Gender Dynamics in Vaccine Acceptance and Hesitancy Among Primary Caregivers in Ethiopia: A Mixed-Methods Study

Abstract

BACKGROUND/OBJECTIVES: Vaccination uptake in Ethiopia is deeply shaped by gender norms, with women serving as primary caregivers but often limited by low autonomy, while men typically control household decisions but remain less engaged in child health. This study examines gendered influences on vaccine hesitancy and acceptance to inform future strategies. METHODS: A community-based cross-sectional mixed-methods study was conducted in four regions of Ethiopia (Amhara, Oromia, Afar, and Tigray). Quantitative data were collected from 992 caregivers through multistage stratified sampling procedure, whereas qualitative data were collected from 26 in-depth interviews, 24 exit interviews and 11 key informant interviews and were analyzed thematically guided by the WHO Behavioural and Social Drivers framework. Multivariable logistic regression was conducted to determine the associations. RESULTS: The result highlighted that the proportion of caregivers who reported willingness to vaccinate their child with all recommended vaccines was high (93.5%) and more likely among those with higher education, family support, religious support, and frequency of health worker contact. However, 51.1% of caregivers displayed some degree of vaccine hesitancy, with higher prevalence among males. Hesitancy was linked to traditional beliefs and norms that assign vaccination responsibility to mothers, urban residence, and being employed, while secondary education, family support, and religious support were protective. While acceptance is high, hesitancy persists. Gender roles, education, social support, and health worker engagement influence immunization outcomes. CONCLUSIONS: The study highlighted that expanding immunization across all age groups and reducing persistent hesitancy requires a shift toward gender-responsive strategies including integrating a gender perspective into the immunization programs that address traditional norms and misinformation.