IFPHPOS0037 Maternal Decision-Making Autonomy’s Influence on Polio Vaccine Delivery Modality in Pakistan: A National Cross-Sectional Study using HIES 2024-25

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Background Pakistan remains one of the last countries with endemic poliovirus, with persistent immunity gaps despite intensive eradication efforts. The influence of maternal decision-making autonomy on mode of polio vaccination (campaign interaction vs non-campaign interaction) is under-researched. We therefore examined the association of maternal decision-making autonomy and mode of polio vaccination for under-5s in Pakistan. Methods Using nationally representative data from the 2024-25 Household Integrated Economic Survey (HIES), we analysed 18,556 children aged 0-5. Maternal decision-making autonomy was measured using a weighted maternal autonomy index across nine household domains, scaled from 0-1 (Cronbach’s α = 0.855). Survey-weighted binary, multinomial, and ordered logistic regression were fitted to assess how autonomy predicts vaccination modality, adjusting for socioeconomic covariates. Results Mean maternal autonomy score was significantly lower in the campaign group versus the non-campaign group (0.32 vs 0.41, p < 0.001). In the binary regression model, higher autonomy was associated with substantially lower odds of campaign reliance (adjusted odds-ratio 0.40, 95% CI 0.26–0.60), with a 14-percentage point reduction of marginal effect between the lowest and highest autonomy mothers. Results were consistent across multinomial and ordered regression models and remained robust to sensitivity analyses of alternative autonomy index scoring. Conclusion Polio campaigns in Pakistan appear to play a critical compensatory role by reaching households with reduced maternal decision-making autonomy. However, long-term eradication will require a shift from campaign-dependent “rescue” to routine immunization systems explicitly gender-responsive and accessible to mothers with low autonomy, so that children’s protection is not dependent on volatile campaign activity.