<p>The vaccination report by the Sanitary Commission of Bengal (1887–1898) highlights persistent gender disparities in smallpox immunization efforts during colonial Bengal, with males consistently receiving higher vaccination rates than females. This inequity was most pronounced in urban centres like Calcutta, where cultural norms, caste hierarchies, and logistical barriers further marginalized women. In contrast, rural areas occasionally demonstrated closer gender parity, facilitated by vaccination practices aligning with local traditions. The absence of female vaccinators, especially in urban areas, compounded these disparities, limiting women’s access to healthcare due to societal norms around modesty and gender segregation. Contextual analysis reveals that public health initiatives of the period failed to address gender-specific barriers, perpetuating systemic inequities. Resistance among urban elites, including the Hindu bhadralok, often stemmed from mistrust of colonial interventions, concerns over ritual purity, and global influences like Victorian England’s antivaccination movements, which framed vaccination as a violation of personal autonomy. Rural programs, however, engaged local leaders and incorporated culturally sensitive practices, resulting in greater acceptance among women. This study situates these findings within a global and historical framework, emphasizing the long-term consequences of gender inequities on public health outcomes. It underscores the need for gender-sensitive policies, community engagement, and equitable resource allocation in healthcare systems. By exploring these historical trends, this research offers valuable lessons for addressing contemporary challenges in achieving healthcare equity.</p>