Universal child immunisation is one of the targets under the Millennium Development Goal programme to reduce child mortality; India is quite far from achieving this goal. The latest UNICEF Coverage Evaluation Survey 2009 estimates 61 per cent of the children in the age group 12 to 23 months were fully immunised, while according to government estimates under the District Level Household Survey-3 2007-08 (DLHS-3), 54 per cent had received the full immunisation schedule. Though the two survey estimates are not strictly comparable, it is apparent that with five years to the target, around 40 per cent of our children are missing out on some vital vaccines. The complete schedule of immunisation for children under two years includes BCG (tuberculosis), three doses each of polio and DPT (diphtheria, pertussis or whooping cough, tetanus) and measles. Often the first doses are given but the schedule for multiple dose vaccines is not followed through.
The disparity across states is, unfortunately, a ubiquitous feature of all Indian data. According to the DLHS-3 results, Arunachal Pradesh, Uttar Pradesh, Meghalaya, Madhya Pradesh and Tripura all had full immunisation coverage of less than 40 per cent, while the ratio is close to 80 per cent or more in Goa, Lakshadweep, Daman & Diu, Andaman & Nicobar Islands, Himachal Pradesh, Tamil Nadu, Puducherry, Punjab and Kerala. Barring the north-east, small states and union territories in general perform better with higher access to their population. States which cause the highest concern are Tripura, Meghalaya, Rajasthan, Arunachal Pradesh, Assam and Manipur where more than 10 per cent of the children had absolutely no vaccination.(Click for graph)
Interestingly, the overwhelming majority of children in India are vaccinated in government facilities, pointing to the relative success in the reach of the public programme. So, what is it that keeps children from being vaccinated? DLHS-3 data shows that 5.2 per cent of the children in rural areas did not receive a single dose vaccination at all, while this share was 2.9 per cent in urban India. The most commonly cited reason for not vaccinating at all is lack of awareness — around half of the mothers, in rural and urban areas said they were unaware of the need to immunise. In addition, mothers cited the fear of side-effects, lack of knowledge of the place or timing of immunisation, absence of medical personnel, distance to the immunisation centre etc. as reasons for not vaccinating their children. Clearly, in spite of the celebrity advertisements promoting vaccination, much more needs to be done to address these gaps in understanding, availability and access.
One important point brought out by the DLHS-3 survey is the link between the level of the mother’s education and child immunisation — a little over a third of the children with illiterate mothers have received the full immunisation cover, while the percentage crosses 50 per cent when mothers have had less than five years of school.
Ultimately, of course, immunisation is just one part of an overall health programme to combat illness and mortality; the key to the health of the future generations lies in creating awareness, not only for vaccination but also for hygiene and sanitation.
Indian States Development Scorecard is a weekly feature by Indicus Analytics that focuses on the progress in India and the states across various socio-economic parameters.
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