Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

BackgroundChildhood vaccination, family planning, healthcare access, and womens empowerment are goals targeted by the Sustainable Development Goals (SDG). Barriers to healthcare access impede vaccination, and tackling goals holistically could create larger gains than siloed efforts. We studied Nepal, Senegal, and Zambia to test the association between childhood vaccinations and other SDG indicators to identify clustered deprivations. We quantified how children with few - or no - vaccines and their mothers were vulnerable in other SDG areas. MethodsWe analyzed Demographic and Health Surveys (DHS) from Nepal, Senegal, and Zambia. Through ordinal logistic regressions, controlling for household/mothers characteristics, we identified strong predictors of the number of vaccine doses one-year-old children received. Through bootstrapping and optimal propensity scores matching, we compared children with no or few childhood doses (0-2 doses in early 2000s, or 0-4 in late 2010s) to children who received eight doses (DTP1-3, MVC1, Pol1-3, and BCG vaccines). FindingsMothers of children who received eight doses were 14-30% more likely than mothers of children with few or no doses to have accessed a health facility in the last year (95% CIs were 16-44% in Nepal 2001, -5% to 33% Nepal 2016, 3-26% Senegal 2005, 1-31% Senegal 2019, 9-38% Zambia 2001-02, 7-36% Zambia 2018), knew on average 0.7-1.5 more contraceptive methods (0.9-2.0 Nepal 2005, 0.1-1.5 Nepal 2016, 0.6-1.7 Senegal 2005, 0.2-1.7 Senegal 2019, 0.1-1.4 Zambia 2001-02, 0.5-1.4 Zambia 2018), and had 10-22% higher literacy rates (12-32% Nepal 2001, -7% to 36% Nepal 2016, 10-26% Senegal 2005, -3 to 22% Senegal 2019, -4% to 28% Zambia 2001-02, 5-36% Zambia 2018). InterpretationChildren with few or no vaccine doses and their mothers were behind in access to family planning, healthcare, and education compared to fully vaccinated children and their mothers. Such differences can further impede immunizations; therefore, integrated education and health services are needed to improve vaccination outcomes. O_TEXTBOXSUMMARY What is already known about this subject?O_LIEffective integrated health services have been implemented to simultaneously improve multiple health outcomes and other Sustainable Development Goals (SDG). C_LIO_LIChildhood vaccinations should be integrated with other initiatives, rather than keeping activities siloed, to further achieve SDG goals. C_LI What are the new findings?O_LIMothers and their children who received few - or no - vaccines in Nepal, Senegal, and Zambia share multiple vulnerabilities related to access to family planning, access to health facilities, and health/women education. C_LI What are the recommendations for policy and practice?O_LIThere is an opportunity to integrate vaccination efforts with other healthcare services and womens education initiatives to increase performance outcomes of vaccination coverage and other SDG goals. C_LI C_TEXTBOX