India has a robust system of documenting births and deaths under the Registration of Births and Deaths Act, 1969, through the Civil Registration System (CRS). It provides a unified process of continuous, permanent, compulsory, independent and universal recording of births and deaths.
Under the CRS, deaths are reported to the registrar of births and deaths of the concerned area for registration through around three lakh registration units nationwide. Although births and deaths are to be reported within 21 days of the occurrence of the event, the Act provides for late registrations as well. Every state generates a report within one year after the index calendar year. This leeway is given to accommodate late reporting and to collate data. Thus, the 2020 death data was reported by the states to the Centre up to December 31, 2021. Thereafter, the office of the Registrar General of India prepared the report for 2020 and released it on May 3.
Over the years, the civil registration system has matured, and with rising awareness and ownership, the registration of births and deaths has become more inclusive. Today, 85 per cent of births and deaths are registered online on the state or national portals. With time, the need for birth/death certificates has also risen, especially for the opening of bank accounts (particularly Jan Dhan accounts) and for property registration.
It may also be noted that each annual report also takes into account the estimated incremental increase in population compared to the preceding year, based on the census and growth rate, which leads to additional deaths being added.
The number of deaths reported through CRS is the actual count of registered deaths due to all the underlying causes. This would include natural deaths in the elderly, deaths due to TB infection, cancer, accidents, other systemic diseases, and so on. The count includes maternal, infant and child deaths. Stillbirths are also recorded. The report thus provides a holistic estimate of overall mortality. It, however, does not provide disaggregated cause-specific proportions by design.
The CRS report for 2020 is of special significance. It was the first year of the pandemic and there is interest in the estimates of the Covid-19-related death burden in this phase.
The 2020 CRS Reports estimate a total of 81,15,882 deaths in 2020. In 2019, the number of registered deaths was 76,41,076 deaths. Thus, compared to 2019, a total of 4,74,806 “extra” or excess deaths were reported in 2020. Since in 2019, there was no Covid-19, the excess death number in 2020 is surely, in part, due to the pandemic. However, all the excess deaths are not due to, and cannot be attributed to, Covid-19 alone. Based on the specially-developed Covid-19 reporting system of the Government of India, 2020 saw a total of 1,48,994 deaths due to Covid-19. It is possible that some additional deaths due to Covid-19 might not have been recorded in this system. But the CRS ensures that deaths from all causes are taken note of.
Before we go further, an important point needs to be made on the trends of reporting excess mortality under CRS year by year. It may be noted, for instance, that since 2016, there has been an increase in the number of deaths registered every year compared to the preceding years. In the year 2019, registered deaths were 76,41,076 compared to 69,50,607 deaths in 2018. Thus, a total of 6,90,469 more deaths were registered in 2019 compared to 2018. This trend is due to reasons such as increased registration activity and incremental increase in population size referred to above. It may also be noted that over the years, the death rate has declined with increasing life expectancy. Therefore, excess deaths can be recorded in the absence of a disease outbreak or any other unusual mortality pattern and, indeed, even in the face of a declining death rate.
An attempt to equate all excess deaths in 2020 to Covid-19 is untenable. The excess volume of 4,74,806 deaths should be seen as the total envelope of deaths within which lies a subset of Covid-19 deaths. In other words, no matter how we count Covid-19 deaths, the exorbitantly high estimate over and above the officially reported number is out of the question.
As per Worldometer, a publicly available database, overall Covid deaths in India have been 373 per million, which is less than half of the world average of 804. The estimates (deaths per million population) for the US (3,052), UK (2,552), France (2,230), Sweden (1,835), Germany (1,613) and Canada (1,025) are much higher. Even after adjustments are made in the reported death estimates by using CRS numbers, India will, in every likelihood, stand tall as a nation that succeeded in keeping the Covid mortality low compared to other nations.
From time to time, academics and agencies have provided modelling-based estimates of Covid-19 deaths in India. For instance, an article in The Lancet estimated that the Covid-19 death count in India is more than eight times the official count. The CRS data rules out such a high multiple for Covid deaths in 2020, given that the all-cause excess deaths documented in CRS are well under five lakhs.
Estimates based on modelling use assumptions that may not necessarily be accurate for application in the diverse subcontinent that our nation is. Unfortunately, such estimates attract media attention and lead to sensational claims that often are far from true. The time has come for the refinement of our understanding of the impact of Covid-19 in India, which should be based on actual numbers provided by CRS.
This report serves a useful purpose in paving the way for clearing the air around the magnitude of pandemic-triggered mortality. It also reposes faith, yet again, in the comprehensive and effective pandemic response effort marshalled by the states and the Centre and, above all, by the people of India.
This column first appeared in the print edition on May 5, 2022, under the title ‘The dead have been counted’. The writer is member (Health), NITI Aayog. Views are personal