republic of the Congo (DRC), where only 34 % of children under five are registered. While numerous studies have identified the socioeconomic determinants of this phenomenon, the role of the place of delivery remains largely unexplored as a primary explanatory factor. This study examines the effect of place of delivery on birth registration in the DRC and analyses how this effect varies across community contexts. It draws on data from the 2023–2024 Demographic and Health Survey (DHS-RDC III) and applies a multilevel logistic regression model. The results show that the place of delivery has a significant effect on birth registration. Children born in health facilities are significantly more likely to be registered than those born at home. However, this effect decreases after accounting for individual, household, and contextual characteristics. Furthermore, its magnitude varies across community contexts, being stronger in those where birth registration levels are low. This finding indicates that health facilities play a substitution role where other channels of access to civil registration are limited. While delivery in a health facility promotes birth registration, its effect depends on the conditions under which it occurs. The use of health facilities, therefore, constitutes an important but insufficient lever on its own, as birth registration also depends on the socioeconomic conditions of households and the organization of services at the community level. In this regard, strengthening the integration of civil registration services within health facilities, combined with targeted interventions in community contexts where birth registration levels remain low, appears desirable to reduce inequalities in birth registration.
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