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AdvocacyMarch 7, 2017

Immunization Matters for Women and Girls Too

We were honored to have Geeta Rao Gupta deliver the Keynote Speech at our 2017 Champion Summit, discussing how immunization matters for women and girls.  Geeta is currently Senior Fellow at the UN Foundation and Co-Chair of the Gender-Based Violence Task Force of the World Bank.  Below are her touching and inspiring words to our Champions. 


We know that vaccines protect the health of children and adults, and save lives. They prevent disease and disability, and even some forms of cancer. You may have heard this before but it bears repetition – globally, vaccines prevent the deaths of roughly 2.5 million children per year – and research has repeatedly shown that they are safe to use. Yet, global coverage of immunization still has not reached the goal of 90 percent or more coverage in every country around the world. The World Health Organization estimates that an additional 1.5 million deaths could be averted if global vaccination coverage improves.

And the case to invest in vaccines is easy to make because they are among the most cost-effective health interventions available today. For every dollar invested in childhood immunization we can expect to save sixteen U.S. dollars in healthcare costs, lost wages and productivity due to illness. In fact, between 2011 and 2020, childhood immunization is projected to offer up to 1.43 trillion U.S. dollars in economic benefits. Those are the facts that have made efforts such as the Global Alliance for Vaccines and Immunization (Gavi) so successful.

I am sure you will use these facts – that vaccines save children’s lives and are cost effective – in your advocacy for vaccines globally. Today, I want to add to that list of benefits and show you how vaccines and immunization also directly and indirectly benefit women, in particular, mothers – as well as adolescent girls.

Let me share with you a personal story to illustrate this point. Bhagirathi, my paternal grandmother, belonged to an orthodox Hindu Brahmin family from southern India. She married at age of 12, before completing her schooling. Her new husband, Hanumanth Rao, was a kind and educated man, who earned his living in a local government printing press. The couple settled in a small town in central India.

Bhagirathi began her married life in the early 1900s, with multiple pregnancies, closely spaced. Over the span of twenty years, she gave birth to eleven infants. Only six survived infancy. Then, at the age of 33, Bhagirathi died – succumbing to TB. My father, one of the babies who survived, was only 11 when his mother died. I remember talking with him when he was 90 years old about how it felt to lose his mother, and what it meant for the family – psychologically and practically. After listening to him, I nodded and said (in a know-it-all technical specialist kind of way), “Yes, Dad, Bhagirathi must have died as the result of maternal depletion caused by multiple pregnancies.” He corrected me.  “No, dear,” he said. “She died of sorrow. She lost five babies within a span of eight years. She died of grief”

Of all the reasons I am going to share with you today on why vaccines are a great benefit to women and girls, that reason, grief, is the most profound and the least talked about. Lack of access to immunization can lead to children dying in infancy from preventable causes, leaving behind grieving parents – mothers who have to cope with the reality of death at a time when they are in midst of celebrating the miracle of life. Sorrow can be exhausting and debilitating. When we talk about the statistics on infant mortality, we rarely pause to think about the grief that infant deaths cause individual mothers. I want us to think about that today, to motivate us as we step forth to champion the cause of vaccines.  Immunization prevents grief.

There are several other ways in which vaccines benefit women. They reduce women’s time burdens. Without vaccines, mothers spend a great deal of their time caring for sick or disabled children – children with mumps, measles, and chicken pox. Mothers or older daughters who help out, like I did when I was a child in India. I am just four years older than my sister, but when she got mumps as a child, and my mother couldn’t stay home from work, I skipped school to take care of her – the only available substitute for my mother’s loving care. Time is a precious commodity for women, and in poor households, in particular, time is definitely money! A sick child forces a mother to forfeit income from productive work to provide the loving care and attention that a sick child needs. By preventing a child from falling sick, immunization saves women precious time.

The other well documented benefit of immunization for women is the strong link between reductions in child mortality and in fertility, the number of children that women have. In fact, demographic research has established that the single most important factor in fertility declines is declining child mortality. Put another way, continuing high rates of infant and child mortality are significant barriers to fertility decline. Once mothers have the reassurance that immunization and other interventions will let their babies live beyond childhood, they begin to make choices to reduce the number of children they have and invest in their futures. In the past, prior to the discovery of the power of vaccines, women counted on some of their infants dying and therefore planned to have more than they needed, so that at least some children would survive into adulthood. They gambled based on the certainty that some of their children would die. Now with immunization, mothers limit the size of their families, gambling on the assurance that all their children will live! And a fewer number of children, in turn reduces women’s time burdens, freeing them up to engage in more productive work to help their families.

Vaccines, thus, provide enormous economic benefits. They free women up to spend more of their time in economic activity, paid or unpaid, that benefits them and their families. And it reduces the health care costs that are inevitable when children are sick and need medical care. In poor households, unplanned economic shocks, like unexpected healthcare costs can be the last straw – they can drive households into destitution. In countries like Bangladesh, India, and Nepal, for example, an estimated 48 to 69 percent of all healthcare costs come from household budgets. When faced with unexpected illness, disease or disability, poor households are forced to dip into their savings or use loans or sell precious assets, such as livestock, to meet out of pocket expenses for healthcare. It is no surprise then that households can experience enormous financial hardship and often impoverishment as a result of spending on healthcare.

There is another way in which immunization programs can economically benefit women. Women are often deployed as the front line workers to disseminate accurate information about vaccines to mothers and even as vaccinators who travel from door to door to immunize children. This is a strategy that has been used around the world, but particularly in countries where there are restrictions on women’s mobility and interaction with men who are strangers to the family. Often, however, they are not paid – they are volunteer workers. And although it is true that the exposure to working outside the home builds confidence and status, ultimately it is important for women to be remunerated for their efforts on an equal basis with men. The polio eradication program, for example, has depended heavily upon women as vaccinators, educators and social mobilizers – but has paid them as full-time staff.  In fact, India could not have achieved its goal of polio eradication six years ago without the help of the millions of frontline workers, the majority of whom were women, who swarmed the country side and went door to door to find and vaccinate every child. In Pakistan and Afghanistan, women are the backbone of the public health system.  For many of them it was their first opportunity to work outside the home. The gains made in those two countries in stopping the spread of polio are primarily because of the courage and commitment of these women. Some of them have been attacked and even killed while on the job by militants who are determined to use attacks on polio eradication for political gain. But the women have persevered.

Finally, certain vaccines directly benefit women’s health, and I want to focus specifically on the vaccine that prevents cervical cancer caused by the Human Papilloma Virus. The significance of the HPV vaccine, is better understood in the context of the following facts – cervical cancer is the fourth most common cancer in women worldwide and results in 266,000 deaths per year, more than 85 percent of which occur in developing countries. In fact, if current trends hold, deaths caused by cervical cancer will eventually outpace maternal deaths. An additional benefit of the HPV vaccine is that it has to be given during the adolescent years thereby bringing adolescent girls into the health system – an age cohort that has typically been missed by the health system. Finding a way to reach girls to immunize them against HPV provides a way to also reach them with other important health interventions – like HIV prevention, menstrual management hygiene, nutrition supplementation and sexuality education.

These are some of the major ways in which vaccines benefit women and girls – by protecting the lives of infants, preventing sorrow, reducing fertility, saving precious time, providing an economic return and lowering the risk of cancer.

Women know these benefits well. I see that when I travel around the world to visit health programs. In countries as diverse as Bolivia, Nepal, and Ethiopia, I am always struck by women’s determination to get their children immunized. I have seen them travel across challenging mountainous terrain, stand in long lines in the heat of the afternoon sun, wait for long hours just to make sure that their children are protected from illness and disease. I have watched awestruck as women health workers in Afghanistan, who at first glance seem shy and reticent, show enormous savvy and confidence in explaining the benefits of vaccination to their peers and cajoling mothers to do whatever is necessary to complete the full cycle of immunization for their babies.

That commitment and determination needs to be applauded and rewarded by us – and we must use our advocacy to insist on further improvements in the quality of immunization services and reductions in the cost to women of accessing them. For although we have succeeded through Gavi and other efforts to reduce the cost of vaccines, we still need to pay close attention to ensure that immunization services respond to women’s particular needs. If a clinic is open only when women have to be at work in the factory or the fields, if the distance to the clinic is too far and too expensive to travel, if the vaccine is out of stock when a mother arrives at a clinic – then we have let women down and failed to make match their commitment to their children.

Let’s harness the energy in this room to make sure that vaccines help to save more lives by making vaccines both available and accessible – knowing that in doing so they will also offer rich benefits to women and girls.

In conclusion, then, let me say thank you! You have come from all across the country, committed to better the lives of children and families far away from here. Thank you because your collective effort will ensure that fewer women suffer the sorrow that my paternal grandma, Bhagirathi endured – fewer families will suffer such terrible and untimely losses. And for that I am grateful. Thank you!

Anna Kavaliunas