Abstract
BackgroundA variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state.MethodsWe analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles.Results Immunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended.ConclusionsGender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. in HindiSee the full article online for a translation of this abstract in Hindi.
Highlights
A variety of studies have considered the affects of India’s son preference on gender differences in child mortality, sex ratio at birth, and access to health services
The sampling, questionnaire structure, and content of the National Family Health Survey (NFHS) surveys follow what has been adopted by the Demographic Health Surveys (DHS) in other developing countries
We considered children age-appropriately immunized if they had received all immunizations for their age according to the WHO’s Expanded Program on Immunization (EPI) immunization schedule
Summary
A variety of studies have considered the affects of India’s son preference on gender differences in child mortality, sex ratio at birth, and access to health services. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically. Girls born in India have a 40% greater risk of ill health compared to boys and are less likely to access health care, in particular immunization [11,13,14]. Contrary to the trends observed in most of the world, in India more girls than boys die of acute respiratory diseases, infectious and parasitic diseases, and viral infections [15,16]
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