Trends in child immunization across geographical regions in India: focus on urban-rural and gender differentials

PLoS One. 2013 Sep 4;8(9):e73102. doi: 10.1371/journal.pone.0073102. eCollection 2013.


Background: Although child immunization is regarded as a highly cost-effective lifesaver, about fifty percent of the eligible children aged 12-23 months in India are without essential immunization coverage. Despite several programmatic initiatives, urban-rural and gender difference in child immunization pose an intimidating challenge to India's public health agenda. This study assesses the urban-rural and gender difference in child immunization coverage during 1992-2006 across six major geographical regions in India.

Data and methods: Three rounds of the National Family Health Survey (NFHS) conducted during 1992-93, 1998-99 and 2005-06 were analyzed. Bivariate analyses, urban-rural and gender inequality ratios, and the multivariate-pooled logistic regression model were applied to examine the trends and patterns of inequalities over time.

Key findings: The analysis of change over one and half decades (1992-2006) shows considerable variations in child immunization coverage across six geographical regions in India. Despite a decline in urban-rural and gender differences over time, children residing in rural areas and girls remained disadvantaged. Moreover, northeast, west and south regions, which had the lowest gender inequality in 1992 observed an increase in gender difference over time. Similarly, urban-rural inequality increased in the west region during 1992-2006.

Conclusion: This study suggests periodic evaluation of the health care system is vital to assess the between and within group difference beyond average improvement. It is essential to integrate strong immunization systems with broad health systems and coordinate with other primary health care delivery programs to augment immunization coverage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cities / statistics & numerical data*
  • Female
  • Geography / statistics & numerical data*
  • Humans
  • Immunization / trends*
  • India
  • Infant
  • Male
  • Rural Population / statistics & numerical data*
  • Sex Distribution

Grant support

No current external funding sources for this study. PKS is supported by the Government of India/National Eligibility Test (UGC/NET) Doctoral Fellowship Award from the Ministry of Health and Family Welfare, Government of India. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.