Gender and Immunization Global Gender Analysis Tool

"Around the world, the responsibility to ensure children's health through routine immunization overwhelmingly rests on the shoulders of women. Gendered analyses have revealed that entrenched and multi-level barriers hinder their use of and access to adequate vaccination services..."

This resource is designed to help United Nations Children's Fund (UNICEF) offices, governments, and partners systematically collect and analyse gender data to inform immunisation efforts across diverse regions and countries. It describes a global standard tool that provides guidance for conducting a gender analysis to explore the root causes of gender and intersecting inequalities, identifying key entry points for field-level programming that can drive structural change in vaccine access and usage.

Existing studies reveal that gender-related barriers to immunisation encompass a range of areas, from poor-quality services and negative health provider attitudes, to low education levels and health literacy, to limited autonomy in decision making and household dynamics, to lack of access and control over resources and mobility, to high prevalence of gender-based violence and harmful practices (UNICEF 2024). Gender barriers impede child immunisations and create socio-economic costs for women.

Developed by researchers, implementers, policymakers, and civil society organisations, the tool facilitates the collection of both general and context-specific data on gender and immunisation. The information gathered through use of the tool can help shape equitable immunisation policies at national and sub-national levels, providing insights that can drive more inclusive, effective vaccine programmes.

To effectively design immunisation programs that address gender-related disadvantages and vulnerabilities, the global tool is designed to provide adequate and actionable gender data through the following key components:
 

1. Identify both barriers and actionable solutions: Examine both the gendered barriers and solutions to immunisation in order to prioritise the design of the most impactful tailored programs that address both children's health outcomes and female caregivers' substantial unpaid workload and time constraints, for both supply and demand sides.
2. Examine both demand- and supply-side barriers: Analyse demand-side barriers, such as lack of awareness, to tailor communication and education strategies to address specific concerns and increase vaccine acceptance. Simultaneously, assess supply-side barriers, such as inadequate healthcare infrastructure or limited access to services that cost women time while waiting and traveling.
3. Encompass various socio-ecological levels: Analyse gender-related barriers and solutions across individual, household, community, health facility, and institutional/policy levels in order to identify at what specific levels barriers need to be addressed on the supply and demand side. Gaps and existing institutional capacity should also be identified.
4. Include an intersectional focus: Analyse the vulnerabilities that specific populations groups face in accessing and utilising vaccination services on the demand and supply side - e.g. children in zero-dose communities, vaccination of adolescent girls, children with disabilities, migrant or internally displaced children, mothers living with HIV, and adolescent mothers.
5. Unveil the role of men: Men's involvement (or lack thereof) in the immunisation process is crucial to develop targeted solutions and gender-transformative programming on the demand side.
6. Unpack the gender barriers in relations to underlying determinants of health: Understand underlying determinants of health and their gendered implications on the demand and supply side, since doing so can help to support solutions that go beyond the health system.
7. Link to overall gender equality context of the country: Connect efforts to improve immunisation offerings, through the supply side in particular, to the broader gender equality context.
8. Analyse existing programmes and opportunities: Include an assessment of programmes that already are in place to highlight key entry points to advance gender equality in immunisation efforts on both supply and demand sides. Assess the capacity and resources within Expanded Programs for Immunisation (EPI) to design, implement, and monitor gender-responsive programming.
9. Investigate the barriers of the health workforce: Identify and understand how gender influences the health workforce's perceptions and experiences on the supply side, and how their gender biases may influence performance, decision-making (in design or deployment), and other consequences.
10. Examine power dynamics: Unveil gendered power dynamics within communities, health systems, and policymaking processes, and shed light on how gender impacts household decision-making, resource allocation, and service access for demand and supply sides.
11. Identify local influencers and women's organisations: Map key stakeholders and allies at the local level who hold some level of authority within a community and who can shape public opinions, such as women led organisations. Specifically, identify those who can be mobilised to support community-based actions to address gender barriers to vaccinations and to mitigate against potential backlash on the demand side.

The document proceeds as follows:
 

• Part One introduces the guide.
• Part Two presents the global standard tool. As outlined here, UNICEF developed this tool by reviewing and evaluating existing tools in terms of their framework's purpose, the socio-ecological levels they encompass, the dimensions and indicators they capture, the methods they use, and their respective strengths and weaknesses (see Section 2.1 and Annex 1). The tool also builds on direct experience from applying some of the existing tools - particularly the UNICEF Regional Office for South Asia (ROSA) and the Behavioural and Behavioral and Social Drivers of Vaccination (BeSD) frameworks - in Nigeria, Tajikistan, and Kyrgyzstan (see Section 3 for some of the key lessons learned).
• Part Three details how to implement the global standard tool for gender analysis in immunization through four main stages: Stage 1 - Inception and Preliminary Research Design; Stage 2 - Secondary Research; Stage 3 - Primary Data Collection; and Phase 4 - Developing Actionable Solutions.
• The Annexes include specific interview guides, an overview of key frameworks, a tentative report outline, and categories and indicators for a literature review.