Gender-related barriers can also have an indirect impact on immunisation. Social and cultural norms, and the unequal status of women in many societies, can reduce the chances of children being vaccinated, by preventing their caregivers from accessing immunisation services. Due to gender norms, it is often women’s responsibility to bring children for vaccination; yet women in lower-income countries often face gender-related barriers to doing so, including: time constraints due to high workload; limited funds for transport; and lack of access to information on disease prevention. In many countries, vaccinators are predominantly women, and they may face barriers in delivering vaccine services due to gender norms, unsafe working conditions, poor or irregular pay, and heavy workload. The United Nations’ Gender Development Index confirms that countries with a high level of gender equality have higher immunisation coverage.

At the global level, there is no significant difference in immunisation coverage for boys and girls. Yet in some countries and communities, gender discrimination means that boys have greater access to vaccines than do girls. In others, the opposite is true – girls have greater access. 

Gavi works with countries to address gender-related barriers, and ensure all children of all genders have equal access to vaccines.

COMMON GENDER-RELATED BARRIERS TO VACCINATION

	Caregivers may lack information and awareness on the benefits of vaccination
	Division of labour in the household may detract from fathers’ involvement with childcare duties, including vaccination
	Low socio-economic status of caregivers or lack of women’s access to household funds may limit means to afford indirect costs of vaccination
	Religious practices or cultural values may prevent women caregivers from seeking immunisation services from men health workers
	Travelling long distances to health clinics may deter women, particularly younger mothers, from bringing children for immunisation due to safety and mobility issues
	Long wait times at clinics and immunisation sites only open during working hours may conflict with caregivers working in income-generating activities
	Negative attitudes of some health service providers may discourage caregivers from return visits to complete immunisation schedule

As part of this effort, Gavi-supported countries are encouraged to analyse and understand how coverage varies by sex, income and geographic location to help identify reasons for low immunisation coverage in certain groups.

Efforts to better understand gender-related barriers and activities are crucial to find solutions to these often subtle but important obstacles, which may prevent children of all genders from being immunised.

For example, in settings where it is considered inappropriate for a woman or girl to see a man vaccinator or health worker, countries can receive Gavi support to help ensure that women health workers are trained and available to provide immunisation services to women and children.

HPV is the main cause of cervical cancer. In 2020, over 179,000 deaths from cervical cancer occured in lower-income countries, where women often lack access to screening and treatment. Vaccinating adolescent girls before they are exposed to the virus can prevent up to 90% of all cervical cancer cases. By 2025, approximately 86 million girls in Gavi-supported countries are expected to have been immunised with HPV vaccine.

Rubella can cause serious malformations and disabilities in babies (including deafness, blindness and heart defects) if their mothers are infected during the first three months of pregnancy. Gavi helps countries introduce the combined measles-rubella vaccine for all children, to fight this devastating but preventable disease.