Gender Equality and Vaccination: Why It Matters for Every Family

This informal CPD article ‘Gender Equality and Vaccination: Why It Matters for Every Family’ was provided by Cima Care, who offer extensive training in vaccination and public health, advancing global health initiatives.

"Why don't we see more women making healthcare decisions in our community?" "Could my daughter's education affect her future children's health? What does gender equality have to do with childhood vaccines? These types of questions matter more than you might think. Research worldwide shows that gender equality is not just about fairness. It is often directly linked to whether children get life-saving vaccines. Understanding this connection can help us protect more children and build healthier communities.

The Hidden Connection Between Gender Equality and Vaccination Rates

Recent research reveals a striking pattern: in regions where women face greater inequality, fewer children receive their full vaccination schedule. Here's what the data shows:

A 2022 study examining 702 regions across 57 countries found that areas with higher gender inequality had significantly lower childhood vaccination rates, with 71.0% coverage in high-inequality areas compared to 79.2% in more equal regions. (1) 

Even more concerning, a comprehensive review of 108 studies found that girls were 3% less likely than boys to be fully vaccinated. (2) In the rural United States, women themselves face vaccination disparities, with rural counties showing first-dose coverage of just 61.4% compared to 77.6% in urban areas. (3)

When Mothers Have Decision-Making Power, Children's Health Improves

One of the most powerful findings in recent research is how maternal authority over healthcare decisions directly affects vaccination rates: (4)

• In Nigeria, when women had more say in household decisions, their children were 64% more likely to receive all recommended vaccines.
• In Ethiopia, the difference is even more dramatic. When mothers could make healthcare decisions independently, their children were significantly more likely to be fully vaccinated than families where husbands made all health decisions.
• In Bangladesh, women with greater freedom in healthcare decisions had higher vaccination rates among their children—86.1% compared to 78.8% among those without such autonomy. (4)

These are not just statistics. They represent millions of children whose protection against preventable diseases depends on whether their mothers have a voice in healthcare decisions.

Education Changes Everything

Maternal education begins with a ripple effect that extends to children's health. Here's why it matters:

Women with limited literacy often struggle to understand vaccination schedules and the importance of completing all vaccine doses. (5) Research shows that children whose mothers had no formal education were about 27% less likely to be fully vaccinated compared to those whose mothers had at least primary education. (2) Education equips mothers with the knowledge to navigate healthcare systems, understand medical advice, and support their children's needs, all crucial factors in ensuring complete vaccination.

The Barriers Women Face

Gender inequality creates practical obstacles that directly prevent children from getting vaccinated:

• Limited mobility and resources: In many regions, women must rely on men for transportation to health facilities, money for healthcare expenses, and even permission to seek medical services for their children. (6, 7)
• Time constraints: Women often shoulder extreme family and caregiving responsibilities, making it difficult to attend vaccination appointments during clinic hours. (6, 7)
• Cultural restrictions: In some communities, women cannot interact with male healthcare workers, yet female health workers remain scarce. In India, districts with more than 50% female medical officers achieved 69.7% full immunisation coverage for children aged 12-23 months, compared to just 63.7% in districts with fewer female officers. (4)

Understanding the Healthcare Workforce Challenge

The healthcare workforce itself reflects gender inequality, which in turn affects vaccination coverage. Despite women comprising 70% of the global health workforce, they occupy only 25% of senior roles. Even more concerning, approximately $1.5 trillion worth of women's contributions to healthcare goes unpaid. (8)

Female healthcare workers face additional challenges, including workplace discrimination, unequal pay, limited advancement opportunities, and sometimes harassment from colleagues or patients. (9) This affects not only their careers but also their ability to deliver consistent immunisation services.

What Can Be Done? Practical Solutions That Work

Addressing gender inequality in vaccination requires action at multiple levels. Here are evidence-based strategies currently making a difference:

Empower Women Through Education and Economic Opportunity

When parents share authority over family decisions and financial resources, their children are more likely to be fully vaccinated. (10, 11) Communities can implement programmes that increase women's employment opportunities, enhance their decision-making power, and improve their health-related knowledge. (10, 11) Incorporating vaccination information into educational materials for women has proved particularly effective. (11)

Make Healthcare More Accessible

Improving women's access to immunisation services makes it easier for carers, primarily mothers, to vaccinate their children. (11) This includes:

• Mobile clinics that bring services to remote communities
• Integrating vaccination with maternal health check-ups to reduce the number of trips required
• Extending clinic hours to accommodate working mothers (11, 12)

Engage Men as Partners

Men play an important role in family health decisions, but their involvement should support, not silence, women's voices. (11, 13)

In Mozambique, successful programmes have improved men's understanding of routine immunisation and how they can support their family's well-being while reducing power imbalances between mothers and fathers. (11) Effective approaches include incorporating equal parenting, shared decision-making, and domestic responsibilities into all health promotion messages. (13)

Work Across Sectors

Addressing gender inequality in immunisation requires collaboration between health, education, and social services sectors. (11, 14) Successful initiatives include:

• Partnerships with transportation services to improve access to vaccination centres in remote areas
• Coordination between different government departments to address root causes of inequality
• Sharing tools and experiences across regions and countries (11, 14)

Support Gender-Responsive Policies

Governments and health organisations can implement policies that prioritise women's and girls' needs in vaccination efforts. (11, 14) Promising approaches include:

• Gender-responsive budgeting that ensures adequate investment in services for women and girls, as implemented in countries like Austria, Morocco, Rwanda, and Colombia. (15)
• Paid parental leave and flexible work arrangements that make it easier for carers to attend vaccination appointments. (16)
• Increased clarity in how healthcare budgets are administered and spent. (15)

Why This Matters for Your Family and Community

Understanding the link between gender equality and vaccination is not just about global health statistics. It's about realising how power dynamics in families and communities affect children's access to life-saving protection. When women have education, economic opportunities, and decision-making authority, the benefits can extend far beyond vaccination. Children grow healthier; families become more resilient, and communities thrive.

Whether you are a parent, healthcare provider, community leader, or simply someone who cares about public health, you can help close the gender gap in immunisation. This might mean:

• Supporting policies that support gender equality in your community
• Ensuring vaccination services are accessible to all women, regardless of their circumstances
• Supporting women's education and economic empowerment initiatives
• Challenging social norms that limit women's decision-making authority
• Conversing up when you see gender-based obstacles to healthcare access (1-16)

Key Takeaways

• Across 702 subnational regions in 57 countries, higher gender equality was associated with about 8 percentage points higher DTP3 vaccination coverage. (1)
• Children of mothers with greater decision-making authority have significantly higher odds of being fully vaccinated. (4)
• Maternal education significantly impacts vaccination rates—children of mothers with no formal education are about 27% less likely to be fully vaccinated. (2)
• Women face multiple barriers to vaccinating their children, including limited mobility, financial dependence, and cultural restrictions. (6, 7)
• Women comprise roughly 70% of the global health workforce yet still face systemic discrimination and barriers to advancement. (8, 9)
• Evidence-based solutions include empowering women through education, improving healthcare access, engaging men as partners, and implementing gender-responsive policies. (10-18)

Looking Forward

Closing the gender gap in immunisation is complex but achievable. By implementing evidence-based strategies and recognising that gender equality and public health are inseparably linked, we can work toward a future where every child—regardless of gender, family circumstances, or community—has equal access to life-saving vaccines.

The data has become increasingly clear. When we advance gender equality, we are more likely to protect children. When we empower women, we can strengthen families. When we remove barriers to healthcare access, we build healthier communities for everyone. 

We hope this article was helpful. For more information from Cima Care, please visit their CPD Member Directory page. Alternatively, you can go to the CPD Industry Hubs for more articles, courses and events relevant to your Continuing Professional Development requirements.

References

1- Johns NE, Kirkby K, Goodman TS, Heidari S, Munro J, Shendale S, Hosseinpoor AR. Subnational gender inequality and childhood immunization: an ecological analysis of the subnational gender development index and DTP coverage outcomes across 57 countries. Vaccines. 2022 Nov 18;10(11):1951.

2- Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J. Vaccine equity in low- and middle-income countries: a systematic review and meta-analysis. International journal for equity in health. 2022 Jun 11;21(1):82.

3- Saelee R, Zell E, Murthy BP, Castro-Roman P, Fast H, Meng L, et al. Disparities in COVID-19 Vaccination Coverage Between Urban and Rural Counties — United States, December 14, 2020–January 31, 2022. MMWR Morbidity and Mortality Weekly Report. 2022 Mar 4;71(9):335–40.

4- Kalbarczyk A, Brownlee N, Katz E. Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low-and Middle-Income Countries. Vaccines. 2024 Jun 5;12(6):625.

5- Breaking the Barriers: How Gender Equity Advances Immunization – VoICE [Internet]. immunizationevidence.org. January 24, 2023, Available from: https://publichealth.jhu.edu/ivac/breaking-the-barriers-how-gender-equity-advances-immunization

6- Gender-related Barriers to Immunization: Zero-dose Children [Internet]. Unicef.org. 2023 [cited 2024 Oct 1]. Available from: https://www.unicef.org/mena/reports/gender-related-barriers-immunization-zero-dose-children

7- Breaking the Barriers: How Gender Equity Advances Immunization – VoICE [Internet]. immunizationevidence.org. January 24, 2023, Available from: https://boostcommunity.org/news/645896

8- Seeking Gender Equality in the Global Health Workforce | Think Global Health [Internet]. Council on Foreign Relations. March 8, 2024. Available from: https://www.thinkglobalhealth.org/article/seeking-gender-equality-global-health-workforce

9- Hennein R, Gorman H, Chung V, Lowe SR. Gender discrimination among women healthcare workers during the COVID-19 pandemic: Findings from a mixed methods study. Plos one. 2023 Feb 6;18(2):e0281367.

10- Amoah A, Issaka J, Ayebeng C, Okyere J. Influence of women empowerment on childhood (12–23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries. Tropical Medicine and Health. 2023 Nov 14;51(1):63.

11- Gerber W, Fields R, Guesela N, Nuhu KA, Manika E. Beyond constructs and principles: addressing gender-related barriers to high, equitable immunization coverage. Frontiers in Global Women's Health. 2024 Apr 3;5:1367590.

12- Bliss KE, Carbaugh A. Gender-Responsive Programming to Improve Immunization Services [Internet]. Csis.org. 2022 [cited 2024 Oct 6]. Available from: https://www.csis.org/analysis/gender-responsive-programming-improve-immunization-services

13- Biko Mwalagho. Beyond the Vaccine: Addressing Gender Barriers in Immunization Efforts - CanWaCH [Internet]. CanWaCH. 2023 [cited 2024 Oct 6]. Available from: https://canwach.ca/article/beyond-the-vaccine/

14- Feletto M, Sharkey A, Rowley E, Gurley N, Sinha A, Gupta A, et al. A gender lens to advance equity in immunization [Internet]. 2018 [cited 2024 Oct 6]. Available from: https://www.gavi.org/sites/default/files/document/programmatic-policies/ERG_A-gender-lens-to-advance-equity-in-immunization.pdf

15- UN WOMEN. What is gender-responsive budgeting? [Internet]. UN Women – Headquarters. 2023. Available from: https://www.unwomen.org/en/news-stories/explainer/2023/11/what-is-gender-responsive-budgeting

16- UNICEF. Family-Friendly Policies A Policy Brief Redesigning the Workplace of the Future [Internet]. 2019. Available from: https://www.unicef.org/sites/default/files/2019-07/UNICEF-policy-brief-family-friendly-policies-2019.pdf

17-- Mucheru D, Mollel H, Gilmore B, Kesale A, McAuliffe E. Advancing Gender Equality in Healthcare Leadership: Protocol to Co-Design and Evaluate a Leadership and Mentoring Intervention in Tanzania. Annals of Global Health. 2024;90(1).

18- Closing the leadership gap: gender equity and leadership in the global health and care workforce [Internet]. www.who.int. Available from: https://www.who.int/publications/i/item/9789240025905‌