Determinants of Non-Acceptance of the COVID-19 Vaccine During Pregnancy in Pregnant and Postpartum Women: A Descriptive Cross-Sectional Study
Abstract
Objective: The rate of COVID-19 vaccination hesitation among Iranian pregnant women is around 50%. The objective of the present study was to determine the reasons for the refusal of COVID-19 vaccination among pregnant and postpartum women.
Materials and methods: This descriptive cross-sectional study was performed on 304 pregnant and postpartum women in the comprehensive health centers of Yazd, Iran, between October 2022 and April 2023. Researchers collected the data of unvaccinated women through phone calls using a validated questionnaire. Data was collected using a questionnaire consisting of baseline characteristics and reasons for refusing vaccination. Descriptive statistics were used to analyze the data using SPSS version 22.
Results: The mean age of the pregnant and postpartum women participating in this study was 28.31 ± 6.47 years. The most common reasons for refusing the COVID-19 vaccine included fear of harming the fetus (32.2%), fear of side effects in the mother (25.7%), disbelief in COVID-19 disease and vaccine (13.8%), lack of information about the vaccine (12.8%), and negative opinions of the media and society (12.8%). Less common reasons included husband's disagreement (8.2%), history of COVID-19 infection (6.9%), gynecologists' disagreement (6.3%), history of infertility (5.9%), and underlying disease (3.3%). Astonishingly, among participants who did not inject a booster dose of the vaccine, 76% reported they didn't receive any training and recommendation on booster dose injection from health providers.
Conclusion: Findings highlight that the most common reasons for refusing the COVID-19 vaccine were fear of harming the fetus and fear of side effects in the mother.
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3. Goncu Ayhan S, Oluklu D, Atalay A, Menekse Beser D, Tanacan A, Moraloglu Tekin O, Sahin D.
COVID-19 vaccine acceptance in pregnant women. Int J Gynaecol Obstet. 2021;154(2):291-296.
4. Sutton D, D'Alton M, Zhang Y, Kahe K, Cepin A, Goffman D, et al. COVID-19 vaccine acceptance among pregnant, breastfeeding, and nonpregnant reproductive-aged women. Am J Obstet Gynecol MFM. 2021;3(5):100403.
5. Schwartz DA, Dhaliwal A. Infections In Pregnancy With Covid-19 And Other Respiratory Rna Virus Diseases Are Rarely, If Ever, Transmitted To The Fetus: Experiences With Coronaviruses, Hpiv, Hmpv Rsv, And Influenza. Arch Pathol Lab Med. 2020.
6. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):194.
7. Jering KS, Claggett BL, Cunningham JW, Rosenthal N, Vardeny O, Greene MF, et al. Clinical Characteristics and Outcomes of Hospitalized Women Giving Birth With and Without COVID-19. JAMA Intern Med. 2021;181(5):714-717.
8. Timircan M, Bratosin F, Vidican I, Suciu O, Tirnea L, Avram V, et al. Exploring pregnancy outcomes associated with SARS-CoV-2 infection. Medicina. 2021;57(8):796.
9. Popescu DE, Cioca A, Muresan C, Navolan D, Gui A, Pop O, et al. A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death. Medicina. 2021;57(7):667.
10. Battarbee AN, Stockwell MS, Varner M, Newes-Adeyi G, Daugherty M, Gyamfi-Bannerman C, et al. Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August–December 2020. Am J Perinatol. 2022;39(1):75-83.
11. Wang PH, Lee WL, Yang ST, Tsui KH, Chang CC, Lee FK. The impact of COVID-19 in pregnancy: Part II. Vaccination to pregnant women. J Chin Med Assoc. 2021;84(10):903-910.
12. Tormen M, Taliento C, Salvioli S, Piccolotti I, Scutiero G, Cappadona R, et al. Effectiveness and safety of COVID-19 vaccine in pregnant women: A systematic review with meta-analysis. BJOG. 2023;130(4):348-357.
13. Kalafat E, Heath P, Prasad S, P OB, Khalil A. COVID-19 vaccination in pregnancy. Am J Obstet Gynecol. 2022;227(2):136-47.
14. Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, et al. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(24):895-9.
15. Rawal S, Tackett RL, Stone RH, Young HN. COVID-19 vaccination among pregnant people in the United States: a systematic review. Am J Obstet Gynecol MFM. 2022;4(4):100616.
16. Sezerol MA, Davun S. COVID-19 Vaccine Hesitancy and Related Factors among Unvaccinated Pregnant Women during the Pandemic Period in Turkey. Vaccines (Basel). 2023;11(1):132.
17. Bianchi FP, Stefanizzi P, Di Gioia MC, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Review of Vaccines. 2022;21(10):1443-54.
18. Moini A, Rabiei M, Pirjani R, Abiri A, Maleki-Hajiagha A. COVID‑19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal - A prospective study in Tehran, Iran. Vaccine. 2023;41(8):1490-5.
19. Alshahrani SM, Alotaibi A, Almajed E, Alotaibi A, Alotaibi K, Albisher S. Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia. Int J Womens Health. 2022;14:1629-39.
20. Masa'deh R, Momani A, Rayan A, Hamaideh SH, Masadeh OM, Al-Yateem N. COVID-19 vaccine hesitancy among women planning for pregnancy, pregnant or breastfeeding mothers in Jordan: A cross-sectional study. PLoS One. 2023;18(6):e0286289.
21. Pairat K, Phaloprakarn C. Acceptance of COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses: a prospective survey. Reprod Health. 2022;19(1):74.
22. Skirrow H, Barnett S, Bell S, Riaposova L, Mounier-Jack S, Kampmann B, et al. Women's views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: a multi-methods study in the UK. BMC Pregnancy Childbirth. 2022;22(1):33.
23. Lynch MM, Squiers LB, Kosa KM, Dolina S, Read JG, Broussard CS, et al. Making Decisions About Medication Use During Pregnancy: Implications for Communication Strategies. Matern Child Health J. 2018;22(1):92-100.
24. Alshahrani SM, Alotaibi A, Almajed E, Alotaibi A, Alotaibi K, Albisher S. Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia. Int J Womens Health. 2022;14:1629-1639.
25. Golder S, McRobbie-Johnson ACE, Klein A, Polite FG, Gonzalez Hernandez G. Social media and COVID-19 vaccination hesitancy during pregnancy: a mixed methods analysis. BJOG. 2023;130(7):750-758..
26. Anderson E, Brigden A, Davies A, Shepherd E, Ingram J. Maternal vaccines during the Covid-19 pandemic:A qualitative interview study with UK pregnant women. Midwifery. 2021;100:103062.
27. Kiefer MK, Mehl R, Costantine MM, Johnson A, Cohen J, Summerfield TL, et al. Characteristics and perceptions associated with COVID-19 vaccination hesitancy among pregnant and postpartum individuals: A cross-sectional study. BJOG. 2022;129(8):1342-1351.
28. Geoghegan S, Stephens LC, Feemster KA, Drew RJ, Eogan M, Butler KM. "This choice does not just affect me." Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study. Hum Vaccin Immunother. 2021;17(10):3371-3376.
29. Lanyi K, Green R, Craig D, Marshall C. COVID-19 Vaccine Hesitancy: Analysing Twitter to Identify Barriers to Vaccination in a Low Uptake Region of the UK. Front Digit Health. 2022;3:804855.
30. Naqvi S, Saleem S, Naqvi F, Billah SM, Nielsen E, Fogleman E, et al. Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research. BJOG. 2022;129(12):2002-2009.
31. Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022;52(14):3127-3141.
32. Griffith J, Marani H, Monkman H. COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework. J Med Internet Res. 2021;23(4):e26874.
33. Phillips R, Gillespie D, Hallingberg B, Evans J, Taiyari K, Torrens-Burton A, et al. Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK. Br J Health Psychol. 2022;27(4):1354-1381.
34. Saied SM, Saied EM, Kabbash IA, Abdo SAE. Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J Med Virol. 2021;93(7):4280-4291.
35. Nair G, Venkatesan K, Nair A, Firoz IN, Haroon NN. COVID-19 vaccine hesitancy and influence of professional medical guidance. J Educ Health Promot.
2022;11:112.
36. Lamptey E. Overcoming barriers to COVID-19 vaccination of pregnant women. Gynecology and Obstetrics Clinical Medicine. 2022;2(1):29–33.
37. Wang X, Wang H, Du A, Wang J, Shi J, Zhang Y, et al. COVID-19 vaccine hesitancy and associated factors among infertile couples undergoing assisted reproductive treatment. Front Immunol. 2022;13:973600.
38. Vieira Rezende RP, Braz AS, Guimarães MFB, Ribeiro SLE, Abreu Vieira RMR, Bica BE, et al. Characteristics associated with COVID-19 vaccine hesitancy: A nationwide survey of 1000 patients with immune-mediated inflammatory diseases. Vaccine. 2021;39(44):6454-6459.
2. Januszek SM, Faryniak-Zuzak A, Barnaś E, Łoziński T, Góra T, Siwiec N, et al. The Approach of Pregnant Women to Vaccination Based on a COVID-19 Systematic Review. Medicina. 2021;57(9):977.
3. Goncu Ayhan S, Oluklu D, Atalay A, Menekse Beser D, Tanacan A, Moraloglu Tekin O, Sahin D.
COVID-19 vaccine acceptance in pregnant women. Int J Gynaecol Obstet. 2021;154(2):291-296.
4. Sutton D, D'Alton M, Zhang Y, Kahe K, Cepin A, Goffman D, et al. COVID-19 vaccine acceptance among pregnant, breastfeeding, and nonpregnant reproductive-aged women. Am J Obstet Gynecol MFM. 2021;3(5):100403.
5. Schwartz DA, Dhaliwal A. Infections In Pregnancy With Covid-19 And Other Respiratory Rna Virus Diseases Are Rarely, If Ever, Transmitted To The Fetus: Experiences With Coronaviruses, Hpiv, Hmpv Rsv, And Influenza. Arch Pathol Lab Med. 2020.
6. Schwartz DA, Graham AL. Potential Maternal and Infant Outcomes from Coronavirus 2019-nCoV (SARS-CoV-2) Infecting Pregnant Women: Lessons from SARS, MERS, and Other Human Coronavirus Infections. Viruses. 2020;12(2):194.
7. Jering KS, Claggett BL, Cunningham JW, Rosenthal N, Vardeny O, Greene MF, et al. Clinical Characteristics and Outcomes of Hospitalized Women Giving Birth With and Without COVID-19. JAMA Intern Med. 2021;181(5):714-717.
8. Timircan M, Bratosin F, Vidican I, Suciu O, Tirnea L, Avram V, et al. Exploring pregnancy outcomes associated with SARS-CoV-2 infection. Medicina. 2021;57(8):796.
9. Popescu DE, Cioca A, Muresan C, Navolan D, Gui A, Pop O, et al. A Case of COVID-19 Pregnancy Complicated with Hydrops Fetalis and Intrauterine Death. Medicina. 2021;57(7):667.
10. Battarbee AN, Stockwell MS, Varner M, Newes-Adeyi G, Daugherty M, Gyamfi-Bannerman C, et al. Attitudes Toward COVID-19 Illness and COVID-19 Vaccination among Pregnant Women: A Cross-Sectional Multicenter Study during August–December 2020. Am J Perinatol. 2022;39(1):75-83.
11. Wang PH, Lee WL, Yang ST, Tsui KH, Chang CC, Lee FK. The impact of COVID-19 in pregnancy: Part II. Vaccination to pregnant women. J Chin Med Assoc. 2021;84(10):903-910.
12. Tormen M, Taliento C, Salvioli S, Piccolotti I, Scutiero G, Cappadona R, et al. Effectiveness and safety of COVID-19 vaccine in pregnant women: A systematic review with meta-analysis. BJOG. 2023;130(4):348-357.
13. Kalafat E, Heath P, Prasad S, P OB, Khalil A. COVID-19 vaccination in pregnancy. Am J Obstet Gynecol. 2022;227(2):136-47.
14. Razzaghi H, Meghani M, Pingali C, Crane B, Naleway A, Weintraub E, et al. COVID-19 Vaccination Coverage Among Pregnant Women During Pregnancy - Eight Integrated Health Care Organizations, United States, December 14, 2020-May 8, 2021. MMWR Morb Mortal Wkly Rep. 2021;70(24):895-9.
15. Rawal S, Tackett RL, Stone RH, Young HN. COVID-19 vaccination among pregnant people in the United States: a systematic review. Am J Obstet Gynecol MFM. 2022;4(4):100616.
16. Sezerol MA, Davun S. COVID-19 Vaccine Hesitancy and Related Factors among Unvaccinated Pregnant Women during the Pandemic Period in Turkey. Vaccines (Basel). 2023;11(1):132.
17. Bianchi FP, Stefanizzi P, Di Gioia MC, Brescia N, Lattanzio S, Tafuri S. COVID-19 vaccination hesitancy in pregnant and breastfeeding women and strategies to increase vaccination compliance: a systematic review and meta-analysis. Expert Review of Vaccines. 2022;21(10):1443-54.
18. Moini A, Rabiei M, Pirjani R, Abiri A, Maleki-Hajiagha A. COVID‑19 vaccine hesitancy among pregnant women and their reported reasons for vaccine refusal - A prospective study in Tehran, Iran. Vaccine. 2023;41(8):1490-5.
19. Alshahrani SM, Alotaibi A, Almajed E, Alotaibi A, Alotaibi K, Albisher S. Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia. Int J Womens Health. 2022;14:1629-39.
20. Masa'deh R, Momani A, Rayan A, Hamaideh SH, Masadeh OM, Al-Yateem N. COVID-19 vaccine hesitancy among women planning for pregnancy, pregnant or breastfeeding mothers in Jordan: A cross-sectional study. PLoS One. 2023;18(6):e0286289.
21. Pairat K, Phaloprakarn C. Acceptance of COVID-19 vaccination during pregnancy among Thai pregnant women and their spouses: a prospective survey. Reprod Health. 2022;19(1):74.
22. Skirrow H, Barnett S, Bell S, Riaposova L, Mounier-Jack S, Kampmann B, et al. Women's views on accepting COVID-19 vaccination during and after pregnancy, and for their babies: a multi-methods study in the UK. BMC Pregnancy Childbirth. 2022;22(1):33.
23. Lynch MM, Squiers LB, Kosa KM, Dolina S, Read JG, Broussard CS, et al. Making Decisions About Medication Use During Pregnancy: Implications for Communication Strategies. Matern Child Health J. 2018;22(1):92-100.
24. Alshahrani SM, Alotaibi A, Almajed E, Alotaibi A, Alotaibi K, Albisher S. Pregnant and Breastfeeding Women's Attitudes and Fears Regarding COVID-19 Vaccination: A Nationwide Cross-Sectional Study in Saudi Arabia. Int J Womens Health. 2022;14:1629-1639.
25. Golder S, McRobbie-Johnson ACE, Klein A, Polite FG, Gonzalez Hernandez G. Social media and COVID-19 vaccination hesitancy during pregnancy: a mixed methods analysis. BJOG. 2023;130(7):750-758..
26. Anderson E, Brigden A, Davies A, Shepherd E, Ingram J. Maternal vaccines during the Covid-19 pandemic:A qualitative interview study with UK pregnant women. Midwifery. 2021;100:103062.
27. Kiefer MK, Mehl R, Costantine MM, Johnson A, Cohen J, Summerfield TL, et al. Characteristics and perceptions associated with COVID-19 vaccination hesitancy among pregnant and postpartum individuals: A cross-sectional study. BJOG. 2022;129(8):1342-1351.
28. Geoghegan S, Stephens LC, Feemster KA, Drew RJ, Eogan M, Butler KM. "This choice does not just affect me." Attitudes of pregnant women toward COVID-19 vaccines: a mixed-methods study. Hum Vaccin Immunother. 2021;17(10):3371-3376.
29. Lanyi K, Green R, Craig D, Marshall C. COVID-19 Vaccine Hesitancy: Analysing Twitter to Identify Barriers to Vaccination in a Low Uptake Region of the UK. Front Digit Health. 2022;3:804855.
30. Naqvi S, Saleem S, Naqvi F, Billah SM, Nielsen E, Fogleman E, et al. Knowledge, attitudes, and practices of pregnant women regarding COVID-19 vaccination in pregnancy in 7 low- and middle-income countries: An observational trial from the Global Network for Women and Children's Health Research. BJOG. 2022;129(12):2002-2009.
31. Freeman D, Loe BS, Chadwick A, Vaccari C, Waite F, Rosebrock L, et al. COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II. Psychol Med. 2022;52(14):3127-3141.
32. Griffith J, Marani H, Monkman H. COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework. J Med Internet Res. 2021;23(4):e26874.
33. Phillips R, Gillespie D, Hallingberg B, Evans J, Taiyari K, Torrens-Burton A, et al. Perceived threat of COVID-19, attitudes towards vaccination, and vaccine hesitancy: A prospective longitudinal study in the UK. Br J Health Psychol. 2022;27(4):1354-1381.
34. Saied SM, Saied EM, Kabbash IA, Abdo SAE. Vaccine hesitancy: Beliefs and barriers associated with COVID-19 vaccination among Egyptian medical students. J Med Virol. 2021;93(7):4280-4291.
35. Nair G, Venkatesan K, Nair A, Firoz IN, Haroon NN. COVID-19 vaccine hesitancy and influence of professional medical guidance. J Educ Health Promot.
2022;11:112.
36. Lamptey E. Overcoming barriers to COVID-19 vaccination of pregnant women. Gynecology and Obstetrics Clinical Medicine. 2022;2(1):29–33.
37. Wang X, Wang H, Du A, Wang J, Shi J, Zhang Y, et al. COVID-19 vaccine hesitancy and associated factors among infertile couples undergoing assisted reproductive treatment. Front Immunol. 2022;13:973600.
38. Vieira Rezende RP, Braz AS, Guimarães MFB, Ribeiro SLE, Abreu Vieira RMR, Bica BE, et al. Characteristics associated with COVID-19 vaccine hesitancy: A nationwide survey of 1000 patients with immune-mediated inflammatory diseases. Vaccine. 2021;39(44):6454-6459.
| Files | ||
| Issue | Vol 18, No 1 (March 2024) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v18i1.15441 | |
| Keywords | ||
| SARS-CoV-2 COVID-19 Vaccines Vaccination Hesitancy Pregnancy | ||
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How to Cite
1.
Dehshiri M, Mansouri M, Jarahzadeh MH, Hatamizadeh N. Determinants of Non-Acceptance of the COVID-19 Vaccine During Pregnancy in Pregnant and Postpartum Women: A Descriptive Cross-Sectional Study. J Family Reprod Health. 2024;18(1):67-74.
