Trends in Childhood Immunisation amongst Muslim Children of Punjab (India): An Empirical Study
Affiliation
Centre for Research in Rural and Industrial Development (CRRID)
Date
Summary
"[R]ather than vaccine rejection, there was vaccine hesitancy and vaccine acceptance. It reflects embeddedness, commitment, acceptance of health workers in the larger community."
Immunisation programmes are a way to protect against diseases as envisaged by the state and informed by medicine. The problem arises when this power of the state is questioned at the level of community, either as a critique for state's inadequate policy or as a mistrust of the state. In India, where gaps are observable in terms of achieving universal immunisation of children, various forms of struggle, resistance, and opposition to immunisation have been documented - particularly due to religion. This paper examines immunisation trends among Muslim children from the northwestern Indian state of Punjab.
Of the 13 Indian states with a Muslim population at 10% or more of the total state population, Punjab is the only one in northwestern region of the country with a high immunisation rate amongst children from Muslim families (67.2%). Rather than focusing on areas of low immunisation, this paper analyses trends in the Muslim-majority region of Punjab (the state with highest immunisation rate in India, as per the National Family and Health Survey) to observe if religion alone has the power to affect rates of full childhood immunisation or if some other factors emerge as prominent.
Based on a cross-sectional study involving mothers of children between 2 and 5 years of age from 400 households in district Sangrur of Punjab, results of the study show that the rate of full immunisation among children from Muslim families was 88%; none of the children were non-immunised. Children of mothers more than 30 years of age are more likely to be fully immunised as compared to children to mothers of lesser age; children of illiterate mothers are less likely to be fully immunised as compared to children to mothers of higher level of education. However, the study shows that "it is not the education level alone that affects the demand for immunisation of children. Role of health workers and family and larger community is also significantly important."
Of the 479 children studied, 56 were partially immunised. These families were concentrated in specific clusters in rural areas of Malerkotla tehsil. Some of the respondents (mothers of both fully and partially immunised children) mentioned having heard rumours (24%) that discouraged them from getting their children immunised. Most ignored such rumours, but a few (2.0%) accepted them as the truth. These aspects reflect the larger global narrative that vaccination is a conspiracy to reduce the Muslim population, which has been highlighted by other studies as well.
Thus, this study found that religion per se does not appear to influence rates of full immunisation. Geographical location, embeddedness of the community in the larger political and social milieu of their area, and reach and acceptance of health workers at grassroots level emerge as strong factors contributing to higher rates of immunisation amongst Muslim children of Malerkotla. In particular, the role of community health workers like the auxiliary nurse midwife (ANM) and the Accredited Social Health Activist (ASHA) is important aspect in acceptance of immunisation. One ANM reported: "People did use to cooperate earlier. They were afraid of getting their children vaccinated. When we used to go out for pulse polio coverage, people used to hide their children in the almirahs, cupboards, manger. But slowly we tried to counsel them, explained them the necessity and benefits of it and finally after sometime we were able to get them to immunise their children....But when MR [measles-rubella vaccine] was introduced, we started facing the same problem of distrust. People believed that this vaccination was government's plan to reduce Muslim population and would make children infertile. Then I took my own child to the school and vaccinated him myself in front of the entire village. Since then people have started coming forward for it."
In conclusion: "Considering that immunisation of children from Muslim families of Malerkotla depicts positive trends, it may be considered as case study wherein more than religion, location and social and political embeddedness of the community is more significant."
Immunisation programmes are a way to protect against diseases as envisaged by the state and informed by medicine. The problem arises when this power of the state is questioned at the level of community, either as a critique for state's inadequate policy or as a mistrust of the state. In India, where gaps are observable in terms of achieving universal immunisation of children, various forms of struggle, resistance, and opposition to immunisation have been documented - particularly due to religion. This paper examines immunisation trends among Muslim children from the northwestern Indian state of Punjab.
Of the 13 Indian states with a Muslim population at 10% or more of the total state population, Punjab is the only one in northwestern region of the country with a high immunisation rate amongst children from Muslim families (67.2%). Rather than focusing on areas of low immunisation, this paper analyses trends in the Muslim-majority region of Punjab (the state with highest immunisation rate in India, as per the National Family and Health Survey) to observe if religion alone has the power to affect rates of full childhood immunisation or if some other factors emerge as prominent.
Based on a cross-sectional study involving mothers of children between 2 and 5 years of age from 400 households in district Sangrur of Punjab, results of the study show that the rate of full immunisation among children from Muslim families was 88%; none of the children were non-immunised. Children of mothers more than 30 years of age are more likely to be fully immunised as compared to children to mothers of lesser age; children of illiterate mothers are less likely to be fully immunised as compared to children to mothers of higher level of education. However, the study shows that "it is not the education level alone that affects the demand for immunisation of children. Role of health workers and family and larger community is also significantly important."
Of the 479 children studied, 56 were partially immunised. These families were concentrated in specific clusters in rural areas of Malerkotla tehsil. Some of the respondents (mothers of both fully and partially immunised children) mentioned having heard rumours (24%) that discouraged them from getting their children immunised. Most ignored such rumours, but a few (2.0%) accepted them as the truth. These aspects reflect the larger global narrative that vaccination is a conspiracy to reduce the Muslim population, which has been highlighted by other studies as well.
Thus, this study found that religion per se does not appear to influence rates of full immunisation. Geographical location, embeddedness of the community in the larger political and social milieu of their area, and reach and acceptance of health workers at grassroots level emerge as strong factors contributing to higher rates of immunisation amongst Muslim children of Malerkotla. In particular, the role of community health workers like the auxiliary nurse midwife (ANM) and the Accredited Social Health Activist (ASHA) is important aspect in acceptance of immunisation. One ANM reported: "People did use to cooperate earlier. They were afraid of getting their children vaccinated. When we used to go out for pulse polio coverage, people used to hide their children in the almirahs, cupboards, manger. But slowly we tried to counsel them, explained them the necessity and benefits of it and finally after sometime we were able to get them to immunise their children....But when MR [measles-rubella vaccine] was introduced, we started facing the same problem of distrust. People believed that this vaccination was government's plan to reduce Muslim population and would make children infertile. Then I took my own child to the school and vaccinated him myself in front of the entire village. Since then people have started coming forward for it."
In conclusion: "Considering that immunisation of children from Muslim families of Malerkotla depicts positive trends, it may be considered as case study wherein more than religion, location and social and political embeddedness of the community is more significant."
Source
Dialogues in Health, Volume 2, December 2023, 100092. https://doi.org/10.1016/j.dialog.2022.100092. Image credit: Johanan Ottensooser via Flickr (CC BY-NC-SA 2.0)
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