Worried parents ignoring scientific advice isn't the only thing reducing child access to immunization. The Times of India reports decreasing immunization among a negative relationship between immunization coverage levels and proximity to towns. "As the proportion of villages in the district which were located at a distance of more than 10 km from the nearest town increased, the probability of decline in immunization coverage decreased,” the report authors present.
While expecting declines in rural districts, as most cities and national health programs have worked to decrease exposure to diseases from low-cost vaccinations. Lower vaccination protection occurs, Rema Nagarajan reports, mostly in "peri-urban areas... inhabited by migratory urban poor and characterized by vulnerability due to concentration of population and social diversity, which co-exists with rural traits of isolation and invisibility to policy makers."
The Indian subcontinent is not the only region to experience higher levels of communicable disease and lower immunization in urban areas in the past several years.
This poses a challenge to planning for services as the growth of cities continues, particularly in poorer peri-urban environments, or ones that fall outside of a municipality or unincorporated area with rising communicable disease threat.