Gender Dynamics in Vaccine Acceptance and Hesitancy Among Primary Caregivers in Ethiopia: A Mixed-Methods Study

Vaccination uptake in Ethiopia is deeply shaped by gender norms, with women serving as primary caregivers but often limited by low autonomy, while men typically control household decisions but remain less engaged in child health. This study examines gendered influences on vaccine hesitancy and acceptance to inform future strategies. A community-based cross-sectional mixed-methods study was conducted in Amhara, Oromia, Afar, and Tigray. Quantitative data were collected from 992 caregivers through multistage stratified sampling. Key variables included education, social support, and gendered attitudes. Qualitative data from key informant and in-depth interviews were analyzed thematically using Behavioural and Social Drivers framework. Multivariable logistic regression was conducted to determine the associations. Overall vaccine acceptance was high at 93.5% (95% CI: 91.7%–94.9%) and more likely among those with higher education, family support, religious support, and frequency of health worker contact. However, 51.1% of caregivers displayed some degree of vaccine hesitancy, with higher prevalence among males. Hesitancy was linked to traditional beliefs assigning vaccination responsibility to mothers (AOR=1.69), urban residence (AOR=1.62), and being employed (AOR=0.59), while secondary education (AOR=0.53), family support (AOR=0.25), and religious support (AOR=0.50) were protective. While acceptance is high, hesitancy persists. Gender roles, education, social support, and health worker engagement influence immunization outcomes. Expanding immunization across all age groups requires a shift toward gender-responsive strategies that address traditional norms and misinformation, especially for men and urban residents.