13 May 2024

Gender-related Barriers to Immunization: Zero-dose Children

A total of 25 million children were un-or under-vaccinated in 2021 and the number of children missing out on any vaccination, or “zero-dose children”, increased by 5 million in 2021 compared with 2019, rising from 13 to an estimated 18 million. Almost half of all zero-dose children live in three key geographic contexts: urban areas, remote communities and populations in conflict settings. Communities with zero-dose children face multiple deprivations, including high levels of poverty, lack of access to quality healthcare, nutrition, clean water, sanitation and other basic services, high levels of illiteracy and pervasive gender inequality.Gender norms, roles and relations affect people’s access to health services, health-related information and their health-seeking behaviours, including for immunization. This report explores gender-related barriers to immunization in Egypt, Iraq, Sudan, Syria and Yemen, with a focus on zero-dose and under-immunized children. Promising and innovative practices from these five countries to overcome gender-related barriers to immunization are highlighted, along with recommended approaches and entry points for addressing these demand and supply-side barriers at the individual, household, community, social and institutional levels in order to increase immunization reach and coverage.The report draws on a desk review of existing literature related to gender and immunization in the UNICEF MENARO region as well a gender and zero-dose questionnaire completed by UNICEF Country Offices, complemented by interviews with key informants. Representing Phase I of UNICEF MENARO’s efforts to identify and address gender-related barriers to immunization, this report provides a snapshot overview of some of the challenges and barriers in zero-dose communities, with a recommendation to conduct in-depth research at the community level through interviews and focus group discussions with caregivers and service providers during the second phase.Zero-dose children are geographically dispersed within each of the five countries, with each area facing specific vulnerabilities and challenges related to conflict, insecurity, poverty, lack of basic health infrastructure and displacement, characterized by entrenched gender inequality. Marginalized communities such as nomadic populations, internally displaced persons (IDPs), ethnic minorities and persons living with disabilities face compounded discrimination and disadvantage. Gender-related barriers to immunization are therefore manifested in several ways on different levels, ranging from women’s restricted mobility, lack of access to transportation, money, time, information and other critical resources, the prevalence of gender-based violence as well as women’s limited agency in household decision-making dynamics to men’s low engagement and participation in children’s health and caretaking. The lack of gender-responsive health systems create additional barriers on the institutional level for the health workforce and caregivers.This report is divided into five main sections for the MENA countries included in this review, with each country section further divided into the following sub-sections: gender roles and responsibilities; access to and control over resources; beliefs, norms and perceptions; needs, preferences and challenges; enabling factors and partnerships, with recommended approaches and entry points for addressing gender-related barriers outlined at the end of each section. The report concludes with summary recommendations for addressing gender-related barriers to immunization at the individual and household level, community and social level as well as at the institutional and structural level.
15 May 2023

4 PRIORITY ACTIONS for Gender Equality

The Regional Gender in Humanitarian Action (GiHA) Working Group  for Arab States/MENA1  is committed to ensure that gender equality is  at the core of the humanitarian response to target the specific gender needs of different crisis- affected groups. This Advocacy Note highlights 4 Priority Actions to ensure that gender equality principles are consistently mainstreamed in the humanitarian response after the 7.8 magnitude earthquake which struck southern and central Türkiye and northern and western Syria on 6 of February 2023. According to the OCHA flash updates of NWS 10th April 2023, following the earthquake, 80,401 individuals living across 108 newly established reception center are in need of a coordinated multi-sectoral response. Prior to the earthquake, of North-West Syria’s population of 4.6 million, about 3.4 million people are living in need, 2.8 million are IDPs and 1.7 million are school-aged children according to2.  Around 80% of people in need in are women (7 million) and children (46 million) living in displacement camps, of whom 7% are female heads of household.3  The earthquake has aggravated the already dare condition of women and children in Syria. After 11 years of conflict, north-west Syria, which is home to more than 4.6 million people, continues to experience recurring waves of violence and forced displacement and disruptions in the provision of humanitarian assistance. For the purpose of this Advocacy note, the key priorities identified cover the earthquake response in North-West Syria. The priority actions have been formulated by the GiHA Working Group for Arab States/MENA and informed Syrian women-led organizations. The note also includes lessons learned from other natural disasters on how best to mainstream gender into a humanitarian response. The priority actions are guided by the Policy on Gender Equality and the Empowerment of Women and Girls of the IASC Reference Group on Gender and Humanitarian Action (2017) and its commitments towards to the goals of gender equality and the empowerment of women and girls in humanitarian action.