A qualitative study of pregnant women’s perceptions and decision-making regarding COVID-19 vaccination in Thailand … – Nature.com

We engaged in in-depth interviews with pregnant women to delve into their knowledge, attitudes, acceptance, and refusal of vaccination. The valuable insights obtained from these interviews were instrumental in shaping the authentic data used to construct a questionnaire.

In our study, 85.3% of the pregnant women were vaccinated before becoming pregnant and understood the potential severity of COVID-19. Nevertheless, once pregnant, 50% of this subgroup had no confidence in the vaccination. They were concerned about the dangers of the vaccine to themselves and their unborn children, especially miscarriage and premature birth. This concern was evident despite their being aware that the vaccine can reduce the severity of the disease.

Our research also found that the pregnant womens level of immunity to COVID-19 did not affect their vaccination decisions. The effectiveness of vaccines varies depending on the vaccine type and evolves over time within the pregnant population. The variations in immunity can be influenced by factors such as maternal age and underlying diseases, body mass index, and gestational age24. Nevertheless, pregnant women continue to express concerns about their immunity following previous injections and are hesitant to receive any further vaccinations during pregnancy.

Even if they knew their immunity level, they still decided not to get vaccinated because they were concerned about possible harm to the unborn baby, miscarriage or preterm delivery. This attitude must be adjusted during the COVID-19 pandemic. Several studies have shown that vaccination against COVID-19 before and during pregnancy is safe, effective and beneficial to both the mother and child. The benefits of getting a COVID-19 vaccination during pregnancy far outweigh any potential adverse consequences23,25,26,27,28.

No COVID-19 vaccine contains a live virus, so the vaccines do not cause COVID-19 infection in recipients, including pregnant women and their foetuses23,25,26,27,28. However, our investigation found that most respondents were uncertain whether the vaccine was safe for themselves and their unborn children. The women were unsure whether the vaccine would help prevent infection in their unborn babies. Most also believed that multiple vaccinations would harm their unborn children. This lack of information made it very challenging for them to decide whether to be vaccinated while pregnant.

Regarding the safety of mRNA COVID-19 vaccines (Moderna and Pfizer-BioNTech), no problems have been found for women vaccinated with them before or during pregnancy or for their unborn children23,25,26,27,28. Data from studies in the United States, Europe and Canada show that their use during pregnancy is not associated with an increased risk of complications, such as preterm birth, miscarriage and postpartum haemorrhage21,26,29. There is no increased risk of miscarriage in pregnant women administered an mRNA COVID-19 vaccine before or during early pregnancy (before 20 gestational weeks)25,26,28,29. A study from Chicago found that COVID-19 vaccination in pregnant women before and during the first trimester was not associated with a risk of congenital malformations30.

The administration of 2 primary doses of a COVID-19 mRNA vaccine to mothers during their pregnancy helped protect babies younger than 6months from being hospitalised due to COVID-19 infection. In our investigation, the majority (84%) of infants hospitalised with an infection were born to women not vaccinated during pregnancy31.

Our research found that the type and number of vaccinations influenced vaccination decisions. In Thailand, the Pfizer-BioNTech and Moderna COVID-19 vaccines are more popular than the other COVID-19 vaccines available in the country, and these 2 vaccines have been reported to be safe in pregnant women23. However, some vaccination centres in Thailand only provide 1 type of vaccine. Consequently, people seeking vaccination may find that their preferred vaccine is unavailable. If an alternative vaccine can be provided by allowing pregnant women to select the vaccine themselves, it would likely increase the vaccination rate among pregnant women.

In addition, our research found that vaccination decisions are influenced by social media news about the dangers to mothers and unborn children, including death and disability. Most of the pregnant women in our study rejected vaccination because they were uncertain whether vaccination would increase their foetuses immunity. Recent research has revealed the role of social media in disseminating information and potentially influencing peoples attitudes towards vaccination. Studies have also shown the positive potential of social media in public health interventions and overcoming vaccination hesitancy among mothers32,33,34,35. Therefore, there should be thorough scrutiny of the various roles of social media in disseminating information to the public and influencing individual behaviour in the context of public health activities. This approach will give pregnant women a correct understanding of COVID-19 vaccines.

Vaccination certifications also play a key role in pregnant womens vaccination decisions. Attending workplaces or meetings involving large groups of people puts individuals at risk of contracting COVID-19. Therefore, most public and private organisations require employees attending workplaces to be vaccinated to the levels recommended by the Thai Ministry of Health. Employers may also require certification of COVID-19 vaccination status. These restrictive policies pressurise pregnant women to get vaccinated even if they disagree with having a vaccination.

WHO has commented that COVID-19 is a health emergency that does not give governments many choices in quickly returning the situation to normal. Regarding calls for the widespread use of COVID-19 vaccination certificates, WHO recognises that introducing such certificates is risky and may result in harm. The general use of the certificates may cause deviations from their initial objectives: to ensure continuity of care and to provide proof of vaccination status. Legal or ethical considerations may be raised by further potential uses for vaccination certificates, for example, public health surveillance, pharmacovigilance, research, and exemptions to public health and social measures. WHO cites legal obligations to protect patient data and the need to respect human rights and fundamental freedoms. To this end, WHO has recommended that data protection measures be in place before adopting digital vaccination certificates. It has also stressed that vaccination certificates must not be considered a substitute for health surveillance36.

Our study presented both similar and different results from the previous study about attitudes, acceptance and rejection of COVID-19 vaccination among breastfeeding women34. Both pregnant and breastfeeding women believed that vaccines can reduce infection and disease severity. The womens COVID-19 immunity levels did not affect their acceptance or rejection of vaccination and some mothers rejected vaccination because of concerns about possible harm to them or their newborns. The safety of COVID-19 vaccination to the unborn and newborn babies and mothers is the main concerning of both pregnant and breastfeeding women. However the different results of pregnant women from breastfeeding women were the effect of social media messages and vaccination certifications to their decision. Pregnant women had more concern about those issue than breastfeeding women. Most of pregnant women were still working and COVID-19 vaccination certifications were important to their works. While breastfeeding women have a right for stop working up to 90days, therefore vaccination certification is not required.

To enhance COVID-19 vaccination rates during pregnancy, it is essential to address the significant decline in pregnant women's confidence in vaccination. Targeted strategies involve implementing comprehensive education and communication campaigns to dispel misinformation and underscore the safety and benefits of vaccination for both mothers and unborn children. Specific measures include developing focused educational initiatives, employing communication strategies to counter social media influence, improving information accessibility about vaccine types, establishing clear certification guidelines for safety, and tailoring messaging to address concerns about potential harm to unborn babies. These efforts aim to increase vaccination acceptance among pregnant women, contributing to improved maternal and fetal health outcomes.

Our study is affected by some limitation. The study design was prospective cross-sectional study which represented the real situation of COVID-19 outbreak during that time. The study is limited by the exclusive recruitment of the sample from Siriraj Hospital. Despite this, it's crucial to recognize that Siriraj Hospital, functioning as both a medical school and a referral center in Bangkok, draws patients from diverse regions of Thailand seeking advanced prenatal care. The selection of 400 pregnant women aimed to represent a varied demographic from different parts of the country. Although participants were not randomly chosen and were exclusively from Siriraj Hospital, the study intended to capture the extensive demographics and geographic diversity inherent in the hospital's patient population. Most of pregnant women (85.3%) had a history of COVID-19 vaccination which would affect the decision making for repeated vaccination. Their actual attitude may be affected by the severity of disease and availability of database of COVID-19 vaccination during pregnancy at that time.

The strength of our study is the less of socially desirable bias. In phase I, participant was in-depth interviewed in a close area by only single interviewer and in phase III, pregnant women response questionnaire in a closed place. The respondent can present the actual attitude, acceptance or rejection of COVID-19 vaccination.

Go here to see the original:

A qualitative study of pregnant women's perceptions and decision-making regarding COVID-19 vaccination in Thailand ... - Nature.com