The impact of Women's empowerment on childhood vaccination coverage in Nigeria: a spatio-temporal analysis

TL;DR

This study investigates how women's empowerment influences childhood vaccination rates in Nigeria, revealing that increased household and healthcare decision-making autonomy generally improves immunization coverage, with effects varying across regions.

Contribution

It introduces two new empowerment indices and applies a spatiotemporal model to quantify their impact on vaccination disparities in Nigeria.

Findings

Empowerment in household decision-making correlates with higher vaccination rates.

Geographical variation affects the strength of empowerment's impact.

Targeted strategies are needed to address regional disparities.

Abstract

Immunization remains one of the most effective public health interventions, substantially reducing childhood morbidity and mortality worldwide. Yet, gender disparity and women's disempowerment continue to hinder access to vaccination services in low- and middle-income countries. In Nigeria, variations in social norms and cultural values shape gender roles, limiting women's autonomy in healthcare decisions and household participation. These constraints contribute to spatial differences in immunization uptake. Using data from four waves of the Nigeria Demographic and Health Survey, we developed two empowerment indices capturing women's participation in household decision-making and their ability to decide on personal healthcare needs. A structured spatiotemporal statistical model was applied to assess how much of the observed vaccination disparities could be attributed to women's empowerment and to predict vaccination outcomes at the third administrative level. We examined five indicators: Bacillus Calmette-Guerin (BCG), zero-dose, complete DPT, MCV-1 (first dose of measles-containing vaccine), and all-basic vaccination coverage. Model validation involved comparing empirical estimates with projections at the second administrative level. Results indicate that empowerment related to household participation and healthcare autonomy generally increases vaccination uptake, though the magnitude of effects varies geographically, particularly among highly empowered women. Despite ongoing national efforts to close immunization gaps, the study highlights the need for context-specific strategies that enhance women's decision-making power and community engagement to reduce regional disparities and improve overall vaccination coverage.