Investigating gender disparities in India’s vaccine rollout
A primary barrier to getting women vaccinated is the limited understanding of the disparate impacts Covid-19 vaccines have on them
While less than 20% of India’s adult population has received their first Covid-19 vaccine dose, clear gender disparities have arisen in the rollout. A recent analysis by Ashoka University shows that for every 100 men, around 86 women were vaccinated. This is significantly lower than India’s sex ratio of approximately 924 women per 1,000 men. In only three states, women have received equal or higher vaccine shots than men: Chhattisgarh, Himachal Pradesh and Kerala. Union Territories including Dadra and Nagar Haveli, Daman and Diu, Jammu and Kashmir, and Chandigarh, and states such as Delhi fare poorly. As the vaccination programme continues, addressing these gaps is an urgent priority.
When India started its vaccination drive, women comprised a majority of recipients because of their roles in frontline work. However, as the general population started getting vaccinated, these numbers began reversing, with more men being vaccinated. In April alone, 2.4 million fewer women were vaccinated than men.
How did we get here?
A primary barrier to getting women vaccinated is the limited understanding of the disparate impacts Covid-19 vaccines have on them. While few clinical trials capture the sex-differentiated impacts, those that exist suggest that women experience more frequent and more severe adverse effects post-immunisation.
Stories of what might happen post-vaccination reflect the fallacies on the ground. In a study released recently by the Self-Employed Women’s Association, poor women expressed their fears of how the vaccine might inject a virus into them and disable them from using the only asset they have – their health. There are also concerns about the effects on pregnant women, menstrual cycles, and fertility rates. Many public health researchers rue the lack of data on the gendered impacts of the vaccine, making it harder to pass on accurate information on the vaccine’s after-effects.
The digital divide worsens the prospects for women seeking vaccinations. The reliance on online registrations (in English only) ignores the lack of access to digital devices and the internet among women. In rural areas, only 33.9% of women have used the internet compared to 55.6% of men, according to the National Family Health Survey-5. Further, only 54.8% of women have their own mobile phone, with far less owning a smartphone.
Mobility restrictions further impede women seeking health services, as they tend to rely on male members of the household to accompany them. The burden of unpaid care work also dissuades women from travelling long distances to health clinics. Some women hesitate to get vaccinated by male health workers, stemming from cultural and religious norms. The lockdown has also prevented health workers from bringing elderly women to wait in long queues in vaccination centres.
But there is a larger narrative around gender-based inequalities within households and the social norms that structure them. Previous studies show gender gaps in the immunisation of children in India. In a study tracking immunisation rates for male and female siblings, fewer females were immunised when compared to their male siblings. Since the comparison is between children in the same household, the study concluded that the gap cannot be due to household factors that drive immunisation (e.g. poverty or access) and, therefore, could be explained by intra-household gender inequalities. Unfortunately, we are not collecting data on intra-household Covid-19 vaccination rates to confirm this hypothesis.
At IWWAGE, we are exploring the links between existing gender inequalities and vaccine coverage. Using data from the government’s CoWin dashboard, we found that states with a higher percentage of female vaccinations are likely to have lower poverty levels, higher female education levels, and a higher share of women reporting intra-household bargaining power.
Two indicators stand out. First, the share of vaccinated women is positively correlated with women’s labour force participation rates, and negatively with the share of women not working due to household care work. Second, the political involvement of women in Panchayati Raj Institutions matters as well. Our findings suggest that states performing better on gender outcomes are more likely to have higher female vaccination rates.
So what can be done?
First, vaccine delivery must account for women’s barriers to information, digital access, and mobility. Greater engagement with community organisations in planning and targeting women, along with effectively communicating with them can help identify barriers and dispel misinformation.
Second, vaccinations drives should be planned based on context-specific needs and preferences of women.
Third, India needs to rely on its overstretched female frontline health staff to ensure the vaccine’s rollout. But to do so, it must ensure that they are vaccinated, trained, and adequately remunerated.
Fourth, sex-disaggregated data needs to be collected to better target vaccines for those in need. On the CoWin dashboard, data on sex has not been reported for nearly 20% of those vaccinated until May. If India were to exclude this population, the share of women receiving the vaccine dips further to 74 women per 100 men.
Above all, we must recognise that improving gender equality on other fronts can improve gender-balanced vaccination efforts. Without this, women will continue to face a disproportionate burden of the pandemic, threatening India’s much-needed recovery.
Soumya Kapoor Mehta and Steven Walker work at the Initiative for What Works to Advance Women and Girls in the Economy (IWWAGE), an initiative of LEAD at Krea University
The views expressed are personal