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This article is part of the supplement: The fallacy of coverage: uncovering disparities to improve immunization rates through evidence. The Canadian International Immunization Initiative Phase 2 (CIII2) Operational Research Grants

Open Access Research

Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006

Daniel J Corsi12*, Diego G Bassani1, Rajesh Kumar3, Shally Awasthi4, Raju Jotkar1, Navkiran Kaur3 and Prabhat Jha1

Author Affiliations

1 Centre for Global Health Research, St. Michael's Hospital, University of Toronto, Toronto, ON, M5C 1N8, Canada,

2 Population Health Research Institute, McMaster University, Hamilton, ON, L8L 2X2, Canada,

3 School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India,

4 Department of Pediatrics, King Georges Medical University, Lucknow, Uttar Pradesh, India

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BMC International Health and Human Rights 2009, 9(Suppl 1):S3  doi:10.1186/1472-698X-9-S1-S3

Published: 14 October 2009



A variety of studies have considered the affects of India's son preference on gender differences in child mortality, sex ratio at birth, and access to health services. Less research has focused on the affects of son preference on gender inequities in immunization coverage and how this may have varied with time, and across regions and with sibling compositions. We present a systematic examination of trends in immunization coverage in India, with a focus on inequities in coverage by gender, birth order, year of birth, and state.


We analyzed data from three consecutive rounds of the Indian National Family Health Survey undertaken between 1992 and 2006. All children below five years of age with complete immunization histories were included in the analysis. Age-appropriate immunization coverage was determined for the following antigens: bacille Calmette-Guérin (BCG), oral polio (OPV), diphtheria, pertussis (whooping cough) and tetanus (DPT), and measles.


Immunization coverage in India has increased since the early 1990s, but complete, age-appropriate coverage is still under 50% nationally. Girls were found to have significantly lower immunization coverage (p<0.001) than boys for BCG, DPT, and measles across all three surveys. By contrast, improved coverage of OPV suggests a narrowing of the gender differences in recent years. Girls with a surviving older sister were less likely to be immunized compared to boys, and a large proportion of all children were found to be immunized considerably later than recommended.


Gender inequities in immunization coverage are prevalent in India. The low immunization coverage, the late immunization trends and the gender differences in coverage identified in our study suggest that risks of child mortality, especially for girls at higher birth orders, need to be addressed both socially and programmatically.

Abstract in Hindi

See the full article online for a translation of this abstract in Hindi.