Abstract Malaysia has a well-established civil registration system dating back to the 1960s. Birth registration is virtually complete at the national level. However, the quality of civil registration in some remote areas is doubtful, as evidenced by the abnormally low birth and death rates in several districts. This study focuses on identifying districts in Sabah, where the reporting of births seems problematic. Sabah is the least developed state in Malaysia, and it is sparsely populated, despite being the second most populous state in the country. Sabah’s civil registration lags behind the other states, to the extent that birth and death statistics were not reported for the state in the vital statistics report for the period 2000 to 2009. A 2016 study found that death registration is almost 100%, except for Sabah (88%). The plausible reasons behind the ultra-low birth rate reported in several remote districts in Sabah include misreporting of the place of occurrence as the usual residence, delayed reporting, non-coverage, ignorance of the law, inaccessibility, presence of a large number of migrants, miscommunication, and errors in data entry. The under-reporting of births may have serious consequences, such as misallocation of resources and deprivation of services to those affected. In line with the transformative promise of “leaving no one behind,” the Sustainable Development Goals urge all countries to strive to improve data quality for planning; this includes complete birth registration for creating effective development programs to reach target groups more effectively.