The Influence of Women’s Empowerment on Child Immunization Coverage in Low, Lower-Middle, and Upper-Middle Income Countries: A Systematic Review of the Literature

Abstract

Objectives: An estimated 1.5 million children under five die annually from vaccine preventable diseases, and 17 % of these deaths can be averted with vaccination. Predictors of immunization coverage, such as maternal schooling, are well documented; yet, preventable under-five mortality persists. To understand these patterns, researchers are exploring the mother–child relationship through an empowerment framework. This systematic review assesses evidence of the relationship between women’s agency as a component of empowerment and vaccine completion among children <5 years in lower-income countries. Methods: We searched in Socindex, Pubmed, Web of Science and Women’s Studies International for peer-reviewed articles focused on two measures of women’s agency—decision-making and freedom of movement—and child vaccination. Our initial search identified 406 articles and abstracts for screening; 12 studies met the inclusion and exclusion criteria. Results: A majority (83 %) of studies revealed at least one positive association of measures for women’s agency with immunization coverage. These relationships varied by geographic location, and most studies focused on women’s decision making rather than freedom of movement. No included study came from Latin America or the Middle East. Conclusions: Overall, women’s agency, typically measured by decision-making, was positively associated with the odds of complete childhood immunizations. Yet, the concept of agency was inconsistently defined and operationalized. Future research should address these inconsistencies and focus on under-represented geographic regions including Latin America and the Middle East.