VoICE Immunization Evidence: Gender Inequity

Key Concept

Key Evidence: A multiple-strategy community intervention program of the National Rural Health Mission (NRHM) in India, designed to reduce maternal and child health (MCH) inequalities was implemented between 2005 and 2012. The gender gap in immunization coverage swung from significantly favoring boys before the intervention to a slight advantage for girls by the end of the intervention. Specifically the coverage differentials changed as follows: for full immunization (5.7% to -0.6%), for BCG immunization (1.9 to -0.9 points), for oral polio vaccine (4% to 0%), and for measles vaccine (4.2% to 0.1%).

Gupta, M., Angeli, F., Bosma, H., et al. 2016. Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic, and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India.. PLoS ONE. 11(3).

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Key Evidence: An impact evaluation for a women’s empowerment program in India found that the children of mothers who participated the empowerment program were significantly more likely to be vaccinated against DTP, measles, and tuberculosis than children of mothers not involved in the program. This study also found that the women’s empowerment program had positive spillover effects: In villages where the program occurred, children of mothers not in the program (non-participants) were 9 to 32% more likely to be immunized against measles than in villages where the program did not occur (controls). Overall, measles vaccine coverage was nearly 25% higher in the program villages compared to the control villages.

Janssens, W 2011. Externalities in program evaluation: the impact of a women’s empowerment program on immunization. Journal of the European Economic Association. 9(11):1082–1113.

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Key Evidence: 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.

Merten, S., Hilber, A.H., Biaggi, C., et al. 2015. Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review.. PloS ONE. 10(8).

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Key Evidence: A study looking at the relationship between gender roles and full immunization coverage of children in Nigeria found that children of mothers who did not have decision-making autonomy were half as likely to be fully immunized than mothers with autonomy. To further assess the roles of gender and relationship power, children were nearly twice as likely to be fully vaccinated in households where only the mother contributed to household earnings compared to children whose parents contributed equally.

Antai, D. 2012. Gender inequalities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study. Journal of Infectious Disease. 16(2).

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Key Evidence: A study conducted in Pakistan exploring the association of maternal education and empowerment with childhood polio vaccination found a positive association between maternal empowerment, defined as mother’s involvement in decision-making regarding family, healthcare, and other issues, and complete polio vaccination of their children.

Khan, M.T., Zaheer, S., Shafique, K. 2017. Maternal education, empowerment, economic status, and child polio vaccination uptake in Pakistan: a population based cross sectional study. BJM Open. 7(3).

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Key Evidence: 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.

From the VoICE editors: 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.

Ebot, J.O. 2014. Place Matters: Community Level Effects of Women’s Autonomy on Ethiopian Children’s Immunization Status. African Population Studies. 28(2).

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Key Evidence: A systematic review of studies from countries in Africa and Southeast Asia investigated the relationship between a woman’s “agency” (defined as the woman’s ability to state her goals and to act upon them with motivation and purpose) and childhood immunizations in lower-income settings. The review found a general pattern among studies in which higher agency among mothers was associated with higher odds of childhood immunizations. Empowering women in these settings shows promise as a means to improve child health.

Thorpe, S., VanderEnde, K., Peters, C., et al. 2016. The influence of women’s empowerment on child immunisation coverage in low, lower-middle, and upper-middle income countries: a systematic review of the literature.. Maternal and Child Health Journal. 20(1).

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