Obstetrician–Gynecologists' Strategies to Address Vaccine Refusal Among Pregnant Women

Abstract

Objective: To describe 1) obstetrician–gynecologists’ perceptions of the frequency of vaccine refusal among pregnant patients and perceived reasons for refusal; and 2) obstetrician–gynecologists’ strategies used when encountering vaccine refusal and perceived effectiveness of those strategies. Methods: We conducted an e-mail and mail survey among a nationally representative network of ob-gyns from March through June 2016. Results: The response rate was 69% (331/477). Health care providers perceived that pregnant women more commonly refused influenza vaccine than Tdap vaccine: 62% of respondents reported ≥10% of pregnant women they care for in a typical month refused influenza vaccine compared to 32% reporting this for Tdap vaccine. The most commonly reported reasons for vaccine refusal were patients’ belief that influenza vaccine makes them sick (48%), belief they are unlikely to get a vaccine-preventable disease (38%), general worries about vaccines (32%), desire to maintain a natural pregnancy (31%), and concern that their child could develop autism as a result of maternal vaccination (25%). The most commonly reported strategies obstetrician-gynecologists used to address refusal were stating that it is safe to receive vaccines in pregnancy (96%), explaining that not getting the vaccine puts the fetus or newborn at risk (90%), or that not getting the vaccine puts the pregnant woman’s health at risk (84%). The strategy perceived as most effective was stating that not getting vaccinated puts the fetus or newborn at risk. Conclusion: Ob-gyns perceive vaccine refusal among pregnant women as common, and refusal of influenza vaccine as more common than refusal of Tdap vaccine. Emphasizing the risk of disease to the fetus or newborn may be an effective strategy to increase vaccine uptake.

Vaccination in pregnancy: A call to all providers for help

“…Many pregnant women refuse the Tdap and infl uenza vaccines 23 for a variety of reasons, 24 including common misperceptions ("It will make me sick"), concerns for the safety of the fetus or neonate, and personal health beliefs ("I never get the fl u shot"). A review by Mossad 25 provides guidance on counseling patients who doubt the value of immunization.…”

Influenza Virus and Vaccination

“…Vaccinating pregnant women is generally regarded as safe [159][160][161][162][163][164][165]. However, some hesitancy over influenza vaccination is present in this population and the benefit of protecting both the mother and the fetus needs to be conveyed as outweighing the risk of potential side effects [223][224][225][226].…”

Why are influenza vaccination rates low and Tdap vaccination rates average in a large military treatment facility? Survey results from providers and patients

“…Despite recommendations from multiple health organizations, the vaccination rates are still far below the Healthy People 2020 goals. Well documented barriers to flu and Tdap vaccination during pregnancy include provider's recommendations, access to care, concern for safety and/or efficacy and cost [9,10]. The purpose of this study was to determine the why the vaccination rates were low for influenza and only slightly above average for Tdap in a large Military Treatment Facility (MTF) where there is ready access to care at no cost.…”