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http://dx.doi.org/10.3961/jpmph.21.592

Women's Empowerment Facilitates Complete Immunization in Indonesian Children: A Cross-sectional Study  

Wirawan, Gede Benny Setia (Center for Public Health Innovation, Udayana University)
Gustina, Ni Luh Zallila (Dokter Debora Medical Care)
Pramana, Putu Harrista Indra (Faculty of Medicine, Udayana University)
Astiti, Made Yuliantari Dwi (Faculty of Medicine, Udayana University)
Jonathan, Jovvita (School of Medicine & Health Sciences, Atma Jaya Catholic University of Indonesia)
Melinda, Fitriana (Faculty of Medicine, Udayana University)
Wijaya, Teo (Department of Paediatrics, Wangaya General Hospital)
Publication Information
Journal of Preventive Medicine and Public Health / v.55, no.2, 2022 , pp. 193-204 More about this Journal
Abstract
Objectives: The primary objective of this study was to examine the effect of women's empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association. Methods: We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women's empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women's empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group. Results: The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women's empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles. Conclusions: To our knowledge, this study is the first to explore women's empowerment as a determinant of child immunization in Indonesia. The results indicate that women's empowerment must be considered in Indonesia's child immunization program. Women's empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women's empowerment on health outcomes.
Keywords
Immunization; Women; Empowerment; Children; Indonesia;
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1 Janssens W. Externalities in program evaluation: the impact of a women's empowerment program on immunization. J Eur Econ Assoc 2011;9(6):1082-1113.   DOI
2 Jaya LP, Auerkari R, Wahyu A. The challenges and opportunities of women's role in child immunization. In: Proceedings of the 2nd International Conference on Strategic and Global Studies (ICSGS 2018); 2019 [cited 2021 Jul 6]. Available from: https://www.atlantis-press.com/proceedings/icsgs-18/125922524.
3 Putra IG, Dendup T, Januraga PP. The roles of women empowerment on attitude for safer sex negotiation among Indonesian married women. Women Health 2021;61(1):95-108.   DOI
4 Vikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Soc Sci Med 2012;75(2):331-339.   DOI
5 Sitepu FY, Depari E, Mudatsir M, Harapan H. Being unvaccinated and contact with measles cases as the risk factors of measles outbreak, North Sumatera, Indonesia. Clin Epidemiol Glob Health 2019;8(1):239-243.   DOI
6 Raj A. Women and girls' health agency: operationalizing the "Can-Act-Resist" of the women's empowerment process. EClinicalMedicine 2020;20:100287.   DOI
7 Ministry of Health. Basic health research (Riskesdas) 2018. Jakarta; Ministry of Health; 2018, p. 457-459 (Indonesian).
8 Ministry of Health. Indonesian health profile 2020. Jakarta; Ministry of Health; 2021, p. 1-139 (Indonesian).
9 Statistics Indonesia, National Population and Family Planning Board; Ministry of Health/Indonesia, ICF International. Indonesia Demographic and Health Survey 2007; 2008 [cited 2021 Nov 1]. Available from: https://dhsprogram.com/pubs/pdf/FR218/FR218[27August2010].pdf.
10 BKKBN, BPS, Ministry of Health, ICF International. Indonesia Demographic and Health Survey 2017; 2018 [cited 2021 Nov 1]. Available from: https://dhsprogram.com/publications/publication-fr342-dhs-final-reports.cfm.
11 Lamiday SP, Machmud PB. The association between women's empowerment and antenatal care coverage in Indonesia in 2017. Jurnal Berkala Epidemiologi 2019;7(3):172-179.   DOI
12 Holipah, Maharani A, Kuroda Y. Determinants of immunization status among 12- to 23-month-old children in Indonesia (2008- 2013): a multilevel analysis. BMC Public Health 2018;18(1):288.   DOI
13 Phan L. Measuring women's empowerment at household level using DHS data of four Southeast Asian countries. Soc Indic Res 2016;126(1):359-378.   DOI
14 Miedema SS, Haardorfer R, Girard AW, Yount KM. Women's empowerment in East Africa: development of a cross-country comparable measure. World Dev 2018;110:453-464.   DOI
15 Alemayehu YK, Theall K, Lemma W, Hajito KW, Tushune K. The role of empowerment in the association between a woman's educational status and infant mortality in Ethiopia: secondary analysis of Demographic and Health Surveys. Ethiop J Health Sci 2015;25(4):353-362.   DOI
16 Larson H, Leask J, Aggett S, Sevdalis N, Thomson A. A multidisciplinary research agenda for understanding vaccine-related decisions. Vaccines (Basel) 2013;1(3):293-304.   DOI
17 World Health Organization. Joint national/international expanded programme on immunization and vaccine preventable disease surveillance review: Indonesia, 10-18 February 2020 [cited 2022 Mar 10]. Available from: https://apps.who.int/iris/handle/10665/339595.
18 Singh K, Haney E, Olorunsaiye C. Maternal autonomy and attitudes towards gender norms: associations with childhood immunization in Nigeria. Matern Child Health J 2013;17(5):837-841.   DOI
19 Sohn M, Lin L, Jung M. Effects of maternal decisional authority and media use on vaccination for children in Asian countries. Medicina (Kaunas) 2018;54(6):105.   DOI
20 Kabeer N. Resources, agency, achievements: reflections on the measurement of women's empowerment. Dev Change 1999;30(3):435-464.   DOI
21 Jones R, Haardorfer R, Ramakrishnan U, Yount KM, Miedema S, Girard AW. Women's empowerment and child nutrition: the role of intrinsic agency. SSM Popul Health 2019;9:100475.   DOI
22 World Bank. Lower middle income; 2021 [cited 2021 Oct 13]. Available from: https://data.worldbank.org/income-level/lower-middle-income.
23 Dube E, Farrands A, Lemaitre T, Boulianne N, Sauvageau C, Boucher FD, et al. Overview of knowledge, attitudes, beliefs, vaccine hesitancy and vaccine acceptance among mothers of infants in Quebec, Canada. Hum Vaccin Immunother 2019;15(1):113-120.   DOI
24 Wirawan GB, Mahardani PN, Cahyani MR, Laksmi NL, Januraga PP. Conspiracy beliefs and trust as determinants of COVID-19 vaccine acceptance in Bali, Indonesia: cross-sectional study. Pers Individ Dif 2021;180:110995.   DOI
25 Efendi F, Pradiptasiwi DR, Krisnana I, Kusumaningrum T, Kurniati A, Sampurna MT, et al. Factors associated with complete immunizations coverage among Indonesian children aged 12-23 months. Child Youth Serv Rev 2020;108:104651.   DOI
26 Holipah H, Maharani A, Sujarwoto S, Hinoura T, Kuroda Y. Trends, spatial disparities, and social determinants of DTP3 immunization status in Indonesia 2004-2016. Vaccines (Basel) 2020;8(3):518.   DOI
27 BKKBN, BPS, Ministry of Health, ICF International. Indonesia Demographic and Health Survey 2012; 2013 [cited 2021 Nov 1]. Available from: https://dhsprogram.com/publications/publication-FR275-DHS-Final-Reports.cfm.
28 Sado L, Spaho A, Hotchkiss DR. The influence of women's empowerment on maternal health care utilization: evidence from Albania. Soc Sci Med 2014;114:169-177.   DOI
29 Thorpe S, VanderEnde K, Peters C, Bardin L, Yount KM. The influence of women's empowerment on child immunization coverage in low, lower-middle, and upper-middle income countries: a systematic review of the literature. Matern Child Health J 2016;20(1):172-186.   DOI
30 Ahmmed F. Women's empowerment and practice of maternal healthcare facilities in Bangladesh: a trend analysis. J Health Res 2021. doi: https://doi.org/10.1108/JHR-11-2020-0559.   DOI
31 Demographic and Health Surveys (DHS) Program. Protecting the privacy of DHS survey respondents; 2021 [cited 2021 Oct 12]. Available from: https://dhsprogram.com/methodology/Protecting-the-Privacy-of-DHS-Survey-Respondents.cfm.
32 Porth JM, Wagner AL, Moyer CA, Mutua MK, Boulton ML. Women's empowerment and child vaccination in Kenya: the modifying role of wealth. Am J Prev Med 2021;60(1 Suppl 1):S87-S97.   DOI