Gender situational analyses for HPV programs and coverage measurement in Liberia, Senegal, and Rwanda

Abstract Background This paper examines how gender shapes both human papillomavirus vaccine (HPVV) program implementation and the measurement of vaccine coverage in Liberia, Rwanda, and Senegal. As part of the HPV IMPACT project, we conducted a multi-country gender situational analysis using a matrix approach that linked gender relations domains with implementation and measurement pathways relevant to HPV vaccination. Methods We synthesized peer-reviewed and grey literature, reviewed national survey and administrative data, and validated preliminary findings with stakeholders in Liberia and Rwanda. Across countries, gender influenced who was reached by vaccination programs, who was missed, and who was visible in coverage estimates. Results Key pathways included school attendance, household decision-making, access to trusted information, health system capacity, and gendered barriers to participation in surveys. Girls who were out of school, geographically remote, or had limited autonomy were more likely to be excluded from both vaccination delivery and measurement efforts. Conclusions These findings show that HPV coverage measurement is not gender-neutral. Survey design choices related to sampling frames, respondent selection, and data collection modes can reproduce or obscure inequities. Embedding gender analysis into coverage measurement is essential for generating more accurate estimates and guiding equitable cervical cancer prevention strategies.