Determinants of child immunization in Nepal: The role of women's empowerment

Background: Approximately 1.4 million or 13% of all children who die each year could be prevented with widely-available vaccines. Objective: We examined if women's empowerment improved child immunization using data on 1,056 mothers with young children from Nepal. Methods: The study utilized the 2006 Nepal Demographic and Health Survey, a nationally-representative sample of 10,793 women from 8,707 households across Nepal. We selected all mothers with first child between the ages of 12 and 23 months at the time of interview. This resulted in a sample of 1,056 mothers. Results: Among the measures of women's empowerment, mothers' education was significantly associated with child immunization. The odds of being fully immunized for children of mothers with secondary education were 5.91 times the odds for children of mothers without any formal education. Other measures of women's empowerment - women's age at birth of first child, gap in age between spouses, women's knowledge about sexually-transmitted diseases, their role in intra-household financial, health and mobility decisions, and their perceptions toward wife beating - were not associated with child immunization. Among control variables, mothers who received antenatal care were 3.31 times as likely to immunize their children as mothers who did not receive any antenatal care. Other such barriers to health service use such as cost of care, distance to health services, and quality of health services were not significant. Conclusions: To improve child immunization, Nepal should strengthen its antenatal care services. Additionally, over 56% of mothers in Nepal had no formal education; to improve child health in the long run, the country should focus on education of women and girls.