Barriers and Facilitators Associated With Vaccine Acceptance and Uptake Among Pregnant Women in High Income Countries: A Mini-Review

Abstract

Vaccination during pregnancy is a safe and effective intervention to protect women from potentially severe consequences of influenza and reduce risk of influenza and pertussis in their infants. However, coverage remains variable. In this mini-review we update findings from a 2015 systematic review to describe results from recent studies in high income countries on the uptake of influenza and pertussis vaccination in pregnancy, reasons for vaccine hesitancy and barriers to increasing uptake, from maternal and healthcare provider (HCP) perspectives. Studies reported highly variable uptake (from 0% to 78%). A main facilitator for uptake among pregnant women was receiving a recommendation from their HCP. However, studies showed that HCP awareness of guidelines did not consistently translate into them recommending vaccines to pregnant women. Safety concerns are a well-established barrier to uptake/coverage of maternal immunization; 7%-52% of unvaccinated women gave safety concerns as a reason but these were also present in vaccinated women. Knowledge/awareness gaps among pregnant women and lack of confidence among HCPs to discuss vaccination were both important barriers. Several studies indicated that midwives were more likely to express safety concerns than other HCPs, and less likely to recommend vaccination to pregnant women. Women who perceived the risk of infection to be low were less likely to accept vaccination in several studies, along with women with prior vaccine refusal. Findings highlight the importance of further research to explore context-specific barriers to vaccination in pregnancy, which may include lack of vaccine confidence among pregnant woman and HCPs, and policy and structural factors.

Attitude and Level of COVID-19 Vaccination among Women in Reproductive Age during the Fourth Pandemic Wave: A Cross-Sectional Study in Poland

“…Similar conclusions were also presented by Schaal and coworkers [ 44 ]. Moreover, our findings are in line with the attitude regarding general vaccine acceptance and uptake presented by pregnant women in high-income countries; namely, women who evaluate the possible risk of infection at the highest level were more likely to receive vaccination [ 46 ].…”

Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis

“…Debate about whether subjective norms have a strong or weak influence on behavior might due to differences in the types of behaviors that have been targeted. In contrast to high-frequency health behaviors, such as exercise, smoking cessation, when making decisions about vaccination, people expect to be counseled by someone close to them (eg, family members and close friends [ 37 ]), or someone they trust (eg, a physician [ 38 ]). Additionally, socially desirable responses likely contributed to our finding that attitudes have less explanatory power for behavior.…”

Oxford COVID-19 Vaccine Hesitancy in School Principals: Impacts of Gender, Well-Being, and Coronavirus-Related Health Literacy

“…This is consistent with previous studies’ findings that vaccine hesitancy is higher in women [ 22 , 36 , 70 ]. This could be explained that women had more concerns about safety [ 71 , 72 ], and reproductive health [ 73 ] during the pandemic. Inconsistently, in some countries, women were more likely to accept a vaccine (e.g., France, Germany, Sweden, and Russia) as they are gatekeepers for their family’s health-related decisions, and with higher empathy levels for their family safety [ 15 ].…”