Gender and intersectional barriers to child immunization: findings from qualitative research in Nigeria

Background Preventable diseases remain a leading cause of child mortality globally, with routine vaccination critical to saving lives. Research has increasingly examined the reasons behind low child immunization. While gender is recognized as important, most studies treat women as homogeneous group, overlooking how intersecting factors like age, religion, and marital status shape vaccine access. This study fills this gap by analysing how different social categories interact with gender to influence caregivers’ experiences with child vaccination in Nigeria. Method A novel conceptual approach was used to capture gender-related and intersectional barriers to vaccination across both supply and demand sides, spanning multiple socio-ecological levels. The study employed a qualitative research design, including a desk review, 67 key informant interviews, and 36 focus group discussions. Primary data were collected across six Nigerian states: Lagos, Kaduna, Cross River, Gombe, Ebonyi, and Kwara. Participants were purposively selected to reflect diverse caregiving experiences. Thematic analysis guided interpretation, with findings compared across caregiver groups through an intersectional lens. Results The article reveals that different groups of women caregivers – married women, religious women, adolescent mothers, and grandmothers – face different challenges when seeking to vaccinate their children in Nigeria. Married women must negotiate the benefits and costs of vaccination with their husbands. Religious mothers have to balance scientific knowledge with deeply held religious beliefs. Adolescent mothers juggle their limited status as young women, lack of knowledge, and negative experiences with health workers in the process of seeking vaccination for their children. Meanwhile, grandmothers manage to promote vaccination and provide hands-on support but face challenges like overcrowded transport and long waits. Conclusion The article concludes that gender-just child immunization requires a nuanced understanding of the diverse circumstances of female caregivers and a recognition of their distinct challenges. However, simply acknowledging these barriers is not enough. Gender-just programming must ease women’s caregiving responsibilities and promote transformative actions to redistribute these responsibilities more equitably between the sexes.