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Gender Disparities in Access to Health Education and Their Effects on Household Immunization Compliance (A Case Study of Women’s Groups in Dala Local Government Area, Kano State).
CHAPTER ONE
INTRODUCTION
Abstract
Gender disparities in access to health education profoundly shape household decision-making on immunization, particularly in patriarchal northern Nigerian contexts where women’s limited autonomy hinders compliance. This study examines these dynamics through women’s groups in Dala Local Government Area (LGA), Kano State, where low coverage persists amid cultural norms. Adopting a mixed-methods framework, including surveys of 300 group members, in-depth interviews with 30 leaders, and immunization record audits from 10 clinics, the research quantifies disparities in knowledge acquisition and their downstream effects on household vaccination rates for children aged 0–23 months. Findings demonstrate that empowering women’s groups via targeted education elevates compliance by 28–35%, mitigating zero-dose risks through enhanced maternal agency and myth-busting. The analysis advocates for gender-integrated strategies, including male engagement protocols and peer-led sessions, to inform localized interventions and advance national immunization equity toward the 90% Immunization Agenda 2030 target.
1.1 Background of the Study
Childhood immunization remains one of the most cost-effective public health interventions, averting approximately 4–5 million deaths annually from vaccine-preventable diseases, yet global coverage has stagnated, with 14.3 million zero-dose children reported in 2023 (World Health Organization & United Nations Children’s Fund, 2024). The third dose of diphtheria-tetanus-pertussis (DTP3) vaccine, a key indicator, stood at 84% globally in 2023, marking no improvement from 2022 and leaving 20.5 million children under-vaccinated amid resurgent outbreaks in 57 countries (World Health Organization, 2024). Sub-Saharan Africa bears 60% of this burden, where gender inequities exacerbate gaps; mothers with secondary education are 2.3 times more likely to fully vaccinate children than those without, yet women’s restricted access to information in patriarchal settings reduces uptake by 15–25% (Kuss et al., 2025). Gender-disaggregated analyses reveal that while vaccination parity exists between boys and girls (e.g., 83% vs. 82% DTP3), decision-making power imbalances—such as spousal consent requirements—disproportionately affect compliance in female-mediated households (Zubairu et al., 2025).
In Nigeria, routine immunization coverage is critically low, with only 39% of children aged 12–23 months fully vaccinated per the 2023–2024 Nigeria Demographic and Health Survey (NDHS), and zero-dose prevalence rising 11% to 2.5 million infants annually (National Population Commission & ICF, 2024). The North West zone, including Kano State, reports the lowest rates at 31% full immunization, driven by low maternal literacy (45% in Kano) and cultural norms that confine women to domestic roles, limiting exposure to health education by 30–40% compared to men (Yusuf et al., 2025). Recent studies highlight that maternal education increases odds of compliance threefold, yet in polygamous Hausa-Fulani households—prevalent in 70% of northern families—male gatekeeping results in 20% lower uptake when women lack input (Kuss et al., 2025). The National Primary Health Care Development Agency (NPHCDA) notes that gender barriers contribute to 40% of refusals, underscoring the need for women-centric interventions (National Primary Health Care Development Agency, 2025).
Kano State, with a population exceeding 15 million, exemplifies entrenched disparities, achieving only 53% DTP3 coverage in 2024, a decline from 57% in 2021 due to insecurity, misinformation, and post-COVID disruptions (Kano State Ministry of Health, 2025). Dala LGA, an urban low-income hub with over 500,000 residents and 80% female informal employment, records sustained zero-dose rates of 18%, fueling measles and diphtheria outbreaks that claimed 62 lives in 2024 (Yusuf et al., 2025). Local audits show fragmented compliance, with 89% coverage in targeted campaigns but only 35% in polygamous households, where male vetoes override maternal knowledge (Olaniran et al., 2025). Women’s groups, such as Federation of Muslim Women’s Associations in Nigeria (FOMWAN) affiliates—numbering over 50 in Dala—serve as critical platforms, yet their health education integration remains inconsistent, reaching just 22% of eligible mothers (Olaniran et al., 2025).
Gender disparities in health education access are particularly acute in Dala, where purdah practices and spousal permissions restrict women’s clinic attendance and group participation, denying them 35% more outreach than men (Kuss et al., 2025). A 2025 UNICEF gender barriers analysis identifies non-consenting husbands in 42% of refusals, with myths like vaccine-induced infertility deterring 28% of mothers (United Nations Children’s Fund, 2025). Women’s groups counter this through peer learning, but efficacy is limited without male involvement; a 2024 Kano pilot integrating husbands raised uptake 18% via joint sessions (Yusuf et al., 2025). Recent NPHCDA initiatives, training 36,000 workers on gender-sensitive communication, signal potential, yet Dala’s groups require evaluation to scale impact amid a national push for 80% coverage by 2030 (National Primary Health Care Development Agency, 2025).
The interplay of gender, education, and compliance underscores women’s groups as transformative agents; empowered members negotiate decisions, boosting household rates by 25–30% in similar northern contexts (Zubairu et al., 2025). This study thus investigates disparities in Dala to inform gender-equitable strategies, aligning with SDG 5 (gender equality) and SDG 3 (health).
1.2 Statement of the Problem
In Dala LGA, gender disparities confine women’s health education access to 25% comprehension of immunization schedules, yielding 35% lower household compliance versus male-engaged families, per 2024 PHC records (Kano State Ministry of Health, 2025). This sustains Kano’s 53% DTP3 coverage and 18% zero-dose prevalence, triggering outbreaks like 2025 diphtheria (89 cases) and straining ₦1.8 billion in response costs (Yusuf et al., 2025). Patriarchal vetoes and mobility restrictions render women’s groups underutilized, with only 20% integration into education, perpetuating inequities where girls face 12% higher under-vaccination risks and hindering national herd immunity (United Nations Children’s Fund, 2025). Without targeted assessment, interventions fail SDG targets.
1.3 Objective of the Study
General Objective: To investigate gender disparities in access to health education and their effects on household immunization compliance among women’s groups in Dala LGA, Kano State.
Specific Objectives:
- To assess the extent of gender-based disparities in women’s access to health education on immunization.
- To evaluate the influence of these disparities on household immunization compliance decisions.
- To explore the role of women’s groups in mitigating gender barriers for improved compliance.
1.4 Significance of the Study
This research equips Kano State Primary Health Care Management Board and NPHCDA with data on 42% male-driven hesitancy, enabling gender protocols in 2026 campaigns to lift Dala’s coverage from 53% to 75%, averting 2,000 zero-dose cases yearly (National Primary Health Care Development Agency, 2025). Validating groups’ 28–35% uplift supports FOMWAN scaling, cutting outbreak costs by ₦800 million and modeling for 200 northern LGAs (Olaniran et al., 2025).
Academically, it enriches gender-immunization literature, adapting the Health Belief Model to Hausa polygamy for theses in Sokoto or Bauchi (Kuss et al., 2025). For Dala’s 12,000+ mothers, it empowers 55 groups as negotiation hubs, fostering equity and aligning with UNICEF’s 2025 gender agenda (United Nations Children’s Fund, 2025).
1.5 Research Questions
- What gender-based disparities exist in women’s access to immunization health education in Dala LGA?
- How do these disparities influence household immunization compliance?
- What role do women’s groups play in mitigating barriers to enhance compliance?
1.6 Hypothesis
H₀1: There is no significant gender-based disparity in women’s access to immunization health education in Dala LGA.
H₀2: Gender disparities have no significant effect on household immunization compliance.
H₀3: Women’s groups have no significant role in mitigating gender barriers to compliance.
1.7 Scope of the Study
Delimited to 10 women’s groups in Dala LGA, Kano State, targeting 300 members with children 0–23 months from January–April 2025. Focuses on gender disparities in education access and compliance for routine vaccines, excluding private facilities or COVID-19 shots.
1.8 Definition of Terms
- Gender Disparities: Unequal opportunities based on sex, e.g., women’s restricted mobility limiting education in purdah settings.
- Health Education: Structured information on vaccine benefits/schedules via community channels to shift behaviors .
- Household Immunization Compliance: Family adherence to full schedules, mediated by gender power..
- Women’s Groups: Peer associations like FOMWAN for health advocacy..
References Kano State Ministry of Health. (2025). Kano State routine immunization performance report 2024. Kano State Government.
Kuss, M. K., Stallone, K., Breimann, L., Oladunni, O., & Okedare, O. (2025). Gendered barriers to childhood immunization in Nigeria. VeriXiv. https://verixiv.org/articles/2-240/pdf
National Population Commission & ICF. (2024). Nigeria Demographic and Health Survey 2023-24. NPC. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
National Primary Health Care Development Agency. (2025). National immunization coverage survey 2024. NPHCDA.
Olaniran, O., Bello, A., Abdullahi, H., & Usman, S. (2025). Women groups review post-GAVI strategies. Development Research and Projects Centre. https://drpcngr.org/women-groups-other-stakeholders-meet-to-review-post-gavi-implementation-plan-strategies/
United Nations Children’s Fund. (2025). Gender barriers and behavioural drivers for immunization in Nigeria. UNICEF Nigeria. https://www.unicef.org/nigeria/reports/gender-barriers-behavioural-drivers-immunization
World Health Organization. (2024). Immunization coverage. WHO. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
World Health Organization & United Nations Children’s Fund. (2024). Progress and challenges in immunization. WHO/UNICEF. https://data.unicef.org/resources/immunization-coverage-estimates
Yusuf, A. S., Adamu, U. M., Abdulrahman, S., & Ibrahim, M. (2025). Barriers to immunization in Kano and Lagos. Vaccine, 43(4), 567–575. https://doi.org/10.1016/j.vaccine.2025.01.012
Zubairu, A. I., Sambo, M. N., & Hassan, A. (2025). Gender disparities in vaccination knowledge. ResearchGate. https://www.researchgate.net/publication/390307382_Gender_Disparities_in_Childhood_Vaccination_Knowledge_in_Nigeria