The influence of women's empowerment on childhood vaccination coverage in Nigeria: a spatio-temporal analysis.

Immunization is one of the most impactful public health achievements, significantly reducing childhood morbidity and mortality worldwide. However, gender disparity and women's disempowerment constitute structural barriers in accessing vaccine services in low- and middle-income countries. In Nigeria, widespread differences in social norms and cultural values affect gender roles and influence women's ability to decide their own healthcare needs and participate in household decision-making. This leads to attitudinal differences in uptake of immunization depending on the child's location of residence. Using data from four waves of the Nigeria Demographic and Health Survey, we constructed two empowerment indices that determine whether caregivers participate in household decision-making and have the ability to decide on their healthcare needs. We used a structured spatiotemporal statistical model to determine whether a significant part of childhood vaccination coverage disparities can be attributed to these women's empowerment measures and predicted events at the third administrative level of the country. We considered five vaccination indicators: Bacillus Calmette-Guerin (BCG), zero-dose, receiving a complete dose of DPT, MCV-1 (first dose of measles-containing vaccine), and receipt of all basic vaccinations. The adopted model was validated by comparing the empirical estimates of vaccination coverage level from the data with model projections at the second administrative level. The findings indicate that although empowerment regarding participation in household decision-making and agency over healthcare access is generally associated with increased vaccine uptake, their effects vary considerably across locations and notably among the highly empowered category of women. Although there are efforts to bridge immunization gaps within the country, the study emphasizes the need for tailored strategies that target up-scaling the ability of women and the wider community to participate in the decision-making process and be able to decide on healthcare needs to address regional disparities and improve vaccination coverage.