Women’s views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: a multi-methods study in the UK

  1. Helen Skirrow
  2. Sara Barnett
  3. Sadie Bell
  4. Lucia Riaposova
  5. Sandra Mounier-Jack
  6. Beate Kampmann
  7. Beth Holder

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

COVID-19 vaccines are advised for pregnant women in the United Kingdom (UK) however COVID-19 vaccine uptake among pregnant women is inadequate.

Methods

An online survey and semi-structured interviews were used to investigate pregnant women’s views on COVID-19 vaccine acceptability for themselves when pregnant, not pregnant and for their babies. One thousand one hundred eighty-one women, aged over 16 years, who had been pregnant since 23rd March 2020, were surveyed between 3rd August–11th October 2020. Ten women were interviewed.

Results

The majority of women surveyed (81.2%) reported that they would ‘definitely’ or were ‘leaning towards’ accepting a COVID-19 vaccine when not pregnant. COVID-19 vaccine acceptance was significantly lower during pregnancy (62.1%, p  < 0.005) and for their babies (69.9%, p < 0.005). Ethnic minority women were twice as likely to reject a COVID-19 vaccine for themselves when not pregnant, pregnant and for their babies compared to women from White ethnic groups ( p  < 0.005). Women from lower-income households, aged under 25-years, and from some geographic regions were more likely to reject a COVID-19 vaccine when not pregnant, pregnant and for their babies. Multivariate analysis revealed that income and ethnicity were the main drivers of the observed age and regional differences. Women unvaccinated against pertussis in pregnancy were over four times more likely to reject COVID-19 vaccines when not pregnant, pregnant and for their babies. Thematic analysis of the survey freetext responses and interviews found safety concerns about COVID-19 vaccines were common though wider mistrust in vaccines was also expressed. Trust in vaccines and the health system were also reasons women gave for accepting COVID-19 vaccines.

Conclusion

Safety information on COVID-19 vaccines must be clearly communicated to pregnant women to provide reassurance and facilitate informed pregnancy vaccine decisions. Targeted interventions to promote COVID-19 vaccine uptake among ethnic minority and lower-income women may be needed.

Article activity feed

  1. Version published to 10.1186/s12884-021-04321-3
  2. ScreenIT

    SciScore for 10.1101/2021.04.30.21256240: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Informed consent was obtained by telephone or e-mail, depending on participant preference.
    IRB: Ethical approval: This study was approved by Imperial College Research Ethics Committee (ICREC) (Ref: 20IC6188).
    Sex as a biological variableA multi-methods approach was taken – using quantitative and qualitative components – with the aim of gaining insight into the acceptability of future COVID-19 vaccines for pregnant women and their children at a time when no COVID-19 vaccines had yet been licensed for use.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: The main strength of this study was the use of multiple methods – the qualitative analysis of the survey and interviews enabled factors behind the quantitative findings to be explored in more detail. The response rate with over 1000 responses from women who had been pregnant during the first peak of the COVID-19 pandemic in the UK was excellent with nearly 1 in 5 respondents leaving freetext responses to the COVID-19 vaccine acceptability questions. The survey included respondents from across the United Kingdom, which enabled us to identify interesting differences in Scotland and Northern Ireland compared to England, however the majority of respondents were from England. Regionally, London and the South-East were overrepresented, however the survey respondents included women with a range of ages and income levels and at different pregnancy gestations. Importantly, the survey captured women with a range of vaccine attitudes and women who had both been vaccinated with pertussis vaccine in pregnancy and those who had not. Although we were able to detect a significantly lower uptake in some ethnic minority groups (Black ethnicities including Black-British African, Black-British Caribbean, Black-other and Black Mixed ethnicities) we were underpowered to detect differences in other ethnic groups. Thus to explore the role of ethnicity in multivariate analyses we had to combine ethnic groups and ethnicity was dichotomised into White ethnicities and all othe...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.30.21256240v1 on medRxiv