Gender Barriers to Immunization: A Synthesis of UNICEF's Analyses to Advance Equity and Coverage

Despite global efforts to improve childhood immunization rates, gender-related barriers continue to hinder equitable access to vaccines worldwide. This study synthesizes gender barrier analyses conducted in various countries to better understand these challenges. This evidence synthesis aims to (1) identify the main gender-related barriers affecting immunization focusing on zero-dose targets, HPV, and COVID-19 vaccination campaigns; and (2) summarize key recommendations and lessons that have emerged from countries to overcome those gender barriers.

A documentary analysis was used by reviewing data from gender barrier analyses that were conducted by multiple governments with UNICEF support. The study classified barriers using the socio-ecological model (SEM), encompassing systemic, health service, community, household, and individual-level gender barriers. Descriptive statistics and inductive thematic coding were used to analyze data.

This synthesis includes 24 documents representing gender barrier analyses across 29 countries. Findings highlight multiple barriers, including systemic discrimination against women in public and healthcare spaces, limited political will to address gender disparities, and limited (sex)-disaggregated and gender data. At the community and household levels, social norms restrict women's autonomy in seeking immunization services, while household duties (culturally assigned to women) also restrict their access to immunization services. Adolescents face additional challenges, particularly regarding HPV vaccination, due to misconceptions and stigma from families and peers.

Addressing gender-related barriers requires a multi-level approach, integrating gender-responsive policies, and comprehensively addressing gender barriers that are hindering the progress of vaccination efforts. UNICEF's commitment to gender-responsive immunization strategies is critical for achieving the Immunization Agenda 2030 and ensuring equitable vaccine access for all.