Immunization coverage can vary dramatically across regions, with some areas having better access than others

An equity impact analysis of the 2016 Ethiopia Demographic and Health Survey dataset identified significant disparities in full immunization coverage across different regions of Ethiopia among children aged up to 36 months. Children in the Addis Ababa and Dire Dawa regions of Ethiopia were 7 times more likely to have full vaccination coverage compared to children living in the Afar region, a rural region with large numbers of pastoralist nomadic communities.

Investments in polio eradication in Africa improved overall immunization systems and increased coverage of routine vaccinations

A systematic review of 8 African countries that had wild polio virus transmission and significant polio eradication activities found evidence that the huge investments made in polio have strengthened capacity in almost all aspects of the overall immunization systems, especially in the areas of microplanning, service delivery, capacity-building (especially supportive supervision and on-the-job training), and program management. This led to substantial increases in coverage of other routine vaccinations – BCG, DPT, measles – in all 8 countries over a 25-year period (1989-2014), including a more than a 3-fold increase in DPT3 coverage in 2 countries and a more than a 2-fold increase in 3 other countries.

Immunization rates increase when Ethiopian mothers receive maternal health services

Ethiopian mothers use of any of three maternal health services — antenatal care, delivery services, or tetanus vaccination — significantly increased the likelihood of their children being fully immunized by 12-23 months of age. Therefore, national immunization initiatives should concentrate on improving access of pregnant women to these key maternal health services.

Efforts to eradicate polio have also led to improved access to other vaccines

The expertise and assets gained through efforts to eradicate polio at least partially explain the improvement between 2013 and 2015 in vaccination coverage of DPT3 in six out of ten “focus” countries of the Polio Eradication Endgame strategic plan. This includes substantial increases in vaccination rates in India, Nigeria, and Ethiopia, which, combined, reduced the number of children not fully vaccinated with DPT by 2 million in 2 years.

Empowering women in a community improves children’s immunization rates and overall health

The level of women’s community-level autonomy is associated with an increased number of children immunized above and beyond that which is seen with individual-level women’s autonomy. These results indicate that empowering women within households not only improves the individual mother’s children’s health, but also serves to improve the lives of other children within the community.

This analysis is from the 2011 Ethiopian Demographic and Health Survey that investigated the relationship between individual- and community-levels of women’s autonomy and children’s immunization status.

Empowering women can lead to greater vaccination rates in children

In a systematic review of qualitative research from low- and middle-income countries, women’s low social status was shown to be a barrier to their children accessing vaccinations. Specific barriers included access to education, income, resource allocation, and autonomous decision-making related to time. The authors suggest that expanding the responsibility for children’s health to both parents (mothers and fathers) may be one important element in removing persistent barriers to immunization often faced by mothers.