The influence of gender on immunisation: using an ecological framework to examine intersecting inequities and pathways to change
Open accessAbstract
There is still a substantial knowledge gap on how gender mediates child health in general, and child immunisation outcomes in particular. Similarly, implementation of interventions to mitigate gender inequities that hinder children from being vaccinated requires additional perspectives and research. We adopt an intersectional approach to gender and delve into the social ecology of implementation, to show how gender inequities and their connection with immunisation are grounded in the interplay between individual, household, community and system factors. We show how an ecological model can be used as an overarching framework to support more precise identification of the mechanisms causing gender inequity and their structural complexity, to identify suitable change agents and interventions that target the underlying causes of marginalisation, and to ensure outcomes are relevant within specific population groups.
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The low societal status of women is increasingly shown to be one of the most universal factors adversely impacting equitable childhood immunisation.
“The low societal status of women —manifesting in a lack of resources, agency, and power—is increasingly shown to be one of the most universal factors adversely impacting equitable childhood immunisation.75–78”
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Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-008-0197-4 · Cited by 1,894 · see citing works
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Haeuser, E., Byrne, S., Nguyen, J., Raggi, C., McLaughlin, S. A., Bisignano, C., Harris, A. A., Smith, A. E., Lindstedt, P. A., Smith, G., et al. (2025) · The Lancet · doi:10.1016/s0140-6736(25)01037-2 · Cited by 143 · see citing works
Addressing the persistent inequities in immunization coverage
Chopra, M., Bhutta, Z., Chang Blanc, D., Checchi, F., Gupta, A., Lemango, E. T., Levine, O. S., Lyimo, D., Nandy, R., O'Brien, K. L., et al. (2020) · Bulletin of the World Health Organization · doi:10.2471/blt.19.241620 · Cited by 90 · see citing works
- Authors
- Feletto, M., & Sharkey, A.
- Affiliations
- United Nations Children's Fund (US)
- Corresponding author
- Sharkey, Alyssa
- Venue
- BMJ Global Health
- Publisher
- BMJ
- Published
- 2019-09
- Volume
- 4
- Issue
- 5
- Pages
- e001711
- ISSN
- 2059-7908 (ISSN-L)
- PMC
- PMC6747884
- OpenAlex
- W2972470382
- Cited by
- 63
- References
- 3
- Citations by year
- 2026: 13 · 2025: 15 · 2024: 5 · 2023: 8 · 2022: 11 · 2021: 4 · 2020: 4 · 2019: 3
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Global Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Gavi, The Vaccine Alliance
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Social Sciences › Sociology and Political Science › Gender, Health, and Social Inequality
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
- Keywords
- gender inequity, childhood immunization, vaccination coverage, intersectionality, social ecology, ecological model, child health, health interventions, marginalization
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