Life opportunities are shaped by social factors such as poverty, caste, social position and gender. Gender roles and gender inequity are pervasive structural determinants of health in our study area. While mothers are considered the primary caregivers for their children, they are often disempowered in their ability to make decisions within the household due to traditional gender roles and low levels of education and knowledge. Restrictions on mobility may also impede mothers’ ability to seek health care for their children.

Scientific research shows that women’s education is positively linked to child survival and flourishing, but educational status is difficult to modify in the short term. We investigated whether maternal health literacy, a rapidly modifiable factor related to mother’s education, was associated with children’s receipt of vaccines in two underserved Indian communities. We found that maternal health literacy is independently associated with child vaccination. This suggests that initiatives targeting mother’s understanding and awareness could help to improve vaccination coverage in lagging populations. The link between maternal education and vaccination coverage was also supported in global analyses. Building on this work, we have been building a gender-sensitive intervention approach to improve immunization uptake while including males and the entire community. Our research has helped to inform the work of the Equity Reference Group for Immunisation (ERG), an action-oriented think tank convened by UNICEF and the Bill & Melinda Gates Foundation to generate innovative ideas to accelerate progress on equity in immunisation.

Child undernutrition is prevalent in our study site, compromising healthy growth, development and life chances. Malnourished children are hardest hit by infectious diseases. Our research revealed that in resource-poor rural and urban settings in India, maternal health literacy is associated with chronic forms of child undernutrition. Programs targeting mother’s understanding and awareness may offer effective entry points for intervention to improve child nutrition. We continue to work on synergies.