VoICE Immunization Evidence: Education Inequity
Key Evidence: Across many South Asian and sub-Saharan African countries, children of mothers who received no formal education were nearly 3 times as likely to die before reaching age 5 as those born to mothers with some secondary education.
Key Evidence: Children in the U.S. whose mothers were not educated beyond high school have significantly lower vaccination rates for rotavirus than children of mothers with advanced degrees (68% vs. 84%).
Key Evidence: In India, inequities in vaccination coverage exist between states, within states, and in urban vs. rural settings. Lower parental education resulted in lower coverage, girls had lower coverage than boys and infants born to families with a large number of children also had lower coverage than others. A direct relationship between household wealth and coverage was also found.
Key Evidence: Wealth and mother’s education are significant predictors of vaccination rates in both urban and rural settings. However, low paternal education, lack of antenatal care, and home births were significantly associated with low vaccination rates only in rural settings. This suggests the need for tailored vaccine programs.
From the VoICE Editors: This study compared the significance of risk factors for low vaccination rates in rural versus urban settings in Tanzania.
Key Evidence: In a large survey in Pakistan, children were about 30% more likely to receive all the national immunization program vaccinations on time if either their mother or father had a secondary school or higher level of education than those whose mothers or fathers had no formal education.
Key Evidence: Nigerian Demographic Health Survey data suggests that community literacy influences immunization status. Children in communities with low levels of illiteracy were 82% less likely to be fully immunized than children in communities with medium levels of illiteracy.
Key Evidence: Children of mothers with secondary education or higher were significantly more likely to be fully immunized than children of mothers with lower levels of educational attainment.
From the VoICE editors: Data was collected in the Democratic Republic of Congo from a cross-sectional survey (the Demographic and Health Survey) and analyzed in the aggregate. However, the authors note high variation in coverage across localities.
Key Evidence: A study conducted in Eastern Uganda found that Ugandan children whose mothers had some secondary schooling were 50% more likely to have received scheduled vaccinations by 6 months of age than children whose mothers had attended school only through primary level. This effect became more pronounced with delivery of the later doses of each vaccine (OPV2, 3 & DPT-HB-Hib 2,3).
Key Evidence: Children born to mothers in Southwest Nigeria who had no formal education were four times more likely to be unvaccinated or partially vaccinated than those born to mothers who completed primary school, and were six time more likely to be partially or unvaccinated than children whose mothers completed a post-secondary education.
Key Evidence: Maternal education benefits immunization rates of all community members, not only mothers’ own children. In Nigeria, children’s odds of being fully immunized improved by 1.06 times for every additional year of education the mothers received. Children’s odds of being fully immunized increased by 1.2 times for each additional year of maternal education in the community.
From the VoICE Editors: The authors controlled for factors including maternal employment, average household wealth, whether the child was born in a hospital, urban status of communities, and geographic location of communities.
Key Evidence: A study looking at WHO data from member states shows that globally, coverage of the third dose of DTP is 26% higher among children born to mothers with some secondary education compared to mothers with no education.
Key Evidence: Data from the Kenya Demographic and Health Survey show that women with a primary school education were 2 to 5 times more likely to have their infants vaccinated (depending on the vaccine) and women with a secondary school education were 2.5 to 9 times more likely to have their infants vaccinated than mothers with less than a primary education or no education [after adjusting for wealth, age, religion and other variables]. Targeted communications activities to sensitize less educated women on the value of vaccination could be a short-term measure to close this gap.
Key Evidence: A study conducted in Pakistan, designed to explore the association of maternal education and empowerment with childhood polio vaccination, showed that mothers with more education are more likely to vaccinate their children – 74% of children of mothers with higher education were completely vaccinated compared to 67% of those with primary education and only 47% of those with no education.
Key Evidence: Researchers looking at vaccination coverage in 45 low- and middle-income countries found that maternal education is a strong predictor of vaccine coverage. Children of the least educated mothers are 55% less likely to have received measles containing vaccine and three doses of DTP vaccine than children of the most educated mothers.
Key Evidence: A study that examined the gender gap in immunization coverage in a rural area of Bangladesh showed that poverty, low maternal education, and second or higher birth order had a stronger negative effect on the likelihood of full immunization coverage for girls compared to boys. In other words, girls from households in this area that were below the poverty line were 11% less likely to be fully immunized than boys from households below the poverty line. Girls were also 6% less likely than boys to be fully vaccinated if their mothers did not attend high school and 5% less likely than boys to be vaccinated if they were not the first born child in the family.