Trends in Women’s Empowerment and Their Association with Childhood Vaccination in Cambodia: Evidence from Demographic and Health Surveys (2010–2022)

Background: Women’s empowerment has been significantly associated with improved child health outcomes. Cambodia, amid rapid socioeconomic transition, offers a critical setting to examine how women’s empowerment influences child immunization. This study evaluated changes in women’s empowerment from 2010 to 2022 and examined its association with the completion of child vaccinations within the first two years of life. Methods: Data from the Cambodia Demographic and Health Surveys conducted in 2010, 2014, and 2021–22, encompassing 9,222 women with recent births, were analyzed. Empowerment was measured across literacy and information access, employment, and decision-making domains. Multinomial logistic regression assessed associations between empowerment factors and completion of oral polio (OPV), diphtheria–tetanus–pertussis (DTP), pneumococcal conjugate (PCV), and measles–rubella (MR) vaccines, adjusting for demographic and socioeconomic variables. Results: Between 2010 and 2022, women’s empowerment in Cambodia improved across literacy, employment, and decision-making. The proportion of women with no schooling declined to 12%, and nearly half completed primary education. Digital access expanded rapidly, with 82.4% owning a mobile phone and about half using the internet daily. Although the share of non-working women slightly increased, agricultural employment fell by one-fifth, and cash earnings rose from 48.7% to 82.5%. Most women, independently or jointly, made decisions about major household matters. Completion rates for OPV, DTP, and PCV ranged from 79% to 83%, while just over half of children were fully vaccinated against measles. Higher maternal education and cash earnings were positively associated with OPV, DTP, and PCV completion but negatively associated with measles vaccination. Joint decision-making on respondents’ income use increased measles non-completion (OR = 2.26, 95% CI: 1.13–4.51), whereas joint decision-making on respondents’ health care was linked to higher completion (OR = 0.42, 95% CI: 0.21–0.83). Conclusions: Women's empowerment remains a key determinant of vaccination outcomes in Cambodia. The distinct pattern of measles underscores structural and behavioral barriers that require integrated approaches to enhance both women's autonomy and service accessibility.