We are addressing vaccine hesitancy among pregnant women the wrong way

“It is not the job of people who are concerned to be more trusting, it is our job to be more trustworthy”
“It is not the job of people who are concerned to be more trusting, it is our job to be more trustworthy”
Image: Reuters/Callaghan O'Hare
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Only one in four pregnant women in the US is vaccinated, according to data from the Centers for Disease Control and Prevention (CDC), far below the US adult average of about 60%.

This is especially concerning because pregnant women, as well as those who recently delivered, are at an increased risk of severe illness if exposed to Covid-19. Pregnant women contracting covid-19 are more likely to be hospitalized, and up to 22 times more likely to die of complications linked to the virus than pregnant women without covid-19.

Yet according to a survey of 500 nationally representative pregnant women in the US commissioned by Maven Clinic, a healthcare company focused on maternity care, the vast majority of them doesn’t feel confident that they received clear information about the vaccine, and would rather defer it.

It might be tempting to blame pregnant women for not wanting to get a vaccine but the situation is very much the result of a failure to communicate effectively with them, said Neel Shah, a professor of obstetrics and gynecology at Harvard and the chief medical officer at Maven Clinic. “It is not the job of people who are concerned to be more trusting, it is our job to be more trustworthy,” he said.

Pregnant women are wrongly being advised against getting a vaccine

Although the CDC recommends vaccinations for pregnant women , 61% are unaware of the guidance, and a significant majority of them (69%) say they were advised against getting a vaccine according to the Maven survey. This advice came primarily from partners, friends, and family (53%), but a significant portion of pregnant women (29%) report being advised against the vaccine by misinformed health practitioners.

Misinformation about the effects of the vaccine is also rampant. Only 35% of pregnant women know the vaccine doesn’t cause infertility, and less than 30% are aware of the increased risk of contracting covid-19 during pregnancy.

But unlike other groups of unvaccinated people, pregnant women who didn’t get the covid-19 vaccine aren’t necessarily opposed to getting it, and a majority (64%) plan to get it either at a later stage of pregnancy or after giving birth.

This shows a window of opportunity that healthcare professionals can use to effectively communicate the necessity of the vaccine, and persuade pregnant women to get one. But in order to do so, said Shah, the message needs to be reframed—rather than putting the focus on the risks women face without the vaccine, a more effective tactic may be highlighting the risks for the baby.

A better way to counter vaccine hesitancy

When making a decision on whether to get a vaccine, women report that their primary concern is the baby’s health, and their own health comes only second.

This reflects common social attitudes toward pregnancy, which put the primary focus on the wellbeing of the child, seeing the mother and her body, to various degrees, as a vehicle for its coming into the world. But while this narrative is being challenged, it’s so entrenched that in the short-term, when it comes to vaccines, explaining the benefits for the child may be more likely to influence a mother’s opinion, said Shah.

After all, most pregnant women receive a whooping cough vaccine in the third trimester of pregnancy, and many get the seasonal flu vaccine, too.  Particularly when it comes to whooping cough, pregnant women know the main reason is to protect the baby from a potentially deadly disease.

Similarly, information about the vaccine during pregnancy should emphasize that babies need the immunity provided by the shot as they aren’t able to make their own antibodies for the first couple of months of life and that they are far less likely to get covid-19 if their immediate family—including, crucially, their mother—is vaccinated.

Severe covid-19 during pregnancy could lead to premature birth, and even miscarriage. The vaccine, by contrast, is not harmful to the child.

How to get pregnant women to trust information on the vaccine

Pregnant women weren’t included in clinical trials for the covid vaccine, so data about its safety wasn’t initially available. While information has been updated since then, it is possible this has misguided opinions about the safety of the vaccine during pregnancy.

It is the medical community’s job to change this, and official campaigns don’t cut it when it comes to helping quench doubts about the vaccine. “We need to establish people’s trust and acknowledge their concerns,” said Shah. Further, he says, messaging on vaccines during pregnancy needs to be addressed to the mother’s immediate support network, too, as it likely partners and close family members will influence her decision.

The medical community has a tendency to dismiss women’s health concerns, and the vaccine rollout wasn’t an exception. Women’s reports that the vaccine was affecting their periods was initially dismissed, with the effect of encouraging misinformation about the effects of the vaccine on fertility. Acknowledging that the shots might temporarily alter periods (as anything, from a change in diet to a fever, can do) while clarifying that has no impact on fertility would have been a more effective and respectful strategy, Shah said.

Pregnant women need to be given opportunities to air their concerns and see them addressed. One way to do that is giving consultations about the vaccine independently from pregnancy check-up, where mothers typically have a lot of questions and information to process, and might not have enough time to get to all they wish to ask about the vaccine.

If you are pregnant and need information about the covid vaccine , here are some resources:

  • Call 800-CDC-INFO and ask for the clinician-on-call service from the CDC
  • Contact your state’s health department (here is a full list)