The Maharashtra vaccination gender divide

Nirmala Vishwakarma, a domestic help in Andheri, cannot afford to take time off work and even unsubstantiated rumours about the vaccine are enough to keep her away from getting an anti-Covid jab

Nirmala Vishwakarma, a domestic help in Andheri, cannot afford to take time off work and even unsubstantiated rumours about the vaccine are enough to keep her away from getting an anti-Covid jab.

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“I’ve heard that after the first shot, I may fall sick. I’ve just resumed my work after almost a year of unemployment,” said 40-year-old Vishwakarma, who is yet to register on either the CoWin platform or the Arogya Setu app.

After eight months of unemployment, Vishwakarma resumed working in January. A month later, as the second wave of Covid-19 hit the city, she found herself out of work yet again. Since May, she resumed work in few houses. A day off is a luxury, she said. Her husband Vijay (56), who lost his jobs as a driver in Covid-19, got his first shot in April. Since then, he has lost his job which makes Vishwakarma the sole earning member of the family.

“If I fall sick, the building societies I work in will ask me to take an RT-PCR test at my own expense. I can’t bear that expense either,” said Vishwakarma.

Forty-five-year-old in Ghatkopar homemaker Tilottama (who goes by her first name) is the only one in her family of four who hasn’t been vaccinated. While her 55-year-old husband has received both his shots, her two sons, aged 20 and 22, took their first shots in May.

“First we (the family) thought that I should get the vaccine last because someone in the house has to be healthy to take care of the others. Now it’s just pending,” she said.

In Maharashtra, more than 1.6 million fewer women have been vaccinated when compared to men, across all age groups eligible for vaccination (18 and above). Of the total vaccinated population in the state, 46.1 % are women and 53.8% are men, as on June 13. In Mumbai, the gender divide is even more prominent as over 350,000 fewer women were vaccinated. The gender divide is most prominent in the neighbouring Raigad district, which includes Alibag, parts of Navi Mumbai, Uran and Pen, where 57.8% men have been vaccinated against 42.2% women. Indeed, even accounting for the skewed sex ratio in India, the gender gap in vaccination is being seen across the country: As of May 28, 161.3 million people have been given at least one dose of vaccines and men comprised 53% of this number.

As it turns out, the gender gap has been seen in other immunization drives, and even in accessing healthcare facilities.

In 2013, the department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College in Pune surveyed 210 children aged 12-23 months in 1,913 houses in the district. The survey found boys (87.61%) outnumbered girls (85.57%) when it came to full immunisation. World Health Organisation defines full immunisation as a percentage of one-year-olds who have received one dose of Bacille Calmette-Guérin (BCG) vaccine, three doses of polio vaccine, three doses of the combined diphtheria, tetanus toxoid and pertussis (DTP3) vaccine, and one dose of measles vaccine.

Experts said that historically women have lagged behind in immunisation drives in the country including that for polio and Bacillus Calmette–Guérin vaccine against tuberculosis.

“The gender gap in Covid-19 vaccination is not surprising, especially because the number of women testing for the virus and seeking hospital treatment is also low. This has to do with lack of mobility and decision-making powers in the family,” said Shalini Bharat, professor at the Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences (TISS), Mumbai.

Bharat, who is also the director of TISS, said that lack of digital familiarity and anxieties over the impact of vaccines on their reproductive health.

“What we have observed with other vaccines is that traditionally there is greater hesitancy, not just among women but among their family members. Worries about effect of vaccine on their fertility, impact on menstruation, pregnancy and lactation can lead to family members discouraging women to seek vaccination. These worries do not apply to men,” said Bharat, whose research areas include social aspects of HIV and TB including stigma and discrimination.

Suvarna Kamble, an Accredited Social Health Activist (ASHA) at the Satpala subcentre in Virar, agreed that women had worries regarding the vaccination. “Once you explain how the vaccine works and that any side effects are temporary, the women understand and then come for the vaccine.”

Gender divide in digital literacy

The registration process for vaccination requires digital familiarity. While Vishwakarma doesn’t even possess a smartphone (husband Vijay, however, does), Tilottama said she didn’t understand the process for vaccine registration. “My husband got me registered but we have been struggling to get a slot,” said Tilottama.

In Maharashtra, 68.2% of women in urban areas and 43.1% in rural areas have a mobile phone that they themselves use, according to the fifth National Family Health Survey. Only 54.3% of women in urban areas have ever used the internet, compared to 76.8% urban men. In the rural set up, only 23.7% women have ever used the internet, as opposed to 47.2% men.

Apart from generating awareness about the vaccine and ensuring that more women are registered on the platform, policy makers can make vaccines available to women closer to their homes.

“While women have lagged in the immunisation drives in the country, the gender gap reduces for polio after the door-to-door immunisation programme started,” said Bharat.

“The pandemic has affected women worse than it has affected men. Being at home, women have been forced to become the primary caretaker of the house and the family. Not just women but men, too, are worried that if the woman falls sick after taking the shot, who will then take care of the house? I know of many men delaying the shots for vaccines for the women in the house for this reason,” said Neelam Gorhe, member of legislative council and a women’s health rights crusader.

“Access to vaccination is a major concern, said experts. “Mobility of women is either restricted or dependent on men. With public transports not available during a lockdown, women find it difficult to reach the vaccination centres,” said Gorhe.

Vulnerable identities

At least 0.01% of vaccinated population comes from other gender communities.

So far Maharashtra has inoculated 2,984 persons who identify as other genders. They include transgender persons and gender non-binary persons, and 61% come from six out of the 35 districts in Maharashtra—Mumbai accounts for 587 (20%) alone; 363 in Pune, 233 in Thane, 176 in Nagpur, 173 in Aurangabad, 159 in Kolhapur and 119 in Nashik.

“The root cause of the problem is that there is no official data for the population of transgender persons in India. So, it’s difficult to bring invisible people in the vaccination drive,” said Amrita Sarkar, advisor, Transgender Wellbeing and Advocacy, India HIV/AIDS Alliance.

Yet another problem is that of identification, Sarkar added. “Most trans persons have identifications that identify them as cis-gendered persons. So, they may be getting vaccinated but must be recorded incorrectly,” she said.

Sarkar has been demanding special vaccination drives for the transgender community. “We need the government’s support. As organisations and community centres, we can arrange for a vaccination drive but we can’t source vaccine shots. The government must help us with vaccine doses,” she said.