Collection: Women and Health Campaigns

This month, the Coalition shines a light on women and health campaigns targeting NTDs, vaccine-preventable diseases, and vitamin A supplementation.

 

Neglected Tropical Diseases:

Uniting to Combat Neglected Tropical Diseases: Women and Girls in Focus Report

This report highlights findings from a literature review and an interactive meeting that set out to assess knowledge about the impact that NTDs and mass drug administration (MDA) programs have on women and girls and identify opportunities to improve access and strengthen the value and positive impacts of MDA for women and girls.

Conclusion: Neglected tropical diseases can disproportionately impact and disadvantage women and girls in some contexts due to biological and cultural reasons that differ by setting and pathogen. Applying a gender equity lens in NTD program design and delivery may position programs to improve gender mainstreaming practices and service delivery for women and girls.

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Gender and neglected tropical disease front-line workers: Data from 16 countries

Delivery of preventive chemotherapy (PC) through mass drug administration (MDA) is used to control or eliminate five of the most common neglected tropical diseases (NTDs). The success of an MDA campaign relies on the ability of drug distributors and their supervisors—the NTD front-line workers—to reach populations at risk of NTDs. In the past, our understanding of the demographics of these workers has been limited, but with increased access to sex-disaggregated data, we begin to explore the implications of gender and sex for the success of NTD front-line workers.

Conclusion: There has been a rapid increase in availability of sex-disaggregated data, but little increase in recruitment of female workers in countries included in this study. Women continue to be under-represented in the NTD workforce, and while there are often valid reasons for this distribution, we need to test this norm and better understand gender dynamics within NTD programs to increase equity.

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Vaccine-Preventable Diseases:

Gender Determinants of Vaccination Status in Children: Evidence from a Meta-Ethnographic Systematic Review

Using meta-ethnographic methods, we conducted a systematic review of qualitative research to understand gender-related reasons at individual, family, community and health facility levels why millions of children in low and middle income countries are still not reached by routine vaccination programmes. A systematic search of Medline, Embase, CINAHL, Cochrane Library, ERIC, Anthropological Lit, CSA databases, IBSS, ISI Web of Knowledge, JSTOR, Soc Index and Sociological Abstracts was conducted. Key words were built around the themes of immunization, vaccines, health services, health behaviour, and developing countries. Only papers, which reported on in-depth qualitative data, were retained. Twenty-five qualitative studies, which investigated barriers to routine immunisation, were included in the review. These studies were conducted between 1982 and 2012; eighteen were published after 2000. The studies represent a wide range of low- to middle income countries including some that have well known coverage challenges. We found that women’s low social status manifests on every level as a barrier to accessing vaccinations: access to education, income, as well as autonomous decision-making about time and resource allocation were evident barriers. Indirectly, women’s lower status made them vulnerable to blame and shame in case of childhood illness, partly reinforcing access problems, but partly increasing women’s motivation to use every means to keep their children healthy. Yet in settings where gender discrimination exists most strongly, increasing availability and information may not be enough to reach the under immunised. Programmes must actively be designed to include mitigation measures to facilitate women’s access to immunisation services if we hope to improve immunisation coverage. Gender inequality needs to be addressed on structural, community and household levels if the number of unvaccinated children is to substantially decrease.

Conclusion: Power politics of immunisation are played out in some regions by political and religious leaders for political gain. In such cases, the cost is again borne largely by women as caretakers and their un-immunised children on the frontlines of resistance. Increasing coverage requires acknowledgment of the unequal power dynamic that exists within the service setting, the politicization of health care services, and the marginalized position of women in these settings. This study shows that overcoming compounded gendered barriers to children’s immunisation requires expanding the dialogue around vaccination beyond the mother as primary caretaker to extended family, fathers and communities. When immunisation of children becomes a family and community responsibility, more progress can be made.

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Impact of measles supplementary immunisation activities on utilisation of maternal and child health services in low-income and middle-income countries

Measles supplementary immunisation activities (SIAs) are an integral component of measles elimination in low-income and middle-income countries (LMICs). Despite their success in increasing vaccination coverage, there are concerns about their negative consequences on routine services. Few studies have conducted quantitative assessments of SIA impact on utilisation of health services.

Conclusion: The team found a reduction in care-seeking for treatment of child cough (OR 0.67; 95% CI 0.48 to 0.95); and a few significant effects at the country level, suggesting the need for further investigation of the idiosyncratic effects of SIAs in each country. Supplementary immunisation activities (SIAs)  do not appear to significantly impact utilisation of maternal and child services.

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Gender and Immunisation: Guidelines from Gavi

At the global level, there is no significant difference in immunisation coverage for boys and girls. Yet in some countries and communities, gender discrimination means that boys have greater access to vaccines than do girls. In others, the opposite is true – girls have greater access. Gender-related barriers can also have an indirect impact on immunisation. Social and cultural norms, and the unequal status of women in many societies, can reduce the chances of children being vaccinated, by preventing their caregivers from accessing immunisation services. The United Nations’ Gender Development Index confirms that countries with a high level of gender equality have higher immunisation coverage.

Conclusion: Common gender-related barriers to vaccination include caregivers lacking information, division of household labor reducing paternal involvement, limited household funds, religious or cultural practices, distance to the health clinic, wait times at health clinics, and negative attitudes of health service providers.

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Vitamin A Supplementation

Vitamin A supplementation in postpartum women

Approximately 1000 women die from pregnancy and childbirth complications worldwide every day. Vitamin A deficiency also affects about 19 million pregnant women, mostly from the World Health Organization (WHO) regions of Africa and South-East Asia. Vitamin A plays an important role in vision, growth and physical development, and immune function. Deficiency of vitamin A increases the risk of night blindness and other ocular conditions such as xerophthalmia. Member States have requested guidance from WHO on the effects and safety of vitamin A supplements for postpartum women as a public health strategy.

Conclusion:Vitamin A supplementation in postpartum women is not recommended for the prevention of maternal and infant morbidity and mortality.

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