As the second wave of COVID-19 hit India and countries across the world, severe oxygen shortages, overloaded hospital beds, and acute shortage of critical medicines resulted in a severe public health crisis. The economic and social fallouts of the pandemic have also affected the entire nation, and even with the vaccination drive currently underway, women continue to remain vulnerable. This blog examines demand-side factors that may have propagated the gender gap in COVID-19 vaccinations and discusses potential approaches for improving gender parity with regard to vaccination.
Vaccination Drive — Uneven Progress
With an exponential rise in cases during the second wave of COVID-19, there was a concerted policy push to ensure mass vaccinations for all eligible citizens, with the Government aiming to vaccinate all citizens by the end of 2021. As of August 18, 2021, India has administered approximately 56,06,52,030 doses (1st dose – 43,57,20,056; 2nd dose – 12,49,31,974) of COVID-19 vaccines, considerably falling short of its planned target of vaccinating all adults by the end of the year 2021.
As of October 2021, fewer women (47.81%) have been vaccinated with at least a single dose, as compared to 52.81% men, resulting in a ~5% percentage points “gender gap”. The Center for Economic Data & Analysis at Ashoka University in one of its studies also revealed the female to male vaccination ratio to be 0.90 (June 2021), implying that for every 100 men who are fully vaccinated, only 90 women received the vaccine that further highlights the gender gap. Emerging reports from the field suggest that in addition to deep-rooted structural issues such as lack of agency over health decisions, poor mobility and access to technology, vaccine hesitancy among women, especially in rural India, is a growing cause for concern.
What is Vaccine Hesitancy?
“Vaccine hesitancy” is a theme that recurs from previous pandemics like American flu and Smallpox in 1918. Studies from other countries show that reluctance towards vaccines is as old as the vaccines themselves. Even in India, studies on immunisation programmes conducted previously show gender gaps. The myths around vaccinations have intensified the gravity of the gender disparity, particularly in the context of COVID-19 vaccinations. The vaccine hesitancy is fueled by misinformation, mistrust and is not only prevalent in rural areas but also varies across gender, with women being more hesitant than men.
The Hesitancy Decoded
Reports and anecdotal evidence suggest that in the absence of reliable information, women are likely to believe claims about side effects such as infertility and disruption of menstrual cycles. After vaccination, the onset of fever is seen as an illness, and not as a symptom of building antibodies.
“All my neighbours and I decided not to take the vaccines; we believe in God and he will save us from this disease”, says Sushma from Ujjain in Madhya Pradesh (name and origin changed).
While this infodemic is a significant cause of concern, women’s hesitation to take the vaccines is also rooted in their lack of agency and mobility. The introduction of the walk-in option for vaccinations favours men, as women are often reluctant or unable to leave their household unaccompanied. Nearly 60% of women in India are still not allowed to go out alone (even to a health facility), pointing towards women’s lack of freedom and passiveness in decision making. Additionally, there is a clear hierarchy in sharing the workload at home, leaving women and girls the last to take the COVID-19 vaccines. The caste system in India adds a further layer to the skewed vaccination campaign.
The Way Forward
While we agree that the vaccine supply should exponentially increase to ensure universal coverage, the demand side problem created by the “vaccine hesitancy” amongst women should be addressed on a priority basis. The following steps are important to consider to bridge the “gender gap” in COVID-19 vaccinations:
- Access to Right Information — Most of the claims around the dangers of the vaccine are unfounded. To tackle this, we could help women to “learn” and “enquire” to access the right information regarding the vaccination and the upcoming vaccination drive. Involving female front-line health workers from the local communities can help spread the right information. Studies show that vaccine hesitancy can be overcome if the information is spread through health care workers that women trust. This would also enable them to see the merit in getting other female family members vaccinated.
- Leveraging Self Help Groups (SHGs) And Community-Based Institutions — The individual determinants for taking up the vaccine also involves learning the experience of their community members. Leveraging the regular SHG meetings to discuss encouraging experiences of vaccinations, perhaps in the presence of a health worker, and its merits in many peri-urban areas of India can help build trust in the vaccination drive. The government can use its existing infrastructure of nurses/ASHA workers/NGOs community service providers and administer vaccines to every household – where each member of the household is vaccinated at their doorstep; much like the polio vaccination drive. This will also benefit the elderly and children in the household.
- Building Effective Communication — Strategizing ways to communicate the perks of getting vaccinated can be helpful in reducing “vaccine hesitancy”. Using popular media (like TV advertisements, newspapers and radio broadcasts) to show vaccinated women leading a normal lifestyle or busting other myths can help reduce misinformation and encourage take-up of vaccination.
- Digital Empowerment — Empowering rural women with digital knowledge, would not only lower their dependence on male members of their household but would also increase vaccination coverage for women. Since a persisting gender gap in mobile ownership can be a challenge, front-line health workers can visit the homes of unvaccinated women (in the villages) and help them register on CoWIN website using their tablets, mobile phones and other devices.
Conclusion
The second wave of COVID-19 resulted in a need for the Government of India to ramp up the vaccination drive. However, in the process, female citizens, especially rural women, seem to have been excluded. Interestingly, this seems to be both a supply (shortage of vaccine) and a demand (lack of willingness to take the vaccine) side problem. We believe that the “gender gap” in vaccination could be due to hesitancy among women in taking them. In order to address this, we discuss a few solutions around myth-busting, enhancing their digital empowerment and also enhancing public support for them.
Image Credit: Trinity Care Foundation/flickr
About the Authors
Bhavya Shrivastava is a Research Associate with the Financial Inclusion vertical at LEAD. She works in most of the areas of Financial Health i.e financial security, resilience, freedom and control. Prior to joining LEAD, Bhavya worked for the Tamil Nadu Household Panel Survey (TNHPS) for a survey that aimed to assess intertemporal changes in income and occupation of the residents in Tamil Nadu, India.
Komal Jain is a Research Associate at the Financial Inclusion vertical at LEAD. She has been involved with an agricultural evaluation, and a meta-analysis of an evidence-gap map, apart from other projects. Komal is interested in evidence-based research and policymaking for agriculture, gender, and health. Prior to joining LEAD, she has worked extensively on agriculture and energy-related impact evaluations with NEERMAN.
Sabina Yasmin is a Research Fellow at LEAD and currently also serves as a Bharat Inclusion Fellow. Her research interests include agricultural economics, rural finance, development economics and applied microeconomics. Sabina is immensely passionate about using her work for the upliftment of marginalised people. Prior to joining LEAD, she taught economics to engineering and social science students at SRM University-Amravati.