India’s struggle to medically certify deaths is a glaring blind spot in the nation’s public health and administrative records. India reports one of the highest number of deaths globally; yet a recent article Scientific Reports revealed that only 22.5% of deaths in the country were medically certified in 2020. The study, which tracked death certification patterns from 2006-2020, highlighted that out of the 8.75 million deaths in India in 2020, 80% were registered but just under 2 million were medically certified. This means that four out of five deaths lacked a doctor-verified cause in official records. The medical certification of a cause of death is a necessity as such data feed into vital administrative systems and are used in a range of activities, such as the planning of public health responses to emergencies. Yet such recording suffers as structural gaps and administrative lapses lead to weak reporting, patchy compliance, and regional disparities, thus explaining the poor standards of medical certification of mortality. Hospitals in many states fail to report deaths reliably. In low-performing states, only half of registered hospitals, the report found, submit cause-of-death data. States in North India and East India record especially low certification rates; even Delhi demonstrated a stagnant rate of 57%-59%. However, some Union territories — Lakshadweep, for instance — showed impressive coverage. A large share of deaths, particularly in rural areas, occurs at home, making medical certification difficult. Staff shortages, poor data systems, and lack of training in coding death compound the problem.

The implications of these shortcomings are serious. Without reliable statistics on the cause of death, authorities are unable to gauge the scale of health challenges like cancer, infectious outbreaks, injuries, suicide, or maternal mortality with precision. This compromises evidence-based health policy, prevention programmes, and resource allocation. Data gaps also distort disease burden estimates and derail epidemic preparedness. What is worse, anecdotal reports suggest that, at times, low-level officials in hospitals and municipal offices solicit informal payments to expedite the processing of documenting death. Delay or under-reporting of deaths by hospitals prevent insurance companies from designing policies calibrated towards disease burdens. Strengthening death certification in India thus demands urgent reform. Digitised reporting, bureaucratic accountability, stiffer penalties for under-reporting, the training of medical and municipal staff, and better oversight could make a difference.