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.
In a study designed to explore the association of maternal education and empowerment with childhood polio vaccination rates in Pakistani mothers, it was observed that the highest percentage of completely vaccinated children (72.6%) was seen among mothers of the richest quintile, followed by 63.4%, 58.0%, 49.8%, and 39% for the richer, middle, poorer, and poorest wealth quintiles, respectively.
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.
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.
An ecological study designed to investigate the association between child mortality rates and gender inequality using the United Nations Development Programme’s Gender Inequality Index (GII), showed that low- and middle-income countries have significantly higher gender inequality and under-5 mortality rates than high-income countries. Greater gender inequality was significantly correlated with lower immunization coverage and higher neonatal, infant, and under-5 mortality.
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%).
In an analysis of statewide survey data collected in Bihar, India, researchers reported that female newborns had significantly lower odds of receiving care if ill compared to male newborns (80.6% vs. 89.1%) and lower odds of having a postnatal check up visit within a month of birth (5.4% vs. 7.3%). This gender inequity is more pronounced among families at lower wealth levels and those with higher numbers of siblings.
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.
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.
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.
