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There is a gender gap in India’s vaccination coverage

India’s Covid-19 vaccination drive seems to have a gender bias.

Women are lagging behind men in the vaccines administered so far. The Co-WIN dashboard gives a gender-wise breakup of the number of people who have been vaccinated so far. As of June 4, 178.9 million people have been given at least one dose of vaccines. Men comprise of 54% of this number. The gender gap in vaccines varies across states and union territories. Jammu and Kashmir, Delhi, and Uttar Pradesh are among the worst performers. In two states – Kerala and Chhattisgarh — women outnumber men when it comes to those who have received at least one dose of the vaccine.

What explains this gender gap in vaccination? It is important to get an in-built statistical bias out of the way before looking at probable causes. Men outnumber women in India. There were 943 women in India per thousand men according to the 2011 census. According to the population projections made for March 2021 by the National Commission on Population, there are likely to be 948 women per thousand men in India. So, is the number of vaccinated men outnumbering women just a function of India’s skewed sex-ratio?

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This is unlikely to be the case. India’s sex-ratio deteriorates as one moves from older to younger age-groups. This number is 1065 for the 60 and above cohort, 982 for the 45–60-year-olds cohort and falls to 939 for the 18–45-year-olds.

Unfortunately, Co-WIN dashboard does not provide a gender-wise break-up of the vaccinated population for these age groups. It does give overall age-wise data on those who have received vaccines. As of June 4, this number is 44.1% for those who are 60 years and above, 36.5% for the 45-60 age group and 7.1% % for the 18-45 age group. Because women have a favourable sex ratio in the 45 and above age-group and it is the population in this age-group which has the biggest share in vaccines administered so far, they should have had a bigger share in the vaccinated population so far. That this has not happened shows that India’s vaccination policy has a gender bias.

To be sure, not all states seem to have done badly in ensuring gender balance in vaccination. The following chart captures this in a simple way. Theoretically, the more favourable a state’s sex ratio in the 45 and above age-group and the higher the share of doses given to this age group relative to their share in vaccine eligible population, the better should the gender balance in vaccines be.

Kerala and Chhattisgarh look like the perfect case in this chart and Delhi, with its worst sex ratio and low relative share of vaccination in the 45 and above age group, is the worst-case scenario. However, states such as Rajasthan and Telangana seem to be bad outliers.

Why is this happening? Public health experts and women on the ground point to a variety of factors, including longstanding structural problems in health care, lack of awareness in rural areas, gender divide in tech access and the oversized control of male members of households on resources.

“The gendered nature of health care access hurts women. For example, within the family, male members often get higher share of food and nutrition. It was therefore surprising that the vaccine policy was gender neutral, not gender sensitive,” said Soumitra Ghosh, a professor at the Tata Institute of Social Sciences.

Take Rashi Devi, a 43-year-old woman in eastern Uttar Pradesh. A resident of Ballia district, Devi is aware of the vaccination drive but said that the elders in her village are not very keen on taking the shot. Moreover, the immunisation centre is not nearby and she doesn’t own a smart phone.

“My husband will register our family along with the other men in our mohalla. He will get the first shot and I will take later; I have heard that after the jab, you get high fever for a week, so someone needs to take care of the household work during that time,” she said. Those between 18 and 45 have to register on the Co-WIN platform and book their slots.

The first phase of the National Family Health Survey (NFHS) conducted in 22 states and UTs in 2019-20 showed that an average of only about three in 10 women in rural areas use the internet, compared to about half the men. The average for urban and rural areas combined for these 22 regions shows that about four out of 10 women used the internet, compared to six out of 10 men.

Such forms of discrimination, coupled with a critical shortage in vaccine supplies, also played into popular stereotypes that project men as the provider who go out for work and women as domestic.

“There is a problem of access to information, access to gadgets and access to finances. Even though women are as vulnerable as men, they are seen as lesser priority. This can have hugely negative impact on maternal and reproductive health, nutrition and public health outcomes,” said Manjula Pradeep, director of the Dalit Human Rights Defenders Network. “This has a further damaging impact on women from marginalised communities, including those in frontline professions such as sanitation workers.”

A way ahead to close the emerging gender gap can be using takeaways in previous mass vaccination campaigns and using the Accredited Social Health Activist (ASHA) network, said Ghosh. “There can be special drives for women, and Asha can be incentivised for every Covid shot they administer. This can be successful because the Asha network is extensive and deep. We need an innovative and multi-pronged approach,” Ghosh said.

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