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.

Children in rural-urban migrant populations in China, India, and Nigeria have lower immunization rates, requiring special efforts to improve vaccination rates and reduce health inequities and disease outbreaks

According to a systematic review and meta-analysis, children who are rural-urban migrants in China, India and Nigeria were less likely to be fully-immunized by the age of one year than non-migrant urban residents and the general population. These inequities in vaccination rates — often concealed in national averages — call for special efforts to improve immunization rates in this rapidly growing sub-population to reduce both health inequities and the risk of infectious disease outbreaks in the wider society.

Children in Shanghai whose families migrated from rural areas have lower rates of measles vaccination

Children in Shanghai, China whose families migrated from rural areas — now roughly 40% of the city’s total population — are half as likely as “local” children to receive the first dose of measles vaccine by 9 months of age and 42% less likely to receive the second measles dose by 24 months. The lower rates of timely first dose measles vaccination among rural migrants vs. local children — 78% vs. 89% – – are a key obstacle to measles elimination in China. This indicates a need to specifically target non-local children for vaccination, especially those living in primarily migrant communities.

Children living in urban slums may be more likely to miss immunizations due to frequent moves

Children living in urban areas in India were significantly more likely to be only partially immunized compared to children in rural areas. In this study, the authors suggest this may be the result of the tendency for those living in urban slums to move frequently, resulting in only partial immunization. No significant difference was found in rates of non-vaccination (children receiving no vaccines) in rural versus urban communities.

Despite improvements, girls and rural children in India still face disadvantages in healthcare and education

In an analysis of of data from India’s National Family Health Survey showed that, despite a decline in urban-rural and gender differences over time, girls and children residing in rural areas remained disadvantaged. Moreover, regions that had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in one region during the data collection period.