Gender inequity is the result of imbalanced power dynamics in homes, communities, health facilities, and policies. The imbalance influences health outcomes, and the way it influences these outcomes can depend on local context. Promoting gender equity creates an environment where parents, especially mothers, are more empowered to make informed decisions about their children’s health including vaccinations.
Optimal health programs address unequal power dynamics that manifest in health systems. That’s the philosophy behind gender-intentional strategies.
In recent years, global stakeholders like Gavi, the Vaccine Alliance, the World Health Organization, and UNICEF have worked to develop a set of principles to raise awareness about gender-related barriers to immunization specifically. Here at PATH, our commitment to gender equity, paired with our deep technical expertise in immunization, has enabled us to organically test approaches and distill insights across multiple aspects of immunization programs.
The COVID-19 pandemic dramatically and rapidly highlighted (and exacerbated) entrenched structural inequities, including those related to gender. It was clear that addressing COVID-19 meant addressing the inequities it amplified, even as we reacted in real-time to the evolving landscape.
Fortunately, we were able to draw upon our previous analysis of gender-related barriers to immunization in Uganda as a guide. We knew, for example, that limited autonomy and low awareness of immunization are common barriers to female caregivers taking their children to get vaccinated.
We applied these insights to our co-created messaging handbook for national influencers, including faith leaders and politicians, to ensure that in their advocacy they would promote inclusion and equitable access for all Ugandans. And we tapped relationships with existing networks, such as the Uganda Parliamentary Forum for Immunization and the Uganda Women's Parliamentary Association, to elevate women as spokespeople for these messages and to center their voices.
Beyond COVID-19 vaccine uptake, such efforts provide a model for ways to organically integrate gender into immunization programs at any stage of implementation.
Fitting immunization within lived experiences
People-centered health care naturally meets people where they are, tailoring services to align with the realities and challenges of their daily lives. It is critical to consider how gender shapes those lived experiences. In PATH’s approach to human-centered design, health solutions are based on an ongoing conversation with intended audiences to ensure programs meet their needs. These conversations illuminate how structural barriers like gender intersect with other factors to impact vaccine access.
We know that the degree to which gender dynamics affect vaccine uptake depends upon interactions with other social determinants of health, like wealth, education/literacy, or geographic location. For example, women who live in remote settings are more likely to have to travel long distances to reach immunization services, but are less likely to do so due to safety concerns and to gender-prescribed childcare tasks, which disproportionately affect them.
These difficulties are especially prevalent for women living in poverty, for whom time away from work (or from home with children when male family members are working) has considerable financial consequences. Outreach campaigns, mobile clinics, home visits, flexible scheduling, integration with other existing services, health education and counseling, addressing cultural and language barriers, and incentives and rewards can remove some of these overlapping risk calculations.
Gender inequity in family and health care dynamics can have long-term health implications for children as they grow up.
Tools for subnational planning
Alongside with entrenched challenges like gender inequity, several emergent themes are compromising immunization rates in the post-COVID era, such as weakened trust in institutions, vaccine misinformation, and health worker turnover.
Across many countries, women—particularly caregivers of under-vaccinated children—report disrespectful interactions with health care workers, which can exacerbate feelings of distrust. Health workers may also unintentionally reinforce gender norms by sharing childcare information with female caregivers only, rather than promoting the joint responsibility of male caregivers, too, who in some cases still hold a disproportionate decision-making role.
A new PATH-led project to support immunization strengthening efforts in three middle-income countries (Indonesia, Ukraine, and Vietnam) will begin with a rapid assessment to identify context-specific barriers to maintaining child immunization coverage, including gender-related barriers. The findings will inform the development of local microplanning tools and community outreach strategies that reflect community context. This may, for example, include a self-assessment for health workers to identify personal biases that may impact service delivery.
Active consideration of gender-related barriers in vaccine access and demand is in everyone’s best interests. Each additional child vaccinated increases the impact of immunization investments and brings us one step closer to a more equitable world.
Visit our Defeat Diarrheal Disease Initiative website to learn more.
