COVID-19 vaccine attitudes, beliefs, intentions and behaviors among pregnant women within the context of dynamic national policy recommendations in Brazil, Ghana, Kenya, and Pakistan.
Jessica L Schue, Emily S Miller, Berhaun Fesshaye, Prachi Singh, Renato T Souza, Caroline Dinam Badzi, Emefa Modey Amoah, Saleem Jessani, Muhammad Asim, Ingrid Gichere, Maria Laura Costa, Jose G Cecatti, Kwasi Torpey, Sarah Saleem, Marleen Temmerman, Sami L Gottlieb, Rupali J Limaye
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Abstract
Introduction: There are many factors associated with maternal immunization decision making. This study aimed to describe COVID-19 vaccination attitudes, beliefs, behaviors, and intentions among pregnant women across four countries within the context of varying and changing policy recommendations related to COVID-19 vaccination for pregnant women.
Methods: This cross-sectional quantitative study surveyed pregnant women in antenatal care facilities serving mostly urban or peri-urban populations in Campinas, Brazil; Accra, Ghana; Nairobi, Kenya; and Karachi, Pakistan. Potential participants were approached in clinic waiting rooms, and if eligible, enrolled after informed consent was obtained.
Results: A total of 1603 women were surveyed, with 64 % overall reporting they received a COVID-19 vaccine, ranging from 46 % in Pakistan to 97 % in Brazil. Among those ever vaccinated, 15 % received a COVID-19 vaccine during pregnancy, most received only one dose during pregnancy and the majority (53 %) reported they were vaccinated in their first trimester. The top two reasons for vaccination were the same across all countries: protecting themselves and protecting their baby. Among those not vaccinated against COVID-19, the majority of participants (68 %) indicated that they did not intend to be vaccinated, and fears that the vaccine was not safe was the highest rank among all countries as the primary reason for not getting vaccinated. In adjusted models, higher disease risk perception (aOR: 1.88; CI: 1.35-2.62), higher beliefs in vaccine effectiveness for the pregnant women (aOR: 1.75; CI: 1.19-2.55), belief in the safety of the vaccine for their baby (aOR: 2.30; CI: 1.46-3.64), and believing that peers were taking the vaccine (aOR: 1.54; CI: 1.14-2.08) were associated with vaccination status. Holding views consistent with vaccine hesitancy was associated with lower odds of vaccination (aOR: 0.28; CI: 0.20-0.40).
Discussion: Enhancing risk perception of COVID-19 in pregnancy, knowledge about safety and benefits of the vaccine compared to the risks, and promoting supportive environments where vaccines are perceived as normative behavior can help increase vaccine uptake among pregnant women.
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