Purpose to determine COVID-19 vaccination coverage among pregnant women and investigate the factors affecting vaccine uptake. Design Analytical cross-sectional study. Setting Palestinian health care facilities. Between October and November 2021 – eight months after the country’s first COVID-19 vaccination. Sample We needed 820 people to estimate vaccination coverage among pregnant women with a precision rate of 3%. Therefore, we invited 950 pregnant Palestinian women who were eligible and had a response rate of 91.6%. Measures An interviewer-administered questionnaire examined vaccination uptake, attitudes, and concerns about the COVID-19 vaccine. Analysis Bivariable and multivariable analysis using SPSS. Results vaccination uptake was reported by 219 pregnant women [25.5%, 95% CI: 22.6% −28.5%]. Knowledge (aOR=2.0; 95% CI: 1.2-3.1), perceived benefits (aOR=1.1; 95% CI: 1.06-1.16), employment (aOR=5; 95% CI: 3.1-8.1), and underlying medical condition (aOR=2.1; 95% CI: 1.1-4.1) predicted uptake. Reporting vaccine barriers reduces vaccine uptake (aOR=.92; 95% CI: .89-95). Conclusions Pregnant women’s COVID-19 vaccination rates are low. Concerns regarding the COVID-19 vaccine for infants affected their decision. COVID-19 vaccination regulations and legislative nudges drove maternal vaccination. Vaccine fears and misconceptions among pregnant women should be addressed.

No abstract