Intersecting Vulnerabilities and Immunization Dropout in Uttar Pradesh: An Equity-Driven Analysis of Structural Disadvantage

Abstract

Despite progress in India’s Universal Immunisation Programme, dropout between vaccine doses remains high among marginalised communities. This study investigates how maternal education, household poverty, caste, and religion intersect to shape child immunisation dropout in Uttar Pradesh. Using National Sample Survey data, we analyse dropout across key vaccine stages (Polio 1–3, DPT 1–3, BCG–Measles) with logistic regression models to estimate odds ratios and synergistic effects of multiple vulnerabilities. Results reveal a steep risk gradient: households facing triple deprivation show dropout rates up to five times higher than non‑deprived households. Maternal education emerges as the strongest protective factor, substantially lowering dropout odds even in poor or minority households. Poverty or religious identity alone does not independently predict dropout; risk intensifies when combined with low education and social marginality. Findings highlight the need for intersectional diagnostics and equity‑focused strategies—particularly maternal literacy and subgroup monitoring—to sustain immunisation completion and achieve national and global coverage goals. What We Already Know: [1] Immunization dropout remains a persistent challenge in India, with states like Uttar Pradesh showing significantly lower completion rates than the national average. [2] Individual social determinants—such as maternal education, household poverty, caste affiliation, and religious identity—have been independently linked to vaccine discontinuity. [3] Aggregate reporting often obscures vulnerable subpopulations, limiting the effectiveness of targeted interventions in high-risk communities. What This Article Adds: [1] This study employs an intersectional framework to illustrate how overlapping disadvantages—specifically, the combination of poverty, educational deprivation, and social marginalization—compound the risk of dropout in early childhood immunization programs.[2] It quantitatively identifies maternal education as the most consistent and impactful protective factor across multiple immunization stages, even in socially excluded households. [3] The findings support a shift toward equity-focused immunization strategies that prioritize multidimensional vulnerability clusters over broad demographic categories.