‘‘Those who do not vaccinate don’t love themselves, or anyone else’’: a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama

Abstract

ObjectivesTo identify pregnant women’s views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups.SettingTwo main urban centres in Panama (San Miguelito and Panama City).ParticipantsFifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27).MethodsIn-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach.ResultsOur findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers.ConclusionsThe acceptability of maternal immunisation was high among the interviewed women. The pregnant women’s receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.

Facilitators and barriers to vaccination uptake in pregnancy: A qualitative systematic review

“…Additionally, many women did not receive adequate or convincing information about vaccination from their healthcare providers [87]. Misinformation from online sources (e.g., social media) [75] and peers suggesting that vaccines lead to adverse outcomes such as miscarriages, autism and developmental disorders were significant barriers to vaccination during pregnancy [71,87,89]. This issue is compounded by the struggle to find reliable information online, with most vaccine-related content on social media negatively casting doubt and causing worry [90].…”

Facilitators and Barriers to Vaccination Uptake in Pregnancy: A Qualitative Systematic Review

“…Safety concerns were also cited as barriers, particularly the lack of safety data regarding side effects and effects on the foetus and the speed of COVID-19 vaccine development [47]. The perception that vaccines were against cultural [73] and religious beliefs [78,85], and concerns about vaccine ingredients were additional barriers [66,67].…”

“…Concerns about onsite safety management around appointment attendance and having to attend a separate appointment for vaccines added to safety concerns, such as the risk of infection at the vaccination site [80]. Lack of access to vaccinations, also served as a barrier [85]. Women with disruptive life events or other concerns may not prioritise vaccinations, even if pro-vaccination [81].…”

“…Underlying health conditions caused a perception of greater risk from illness [66]. The perception that maternal immunisation is a social or cultural norm also enhanced vaccine uptake [85] as did highlighting the bene ts of vaccination for mother and baby [82]. Some women in France and the UK mentioned community protection, stating that they would consider getting vaccinated to protect those around them [67].…”

“…Additionally, belief in myths and conspiracy theories predicts vaccine hesitancy [96]. These beliefs included claims that vaccines are 'something that the government are putting in people' [74], the unfounded link between vaccines and autism [83] and that certain vaccines may cause HIV [85].…”