The Drum Beat 821 - Gender and Polio

• 1.Why Does Gender Matter for Immunization?
  by Tracey Goodman, Olivia Bullock, Jean Munro, et al. There are multiple ways in which gender roles, norms, and relations influence resource allocation, decision making, access, and outcomes of immunisation programmes. Gender is an important cross-cutting consideration for all 7 Immunization Agenda 2030 (IA2030) strategic priorities, especially #3: Coverage & Equity. This paper explores intersections between gender and IA2030's 4 core principles and outlines ways to design gender-responsive interventions that aim to contribute to more effective immunisation programmes and increased coverage for all. [Dec 2022] 
   
• 2.Subnational Gender Inequality and Childhood Immunization: An Ecological Analysis of the Subnational Gender Development Index and DTP Coverage Outcomes across 57 Countries
  by Nicole E. Johns, Katherine Kirkby, Tracey S. Goodman, et al. Gender-related barriers to immunisation operate at the individual, interpersonal, community, and broader socio-structural levels. This paper finds that subnational regions with higher gender inequality (favouring men) are expected to have 5.8 percentage points greater zero-dose prevalence (children who failed to receive any routine vaccination) than regions with lower inequality. "[T]hese findings lend further strength to calls for efforts towards greater gender equality to improve childhood immunization and child health outcomes broadly." [Nov 2022] 
   
• 3.World Polio Day Online Event on the 'Role of Women in Polio Eradication'
  This recording of an online GPEI event hosted by the United Nations Children's Fund (‎UNICEF) on World Polio Day 2021 includes a virtual trip around the world to hear from women involved in different roles in the polio eradication effort. For example, Nigeria's 20,000 polio community workers - more than 90% of them women - played a critical role in the country being certified wild polio virus (WPV) free in 2020. These women reached out to caregivers in areas where social norms prevented male polio team members from interacting with women in the community. There are similar examples from Pakistan and Afghanistan, where the increase in the female polio community workforce has contributed to growing vaccine acceptance in some previously-hesitant communities. [Oct 2021] 
   
• 4.Mid-term Review of the Global Polio Eradication Initiative (GPEI) Gender Equality Strategy 2019-2023
  by Sini Ramo This midterm evaluation found that the GPEI has made steady progress towards achieving most of the objectives set out in the Gender Equality Strategy, taking decisive steps to move from gender-blind programming to being more intentionally gender responsive. Going forward, strengthening meaningful and results-driven gender mainstreaming across the partnership requires dedicated gender expertise, scaled-up resources, and greater capacity on gender, as well as ownership by all staff at different levels. [Oct 2022] 
   

• 5.A Light Touch Intervention with a Heavy Lift - Gender, Space and Risk in a Global Vaccination Programme
  by Anna Kalbarczyk, Svea Closser, Selamawit Hirpa, Utsamani Cintyamena, Lutfhi Azizatunnisa, Priyanka Agrawal, Ahmad Omid Rahimi, Oluwaseun O. Akinyemi, Eric M. Mafuta, Wakgari Deressa, and Olakunle O. Alonge Frontline workers (FLWs) in the GPEI go door to door delivering oral polio vaccine (OPV) to children. They have played a pivotal role in eliminating WPV from most countries; at the same time, the mostly female FLWs face difficult work, long hours, very low pay, and bodily risk. This study explores how polio FLWs manage these complex demands through an approach grounded in body work (handling, assessing, and manipulating bodies). In so doing, it highlights aspects of health delivery, including intersections with gender, that are often neglected in the literature yet are, as argued here, critical for explaining the success or failure of global health programmes. [Jul 2022] 
   
• 6.Community Health Workers as Vaccinators: A Rapid Review of the Global Landscape, 2000-2021
  by Emily Gibson, Mariam Zameer, Rebecca Alban, and Luc Mahougbé Kouwanou This rapid review aims to identify conditions and circumstances under which community health workers (CHWs) can provide vaccination, given decreasing immunisation coverage rates and health workforce shortages in various contexts around the world. Safety concerns for female CHWs were mentioned for 2 cadres: auxiliary nurse midwives (ANMs) in India and lady health workers (LHWs) in Pakistan. ANMs and LHWs, who are all women, have experienced verbal, physical, and sexual abuse while conducting their work in remote areas. Recommendations to ensure equitable treatment of CHWs who vaccinate and increase immunisation access and equity in under-reached and rural communities are provided. [Feb 2023] 
   
• 7.Perceived Barriers to Accessing Female Community Health Volunteers' (FCHV) Services Among Ethnic Minority Women in Nepal: A Qualitative Study
  by Sarita Panday, Paul Bissell, Edwin van Teijlingen, and Padam Simkhada A thematic analysis of the data identified 5 major themes underlying barriers to accessing available services by Nepal's ethnic minority groups, such as lack of knowledge and low decision-making power of women. To promote women's use of health care, female community health volunteers (FCHVs) are mobilised across the country. One FCHV said, "I walked two to three hours up hill to provide polio drops. The woman did not accept the medicine. She said, 'Our children do not need medicine, they will survive'." This comment was consistent with the views of some service users for whom the concept of modern medicine was new. [Jun 2019] 
   
• 8.Bargaining and Gendered Authority: A Framework to Understand Household Decision-making about Childhood Vaccines in the Philippines
  by Jonas Wachinger, Mark Donald C Reñosa, Vivienne Endoma, Mila F Aligato, Jhoys Landicho-Guevarra, Jeniffer Landicho, Thea Andrea Bravo, and Shannon A McMahon In-depth interviews with caregivers of children under 5 in the Philippines who had delayed or refused vaccination revealed that gendered authority and power formed an unequal basis on which bargaining around childhood vaccination took place among household members. Although bargaining among parents, as well as paternal and maternal families, was based on ingrained, gender-based power imbalances, disadvantaged stakeholders drew on a range of interrelated sources of bargaining power to shape decision-making. [Sep 2022] 
   
• 9.Routine Immunization Strengthening in Polio High-Risk Geographies: Gender Integrated Approach
  by Samantha Le Duc, Santiago Estrada, Alison Wiyeh, and Paul Drain Understanding how gender norms, roles, and cultural restrictions influence access to immunisation is important for addressing issues related to global vaccine inequity and is a key component of polio eradication. This report examines the sociodemographic and immunisation context of 10 specific countries whose intrinsic factors disproportionally increase gender-related barriers, and it describes the association between gender and routine immunisation on the individual, household, community, health system, and policy levels. As argued here, policies and programmes that address gender-specific issues benefit both men and women - supporting the notion that gender-integrated approaches improve the quality of services and outcomes for all. [Sep 2021] 
   

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• 10.Seeing Old Problems Through a New Lens: Recognizing and Addressing Gender Barriers to Equitable Immunization - Webinar Recording
  Hosted by the United States Agency for International Development (USAID)-supported MOMENTUM Routine Immunization Transformation and Equity, this webinar shares key learnings about how gender barriers obstruct equitable access to immunisation services throughout a person's life. The discussion also highlights the global movement to strengthen country-level implementers' capacity, commitment, and confidence to develop and implement strategies addressing gender-related barriers to immunisation. One speaker spoke about Gavi's use of a gender lens in the implementation of the Zero Dose Strategy, as well as learnings from promising gender-responsive interventions in various countries around the world (e.g., leveraging female mobilisers in Afghanistan's polio Immunization Communication Network). [Apr 2022] 
   
• 11.Adopting a Gender Lens to Improve and Sustain Polio Vaccine Uptake in Afghanistan
  UNICEF conducted this study to understand the role of women in Afghanistan's polio programme. The study aimed to identify gender challenges, assess internal policies and procedures around women's participation, review communication for development (C4D) and social and behaviour change (SBC) materials through a gender lens, and provide actionable advice, including how to: (i) mainstream gender in communications and community engagement - e.g., produce pre-recorded radio drama episodes/spots and discussion guides with the relevant gender content integrated for different audiences; (ii) strengthen women's participation in the polio programme - e.g., improve knowledge and skills related to gender concepts, gender mainstreaming, and the influence of gender on immunisation; and (iii) improve gender and security factors affecting women's participation - e.g., continue to encourage Imams who are engaged in child health to mobilise men. [Feb 2022] 
   
• 12.Covering the Last Mile for Vaccination: Feasibility and Acceptability of Traditional Birth Attendant-Based Referral System in Hard-to-Reach Areas in Rural Pakistan
  by Ambreen Sahito, Siraj Ahmed, and Zafar Fatmi This study explored the feasibility of engaging traditional birth attendants (TBAs) to improve vaccination coverage in hard-to-reach areas of rural Sindh province, Pakistan. TBAs and LHWs were educated about vaccination and its importance, common misconceptions, how to counsel parents, etc. The highest increase from the baseline (74% Bacillus Calmette-Guérin (BCG) and 147% Penta-3) was observed in the TBA arm. While there was a 226% increase in vaccine dropout in the district overall, in the TBA area, dropout decreased by 62% in the TBA area. Being female, TBAs have access to homes in this culture; being from the local community, they can communicate with mothers more easily and have more information about newborns. [Dec 2020] 
   
• 13.Women's Empowerment and Children's Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis
  by Xinran Lu, Chuchu Fu, Qianyun Wang, et al. This study examined the association between women's empowerment and complete vaccination of children in the Democratic Republic of the Congo. The study of 3,524 women with children aged 12-23 months found that children of women who strongly opposed domestic violence or possessed more social resources were more likely to be completely vaccinated. Thus, the researchers conclude that: "National immunization campaigns should focus on women under unequal power relations, especially those in poor families." [Oct 2021] 
   
• 14.Why Gender Matters: Immunization Agenda 2030
  Gender-related barriers and gender inequality can prevent people, both male and female, from getting vaccinated. This document from World Health Organization (WHO), UNICEF, and GAVI, the Vaccine Alliance explains the need for mainstreaming of gender across the core principles and strategic priorities of IA2030. Chapter 4 outlines 9 gender-responsive approaches to increasing immunisation coverage along a continuum of gender-responsiveness. [Dec 2021] 
   

• 15.Gender and Immunization Demand: Final Report and Recommendations
  by Ami Sengupta This document provides guidance on how to integrate a gender perspective into demand interventions. UNICEF stresses that recognising the linkages and planning interventions that contribute to immunisation coverage as well as gender norm shifts requires robust gender analysis, strategic planning, and evidence-based design and adaptations. To that end, the report offers a series of practical recommendations to plan, design, implement, and monitor and evaluate demand generation interventions that have integrated gender. [2022] 
   
• 16.Gender and Immunization Demand Checklist
  From UNICEF, this checklist aims to guide country offices on key gender considerations as they plan, implement, monitor, and evaluate gender-responsive or transformative demand interventions for immunisation. It provides a broad list of considerations so planners can select those actions that are relevant or feasible in their contexts. [2022] 
   

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