The supply is there. So why can’t pregnant and breastfeeding women in rural India get the COVID-19 vaccine?

Abstract

Despite COVID-19 vaccines being available to pregnant women in India since summer 2021, little is known about vaccine uptake among this high need population. We conducted mixed methods research with pregnant and recently delivered rural women in northern India, consisting of 300 phone surveys and 15 in-depth interviews, in November 2021. Only about a third of respondents were vaccinated, however, about half of unvaccinated respondents reported that they would get vaccinated now if they could. Fears of harm to the unborn baby or young infant were common (22% of unvaccinated women). However, among unvaccinated women who wanted to get vaccinated, the most common barrier reported was that their health care provider refused to provide them the vaccine. Gender barriers and social norms also played a role, with family members restricting women’s access. Trust in the health system was high, however, women were most often getting information about COVID-19 vaccines from sources that they did not trust, and they knew they were getting potentially poor-quality information. Qualitative data shed light on the barriers women faced from their family and health care providers but described how as more people got the vaccine that norms were changing. These findings highlight how pregnant women in India have lower vaccination rates than the general population, and while vaccine hesitancy does play a role, structural barriers from the health care system also limit access to vaccines. Interventions must be developed that target household decision-makers and health providers at the community level, and that take advantage of the trust that rural women already have in their health care providers and the government. It is essential to think beyond vaccine hesitancy and think at the system level when addressing this missed opportunity to vaccinate high risk pregnant women in this setting.

COVID-19 Vaccine Coverage in India: A District-Level Analysis

“…We found negative significant correlation between vaccination rates and pregnancy rates (between the ages of 15 and 19 years) and percentages of children exclusively breastfed. Women of childbearing age were eligible for vaccination during the fourth phase of vaccination, but a lack of scientific evidence and clear communication surrounding potential side-effects of the vaccine on a pregnant or a breastfeeding woman might have driven this finding [ 65 , 66 , 67 ].…”

Feasibility and acceptability of Saheli, a WhatsApp Chatbot, on COVID-19 vaccination among pregnant and breastfeeding women in rural North India

“…Health education dissemination strateg innovation is critical to meet the scope and depth required for population-level coverage, particularly for novel threats. Our team’s formative research identified vaccine misinformation related to pregnant and breastfeeding women, but confirmed high vaccine interest and need for tools to negotiate with other household decision-makers 24. Additionally, we found that women were in need of trusted information sources 24…”

“…Main vaccination barriers for pregnant and postpartum women included fear of adverse effects (48.3%) and unsure of safety (25.1%) 23. Our formative research found low vaccination despite high healthcare provider access for antenatal care; half of unvaccinated women wanted to receive COVID-19 vaccination now (47%), 20% soon and 27% not at all 24. Safety concerns were reported more frequently by unvaccinated participants 24.…”

“…CoWIN, India’s COVID-19 vaccination dashboard, does not track vaccine status by pregnancy/breastfeeding status so national data are unavailable22; however, research studies have identified lower vaccination among this subpopulation. For example, 12.9% of 2821 pregnant Indian participants in the Global Network for Women and Children’s Health Research (GNWCHR) were vaccinated by November 2021,23 and our formative research in Haryana found only one-third of pregnant and breastfeeding women were vaccinated 24. At the time, COVID-19 vaccines were offered freely at government clinics and hospitals and for a fee at private facilities, thus were largely available, despite some logistical challenges with maintaining supply 25…”

Covid-19 Vaccination in India: An Exploratory Analysis

“…During phase 4, districts that had higher pregnancy rates between the age of 15 and 19 years and higher percentage of children exclusively breastfed had lower vaccination rates. Women of child bearing age were eligible for vaccination during the fourth phase of vaccination, but lack of scientific evidence and clear communication surrounding potential side-effects of the vaccine on a pregnant or a breastfeeding woman could have driven this finding [65,66,67].…”