Peer-reviewed article
How does birth order influence full immunization coverage among children aged 12-23 months in India? evidence from the National Family Health Survey.
Tanmoy Ghosh, Puja Das, Apurba Sarkar, Pradip Chouhan ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how birth order affects immunization coverage among children aged 12-23 months in India using data from the National Family Health Survey. The researchers analyzed 43,436 children and found that immunization coverage drops significantly as birth order increases, with children born fifth or later having only 41% of the odds of complete immunization compared to first-borns. Female children, children from Muslim families, and those in northeastern India also had lower immunization rates. The findings highlight the need for targeted interventions to remove barriers for families with more children.
Key points
- Full immunization coverage declines with birth order: 2nd born (OR 0.91), 3rd (0.74), 4th (0.64), 5th (0.56), 6th+ (0.41)
- Spatial analysis showed positive association between 1st and 2nd birth orders and immunization coverage
- Female children had lower immunization likelihood (AOR 0.95) compared to males
- Children from Muslim families had significantly lower coverage (AOR 0.72)
- Residence in northeastern India was associated with lower immunization (AOR 0.52)
Limitations
This is a cross-sectional analysis of survey data, so it cannot establish causation or explain the mechanisms behind birth order disparities. The study does not provide information about specific barriers families with multiple children face or test interventions to improve coverage.
Abstract
Despite the availability of free basic vaccination programmes, the disparity continues in immunization coverage among children aged 12-23 months in India, particularly with increasing birth orders. Using the data from the NFHS 5 (2019-21), the study seeks to investigate how birth order affects the likelihood of children's immunization aged 12-23 months in India. The analysis included a nationally representative sample of 43,436 children aged 12-23 months. Bivariate LISA and multilevel logistic regression models were performed to assess spatial and statistical patterns. The study found that spatial autocorrelation analysis indicated a positive association between 1st and 2nd birth orders and child full immunization coverage. However, the likelihood of full immunization declines significantly with increasing birth order [2nd (OR: 0.91); 3rd (OR: 0.74); 4th (OR: 0.64); 5th (OR: 0.56); 6 and more (OR: 0.41)]. Similarly, other socio-demographic covariates such as female children [AOR: 0.95], children who belong to Muslim families [AOR: 0.72], and resided in the northeastern part [AOR: 0.52] of India had a lower likelihood of being completely immunized. Therefore, the present study underscores the urgent need for targeted public health interventions that address both familial and structural barriers to immunization, specifically for mothers who have more than two children, to ensure that no child is left behind, regardless of their birth position within the family.