Women’s views and experiences of accessing vaccination in pregnancy during the COVID-19 pandemic: A multi-methods study in the United Kingdom

Abstract

Background

COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19.

Methods

An online cross-sectional survey was completed, between 3 ^rd August-11 ^th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23 ^rd , 2020. Ten follow-up semi-structured interviews were conducted.

Results

Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination; however, access issues were reported.

Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19.

Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies.

Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccines in pregnancy.

Conclusion

During the ongoing and future pandemics, healthcare services should prioritise equitable access to routine vaccinations, including tailoring services for ethnic-minority families who experience greater barriers to vaccination.

Highlights

Access to pregnancy vaccines in the United Kingdom was disrupted by the COVID-19 pandemic.
UK women reported difficulties in physically accessing vaccine appointments and feeling less safe accessing vaccine appointments for themselves when pregnant and for their babies during COVID-19, with women from ethnic minorities in the UK were more likely to report difficulties.
Vaccine services must ensure equitable access to vaccine appointments during the ongoing COVID-19 pandemic including tailoring services for lower income and ethnic minority families.

SciScore for 10.1101/2021.09.14.21263505: (What is this?)

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

Table 1: Rigor

Ethics	IRB: Ethical approval: This study was approved by Imperial College Research Ethics Committee (ICREC) (Ref: 20IC6188). Consent: Informed written and verbal consent was obtained from participants.
Sex as a biological variable	Women were also asked whether they felt it was important to have their baby vaccinated during the pandemic.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not 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:

Consistent with the findings by Bell et al., we also observed that women from ethnic minorities were more likely to report physical limitations and feeling unsafe when accessing vaccines for their children during the pandemic (18). Different factors affect ethnic minorities living the UK having lower vaccine uptake including access barriers and vaccine confidence (27, 28). However, during COVID-19 the increased risk to ethnic-minority populations has been well publicised (29) and ethnic-minority pregnant women are also more likely to admitted to hospital with COVID-19 (30). Ethnic-minority women may have therefore been more nervous about attending healthcare settings for pregnancy vaccines. We found that more women were vaccinated at hospital antenatal settings during COVID-19 compared to previous pregnancies which supports previous work that antenatal hospital vaccine clinics play a key role in delivering pregnancy vaccines (15) and only 7.5% of women reported a hospital vaccine appointment being changed. Further evaluation of the impact of antenatally delivered vaccines on uptake, including during COVID-19 is required (14, 31). We also found that where women received pregnancy vaccines varied geographically across the UK nations and regionally. This could reflect variation in pre-existing maternal vaccine service provision prior to the pandemic, changes to services in response to the pandemic or transport variation. Mcquaid et al found that the impact of COVID-19 on routine...

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.

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