How to ensure women aren't left behind in India's immunization drive

The gender gap in India has always been skewed, with most health indicators, literacy levels and employment statistics favoring men. As India embarks on its largest immunization drive against COVID-19, this gap is glaring - and must be addressed.

According to estimates, on 24 Aug 2021, more than 58 million doses have been administered so far, more than the entire population of some of the countries in the world. Yet women comprise only 46% of the total population vaccinated in India.

As a public health professional, I've seen this discrepancy before. During my tenure at the Immunization Technical Support to the Government of India, I visited most of the states in India for reviews, surveys and programmatic assessments relating to the Universal Immunization Programme, which is hailed as the largest immunization program in the world, reaching 26 million children and 30 million pregnant women annually with lifesaving vaccines. In 2015 I founded the nongovernmental organization Samarpann to address socio-economic issues at the grassroots levels. Since COVID-19 struck, we have been working to create awareness and access to the COVID-19 vaccine for women.

In this work, I've spoken to numerous women - mothers, caregivers and front-line workers - in urban and rural settings. What I found is that women's health is often neglected for multiple reasons, and that these challenges have been exacerbated by the pandemic.

Too often women are not the decision makers of their health. Their fathers, husbands and sons script how they approach their health. According to the National Family Health Survey, more women would let their husbands decide about their health care than those who said they would take decisions themselves.

In addition, women who do not go out to work are often not considered at risk of acquiring the disease. Adding to this challenge, immunization sessions are held during the day, when many are busy with household chores or taking care of their children. Women who are daily wage earners earn $2 – $3 per day and cannot afford to miss a day’s work. Getting two square meals a day is more essential for them than the protecting against a disease they haven’t contracted yet.

Compounding these challenges, the immunization sites or the mobile camps are often located far from their homes. Since many women are dependent on men for mobility, this would mean both of them missing work. Vaccine shortages add to the hesitancy, as despite travelling long distances and taking days off, they are still not assured a shot.

The fear of adverse effects from the vaccination is another roadblock. Many women are concerned that they would have side effects and miss additional days work. Moreover, in rural settings, paracetamol is seldom given, which means if they did have fever after the vaccine, they couldn't treat it.

Another difficulty is low rates of digital literacy and poor access to smart phones, making it a challenge for women to book appointments at vaccinations sites where online registration is mandatory.

At Samarpann we working with panchayats (local government bodies), local school teachers and community leaders to address fears and hesitancy in the population. Women have come up to me asking if immunization is safe during menstruation and if they can take it during pregnancy or trying to conceive. Vaccination is absolutely safe during pregnancy and has no linkages to affecting the fertility of a woman or man.

There is a mammoth task ahead for government and society. To bridge the immunization gap, the government needs to invest in behavior change communications - with personal communication from doctors, front-line workers and local community leaders. The government also needs to organize more camps near villages to make immunization sites more accessible and offsite registration in urban areas more common.

There must be also be strategies of providing non-financial incentives to compensate for the loss of work for poor families who get themselves immunized. For example, Samarpann is providing 10 days of ration and one year of stationery to children whose parents get immunized.

Most importantly, women need to be empowered. This holds true not only for COVID-19 immunization but for improving each aspect of their health, education and livelihood. Empowerment will come with financial independence, changing mindsets, giving them equal opportunities, and breaking the social barriers which mar their progress. Society cannot afford to leave women behind.