Intersectional inequalities in immunization in India, 1992-93 to 2005-06: a progress assessment

Health Policy Plan. 2015 May;30(4):407-22. doi: 10.1093/heapol/czu023. Epub 2014 Apr 16.


Immunization in India is marked with stark disparities across gender, caste, wealth and place of residence with severe shortfalls among those disadvantaged in more than one dimension. In this regard, an explicit recognition of intersectionality and intersectional inequalities has 2-fold relevance; one, being the pathway of health inequality and the other being its role as a deterrent of progress particularly at higher (better) levels of health. Against this backdrop, this study examines intersectional inequalities in immunization in India and also suggests a level-sensitive progress assessment method. The study uses group analogue of Gini coefficient for highlighting the magnitude of intersectional inequality and for comprehending its association with immunization level. The results unravel the plight of vulnerable intersectional groups and draw attention to disquieting shortfalls among female SCST (scheduled castes and tribes) children from rural areas. There is also some evidence to indicate leveraging among rural males in matters of immunization and it is further discerned that such gender advantage is greater among rural non-SCST community than the rural SCST group. In concluding, the study calls for intensive immunization planning to improve coverage among vulnerable communities in both rural and urban areas.

Keywords: Health inequality; India; immunization; intersectional approach; level-sensitivity.

MeSH terms

  • Child, Preschool
  • Female
  • Healthcare Disparities / statistics & numerical data*
  • Humans
  • Immunization / statistics & numerical data
  • Immunization / trends*
  • India
  • Infant
  • Male
  • Rural Population
  • Socioeconomic Factors
  • Urban Population
  • Vulnerable Populations