Gender Equality Can Boost Vaccine Coverage

Understanding the gender gap in immunity

Gender equity in immunization is not just a moral imperative; it's a crucial factor in reaching global health goals. Studies provide evidence for the negative impact of gender inequality and the related barriers to childhood immunization coverage. The impacts strengthen calls for transformative approaches and practices to offer gender equity in immunization services.

• Gender inequality and immunization coverages: A 2022 study analyzing 702 subnational regions across 57 countries found that areas with higher gender inequality had lower DTP3 immunization coverage (71.0% in higher-inequality regions vs. 79.2% in the lower-inequality areas). [1] A systematic review and meta-analysis of one hundred and eight studies found that females were 3% less likely to be fully vaccinated. [8] Moreover, 2022 findings reveal a significant disparity in rural regions of the United States, where women are less likely to be vaccinated, with lower first-dose coverage in rural counties (61.4%) compared to women in urban counties (77.6%). [9]
• National-level gender inequality and immunization: A multi-country study among children aged 12-23 months, using data from 2010-2019, found that higher gender inequality at the national level was significantly associated with more zero-dose DTP vaccine doses and lower full DTP3 immunization coverage. The study concludes that national gender inequality impacts childhood immunization rates, emphasizing the need to address gender barriers to achieve universal vaccine coverage and ensure no child is left behind. [2]
• Women's empowerment and decision-making authority: Research shows a strong link between mothers' decision-making power and childhood vaccination rates. For instance, in Nigeria, when women had more say in household decisions, their children were 64% more likely to receive all recommended vaccines. Another study in Ethiopia is even more dramatic. When mothers could make healthcare decisions independently, their children were four times more likely to be fully vaccinated than families where husbands made all health decisions. Similarly, in Bangladesh, women with greater freedom in healthcare decisions had a higher rate of fully vaccinated children than those without such autonomy (86.1% vs. 78.8%). [3]
• Maternal education: Several studies have shown that maternal education is significantly associated with children's vaccination coverage. Women with limited literacy or poor education are less likely to comprehend vaccination schedules and the importance of numerous vaccine uptakes. [5] According to a study, children of mothers without formal education were 27% less likely to be fully vaccinated compared to those whose mothers had at least primary education. [8]
• Access and decision-making barriers: Gender inequality makes access barriers for women. Such as limited mobility, lack of access to transportation, limited access to money and other resources, and time restrictions due to family and caregiving burdens. Moreover, in many regions, women must depend on men to provide transportation, therapy fees, and permission to receive immunization services for children. These obstacles directly contribute to lower vaccination coverage rates, preventing timely and equitable coverage of essential healthcare services. [4 & 5]
• Health workforce composition: In some regions, women are not allowed to interact with unrelated men, and men often prefer that female health workers vaccinate their wives and daughters. In India, a study found that districts with over 50% lady medical officers had higher full immunization rates for children aged 12–23 months compared to districts with fewer female officers (69.7% vs. 63.7%). However, many female health workers face challenges, including safety concerns, harassment from caregivers, and issues with low or delayed payment. [3]

Training Disparities and Deployment Challenges

• Limited Access to Education: In many low- and middle-income countries, girls and women face significant educational barriers, restricting their ability to enter healthcare professions and advance in their careers.
• Stereotyping and Mentorship: Gender stereotypes often limit women to roles like nursing and discourage them from leadership or surgical positions, while governments and organizations may prioritize mentorship opportunities for males.
• Occupational Segregation: Women in healthcare often engage in lower-status roles, mainly in nursing, midwifery, and primary care, limiting their career advancement.
• Gender Occupancy, Senior Role, and Payment: Despite making up 70% of the global health workforce, women occupy only 25% of senior roles, and around $1.5 trillion of women's assistance to health is unpaid. [6]

Workplace Discrimination

Gender inequality in the workplace affects female healthcare workers' placement and continued employment. As a result, vaccination coverage rates suffer, especially among women and children, who may be less likely to access immunization services in the absence of female healthcare workers.

• Belittlement by colleagues: Women healthcare workers report experiencing belittlement from colleagues, impacting their confidence and career progression.
• Gendered workload distributions: Female healthcare workers often face an unequal distribution of tasks, with expectations that they take on more administrative assistance or caregiving roles.
• Unequal opportunities: Women report fewer prospects for professional advancement than their male counterparts.
• Communication expectations: There are often different expectations for how women should communicate in the workplace, which can impact their effectiveness and perception by others. [7]

From Data to Action: CIMA's Commitment to Global Health

At CIMA Care, we recognize the complex challenges of gender inequality in global immunization. We invite healthcare professionals, policymakers, institutions, and researchers to address gender disparities in immunization. By fostering awareness and providing equal access to information and digital tools, we hope to contribute to a more equitable global health landscape. Visit www.cima.care to explore how our tools can support your work in improving vaccination rates for all.

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