A major failure of our global society in the 21st century is that many people in developing countries are not only born and live without any official record of their existence a flagrant deprivation of an essential human right but also die without having been seen by medically qualified personnel. The resultant uncertainty about the real burden of specific causes of death is being increasingly recognised by international health and funding agencies as a crucial limitation in the prioritisation of effective public health programmes and assessment of their effect.