GENDER EQUITY IN EXPANDED PROGRAMME ON IMMUNIZATION (EPI) SERVICE UTILIZATION AMONG FORCIBLY DISPLACED MYANMAR NATIONALS (FDMN): A MULTI-CAMP ANALYSIS OF CHILD VACCINATION PARITY IN COX'S BAZAR, BANGLADESH 2024–2026

Abstract

Background: Gender inequity in childhood immunization remains a significant public health challenge in many low- and middle-income countries, particularly within humanitarian and conflict-affected settings where healthcare access is often severely disrupted. In several South Asian societies, male children frequently exhibit higher rates of complete vaccination compared to female children, a disparity often attributed to prevailing sociocultural preferences, gender norms, and inequitable healthcare-seeking behaviors. However, comprehensive evidence regarding gender parity in vaccination utilization among Forcibly Displaced Myanmar Nationals (FDMN) residing in the Cox's Bazar camps remains limited. This study aimed to assess the extent of gender equity in Expanded Programme on Immunization (EPI) service utilization among children living in Camps 1E, 11, and 22 in Cox's Bazar, Bangladesh.Methods: A retrospective descriptive analysis was conducted utilizing routine EPI service data collected from health post vaccination registers operated by Gonoshasthaya Kendra between July 2024 and April 2026. Sex-disaggregated vaccination data for Bacillus Calmette–Guérin (BCG), Oral Polio Vaccine (OPV0–3), Pneumococcal Conjugate Vaccine (PCV1–3), Pentavalent Vaccine (PENTA1–3), Inactivated Polio Vaccine (IPV1–2), and Measles-Rubella Vaccine (MR1–2) were meticulously extracted and analyzed. Comparisons were made across camps regarding the total vaccine doses administered to male and female children, as well as the total number of vaccinated children. Male-to-female ratios were calculated to ascertain equity, with ratios ranging between 0.90 and 1.10 considered indicative of equitable utilization.Results: Over the study period, a total of 4,417 child vaccine doses were administered across the three camps, comprising 2,218 doses for male children and 2,199 for female children, resulting in an overall male-to-female ratio of 1.01. Similarly, the total number of children receiving at least one EPI service was nearly balanced between sexes, with 674 male children and 656 female children vaccinated. Across individual vaccine categories and camps, the majority of male-to-female ratios consistently fell within the predefined equitable range. Among 63 vaccine-specific comparisons, 85.7% demonstrated equitable utilization. The only notable deviation was observed for MR2 vaccination in Camp 22, where the male-to-female ratio was 0.69; however, this anomaly was primarily attributed to low overall MR2 uptake rather than a systematic gender bias.Conclusion: The findings unequivocally demonstrate substantial gender equity in childhood immunization utilization among FDMN populations served by Gonoshasthaya Kendra in Cox's Bazar. These results suggest that humanitarian immunization systems can effectively achieve equitable vaccine access when underpinned by gender-neutral service delivery approaches, robust active community outreach, and continuous monitoring of sex-disaggregated indicators. Continued efforts are imperative to enhance overall vaccine completion rates, particularly for MR2 coverage, while steadfastly maintaining equitable service utilization for both male and female children.