The percentage of children starting kindergarten whose parents claim that vaccination conflicts with their religious beliefs has ticked up in recent years, even while the portion of Americans who profess to be part of an organized religion has fallen. A new study suggests some of the increase may be related to a tightening of school-entry vaccination policies.

State law around vaccine exemptions varies, with some states permitting parents to forgo immunization of their children not only on religious grounds but also because of so-called personal beliefs.

The new study, released Monday, reports that states that do not have personal belief vaccination exemptions are four times more likely to have children claiming religious exemptions than states that offer parents both types of exemptions.

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After state authorities eliminated personal belief exemptions in Vermont in 2016, there was a sevenfold increase in religious exemption claims, the authors reported in the journal Pediatrics. They suggested that in some cases religious exemptions are probably being used when personal belief exemptions are no longer available.

“Our hypothesis going in is that in states that offer both exemptions types, the rate of religious exemptions would be quite low, but that we would be able to see a significant difference then looking at religious exemptions in states that only offered religious exemptions,” explained Dr. Joshua Williams, the lead author.

“We were hoping that the state of Vermont would provide a nice case study of that, with a potential for a change in religious exemptions before and after their policy change in 2016. And that’s exactly what we found,” said Williams, a physician-researcher and an assistant professor of pediatrics at the University of Colorado.

All states and the District of Columbia require children to be vaccinated to enroll in school. But all also offer medical exemptions for children who have health conditions that would make it unsafe for them to be vaccinated. In five states — Mississippi, West Virginia, California, New York, and Maine — that is the only type of exemption a parent can claim.

In 45 states and the District of Columbia, religious exemptions are also available, even though no major religion objects to vaccination. Fifteen states also offer what is called a personal or philosophical exemption, which allows parents to say vaccinating their child would run counter to their beliefs.

The percentage of children with a vaccination exemption entering school remains low — at only 2.5% in the 2018-2019 school year, the Centers for Disease Control and Prevention reported. But it has risen slightly in recent years.

With measles cases in the country rising to the highest levels in decades this year — 1,250 cases so far — a number of states have moved to tighten their exemption rules. New York, which had the biggest outbreaks this year, eliminated all non-medical exemptions, and Washington state removed the personal exemption for measles, mumps, and rubella vaccine.

Williams and his co-authors wanted to look at religious exemptions, to see what the trends there were. They found that in 2017-2018, 1.7% of children entering kindergarten had a religious exemption; in 2011-2012, the figure had been 1.25%.

States that only offered religious exemptions were four times more likely to have children claiming religious exemptions than states where personal belief exemptions were also an option.

“What our study shows is that the rate of religious exemptions varies by whether or not the state offers an alternative personal belief exemption,” Williams said.

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