Recent statistics reveal approximately 3.7 million people in Asia and the Pacific died without a trace in official records in 2023. No paperwork. No cause of death. No data. Just silence. And this silence is felt most in places with few resources – in rural, remote and marginalized communities.
When deaths aren’t counted, governments know little about who these people were or how they died. They are unable to track the health of their populations, plan for emergencies, or appropriately allocate resources.
Why are deaths not properly documented?
Many deaths take place at home or in communities, and it is usually the families’ responsibility to register the death. Whether they do so can depend on where they live, their education and awareness of the system, cultural practices, and even how helpful the registration officials are. Often, families do not see a reason for registration, particularly when there is no inheritance or legal benefit involved.
Stigma and inequality also play a role. Women’s deaths, for example, are less likely to be reported due to social norms, lack of identification, or cultural taboos. Even when deaths are registered, many death certificates will give “fever”, “heart failure” or “old age” as the cause of death. These so-called garbage codes hide the real causes and leave the data nearly useless.
Hospitals tend to do better, but often not by much. In some countries, up to 57% of hospital-recorded deaths still have ill-defined causes. And dying in a hospital doesn’t always mean the death is officially registered. Weak and fragmented systems mean that even facility-based records can fall through the cracks. The result is a double burden: too many deaths go uncounted, and too many of those that are counted are misclassified.
From missing to misclassified
The most fundamental gap is simple: many deaths are never registered at all. Often, families must travel long distances, pay fees, or navigate slow, paper-based processes just to report a death. These hurdles leave millions uncounted. Strengthening the basics—linking health facilities with civil registries, offering mobile and digital registration options, and reducing legal and financial barriers—would help ensure every death is at least recorded. ESCAP’s work on CRVS business process improvement supports countries in making these systems more efficient and accessible.
But getting a death in the system is only half the job. The data that comes with it is also hugely important. That’s where the International Classification of Diseases (ICD) and verbal autopsy come in to capture how people die. The medical certificate of cause of death, together with the ICD, provides global standards for recording causes of death, while Verbal Autopsy (VA) enables trained workers to interview families when deaths have happened and no medical certificate of cause of death has been completed. Together, these tools are transforming both the quality and comparability of mortality data.
Without closing both gaps—registering every death and ensuring the cause is accurately recorded—mortality statistics will remain incomplete and unreliable.
So how do we close the gaps?
At the 2025 Ministerial Conference on Civil Registration and Vital Statistics in Bangkok, governments reaffirmed their commitment to building CRVS systems that are universal, inclusive and effective. Their declaration sent a clear message that closing these gaps is an urgent priority.
One of the critical steps is to make the invisible visible. Through its work on CRVS inequality assessments, ESCAP supports countries to explore this invisibility. Characteristics such as sex, age, socioeconomic status and geography, and importantly, the way that these characteristics intersect and deepen exclusion, are critical to identifying which deaths are most likely to go unregistered and whose causes of death are poorly documented.
To truly close the gaps, the systems that record deaths must be strengthened to ensure that every death is registered. The absence of a medically certified cause of death should never be a barrier to registration. Where medical certification is not possible, verbal autopsy must be scaled up, as an interim measure. At the same time, countries ready to digitize and standardize their cause of death data should advance the adoption of the latest revision of ICD (ICD-11).
Finally, stronger collaboration is essential, especially with the health sector, which is in contact with individuals and families throughout their lives and is often the only point of access to essential services in remote or underserved areas. Not only do they support families in registration process, but they are also the only professionals qualified to certify causes of death in accordance with international standards.
The 3.7 million unregistered deaths are not just numbers; they are a reminder of the work still ahead. When every death is counted and every cause accurately recorded, high-quality mortality statistics can be produced, giving governments the evidence they need to protect the living and prevent premature deaths.
It’s time to invest, scale, and coordinate because behind every data point is a human life that deserves to be seen, counted and valued. Only then can the region move from one marked by missing or misclassified deaths to one where every one is in the picture, both in life and in death.
