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Gender Bias in Death Registration Among Adults and Its Implications for Mortality Measurement in Kenya
23 Pages Posted: 2 Jun 2026
More...Abstract
Background: Civil registration systems in many low- and middle-income countries capture only a fraction of vital events, with deaths recorded less completely than births. Globally, female deaths are more often unregistered, yet evidence from Kenya is lacking. We examined gender bias in adult death registration across three Kenyan Health and Demographic Surveillance System (HDSS) sites.
Methods: We conducted a cross-sectional household survey of 1,363 households reporting a recent death (2022–2023) across three HDSS sites in Nairobi, Kisumu, and Kilifi. Mixed-effects logistic regression identified determinants of registration, and Fairlie decomposition quantified the gender gap. Reported reasons for (non)registration were also analysed.
Findings: Among 1,111 adult deaths, registration was 22·8% overall and significantly higher in males than females (26·1% vs 18·8%; p=0·006). Among females, registration odds were higher in those aged 45–64 than 65–84 years (AOR 2·32; p=0·019) and in Muslims (AOR 2·53; p=0·042), and lower in the unemployed (AOR 0·43; p=0·004). Among males, odds were lower for single individuals (AOR 0·30; p=0·012) and home deaths (AOR 0·64; p=0·048), and higher with employment or retirement (AOR 2·16; p=0·001) and greater wealth. Observable factors, principally economic activity and place of death, explained 50·2% of the 7·4 percentage-point gender gap. Inheritance needs and social benefits motivated registration; low awareness, perceived low benefit, and cost were key barriers.
Interpretation: Gender bias in adult death registration persists in Kenya, driven by socioeconomic and structural barriers that disadvantage women, underscoring the need for gender-responsive civil registration and vital statistics reforms.
Note:
Gates Foundation Grant Number(s): #224272, #212176 & #203077.
Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Keywords: CRVS, Death registration, Gender disparity, LMICs
Suggested Citation: Suggested Citation