India’s women are getting left behind in its vaccination drive

India began its vaccination programme with healthcare and frontline workers on 16 January, and subsequently expanded it to people over the age of 60 from 1 March and finally to people between the ages of 18 and 44 from 1 May. As of 30 May, India had given over 165 million people or under 19% of its adult population at least one dose of a vaccine.

On account of the high proportion of women healthcare workers and frontline workers, more women were getting vaccinated than men in the early days of the vaccination campaign. However, since 31 January, a shrinking share of women is being vaccinated relative to total vaccinations. By 30 May, just 871 women had been vaccinated for every 1000 men. This is in contrast to countries such as the US, where a greater share of women have been vaccinated than men, despite being a minority in the American population.

The reasons for India’s gender gap are as yet unclear. Some government officials have reported greater difficulty in contacting women and greater vaccine hesitancy among women.

“Men hang around in groups outside more so they see things like signs for camps. They are also more comfortable going out unaccompanied," a senior public health official involved in Tamil Nadu’s vaccination campaign said, requesting anonymity as this was not a formal position of his department.

The vaccine sex ratio

Women form a smaller proportion than men in the adult population of India on account of a male-biased sex ratio at birth. Even accounting for this skew in the sex ratio of the adult population, the gap between the share of adult men who have been vaccinated and the share of women who have been vaccinated has systematically widened and is at its widest yet.

Both vaccination rates and sex ratios vary substantially among states. But just three Indian states have vaccinated a higher share of adult women than men - Himachal Pradesh, Chhattisgarh and Kerala. The largest population-adjusted gender gaps in vaccination are in Jammu & Kashmir, Delhi and Odisha, the data show. Uttar Pradesh, Maharashtra and West Bengal have vaccinated over one million more men than women. This gender gap in vaccinations also exists for the north-eastern states and union territories for which 2021 population estimates are not available.

Vaccine hesitancy?

“We have found much more fears about the vaccines among women when we go into the community to talk to them," the Tamil Nadu official cited earlier said. Yet hard data on vaccine hesitancy among women in India is relatively limited. Although fewer than 15% of respondents in a small national C-Voter opinion poll said that they had received one dose of vaccine by May 19, an additional 67% said that they had not yet been vaccinated but intended to get vaccinated. Among those expressing hesitancy, there was little difference between men and women. The COVID-19 Symptom Survey conducted over Facebook by the University of Maryland and Carnegie Mellon University, shows much higher (but declining) hesitancy, but again, little difference between men and women. In states such as Tamil Nadu, Punjab and Andhra Pradesh where vaccine hesitancy was high, it was higher still among women.

Tech and the Indian woman

One possible explanation could lie in the tech-first roll-out of the vaccine, T Sundararaman, public health expert and global coordinator of the People’s Health Movement, said, adding that more detailed data about the gender gap by age group was first necessary.

“When you have a system that relies on a website, the most privileged will be at an advantage," said Sundararaman. “This means upper class, urban, young men."

In Bihar, for instance, the 2019-20 National Family Health Survey showed that just 51% of women had a phone that they could use themselves, and among them, just 49% could read SMSes. Just over a third of households in the state had any form of access to the internet.

However, the problem could be beyond internet access, Sundararaman said, pointing to the fact that the bias against women in vaccination data began even during the first phase when only healthcare workers and frontline workers were being vaccinated.

The Indian government currently does not permit pregnant women to be vaccinated except in special circumstances, and only last week permitted vaccinations for nursing mothers. But that too is perhaps only one piece in the gender gap puzzle.

(Rukmini S. is a Chennai-based journalist)