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Weighing up the risks — Vaccine decision-making in pregnancy and parenting

Published:February 18, 2022DOI:https://doi.org/10.1016/j.wombi.2022.02.007

      Abstract

      Background

      Immunisation is universally accepted as one of the most significant health initiatives in recent times. However, vaccine hesitancy is increasing in Australia and other high- and middle-income countries. There is evidence to suggest that many parents, even those who elect to immunise, may have a degree of vaccine hesitancy. The recommendation of a healthcare professional is a predictor for vaccine uptake.

      Aim

      The purpose of this study was to explore the values, beliefs and choices made by vaccine hesitant parents and pregnant women, regarding their decision not to vaccinate their child or children. The aim being to determine the factors that influence this decision making and to give a voice to vaccine hesitant parents.

      Methods

      A qualitative exploratory online survey of 106 vaccine hesitant parents and pregnant women was conducted in 2021. The survey utilised closed and open-ended questions.

      Findings

      Pregnant women and parents obtained most of their immunisation education from nurses, midwives, and general practitioners. Vaccine decision-making was however, influenced by multiple factors including vaccine safety concerns, the sources of information accessed, and a previous negative immunisation experience. Other influential factors included the use of alternative therapies, diet, and lifestyle factors.

      Discussion

      Along with general practitioners, nurses and midwives are a popular, respected and a vital source in the provision of accurate and timely immunisation education. However, further education is required at an undergraduate level to adequately prepare them for their role of listening to and educating vaccine hesitant pregnant women and parents.

      Keywords

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      References

        • WHO
        Ten Threats to Global Health.
        2019
        • Department of Health
        Immunisation Coverage Rates for All Children.
        2021
        • Logan J.
        • Nederhoff D.
        • Koch B.
        • et al.
        ‘What have you HEARD about the HERD?’ does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate?.
        Vaccine. 2018; 36: 4118-4125
        • National Centre for Immunisation Research and Surveillance
        No Jab No Play, No Jab No Pay.
        2021
        • Mohammed H.
        • Roberts C.T.
        • Grzeskowiak L.E.
        • et al.
        Psychosocial determinants of pertussis and influenza vaccine uptake in pregnant women: a prospective study.
        Vaccine. 2020; 38: 3358-3368
        • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists
        COVID-19 Vaccination in Pregnant and Breastfeeding Women and Those Planning Pregnancy.
        2021
        • Department of Health
        Immunisation for Pregnancy.
        2021
        • Arthurs A.L.
        • Jankovic-Karasoulos T.
        • Roberts C.T.
        COVID-19 in pregnancy: what we know from the first year of the pandemic.
        Biochim. Biophys. Acta Mol. Basis Dis. 2021; 1867166248
        • Villar J.
        • Ariff S.
        • Gunier R.B.
        • et al.
        Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID multinational cohort study.
        JAMA Pediatr. 2021; 175: 817-826
        • Adegbola R.
        • Nesin M.
        • Wairagkar N.
        Immunogenicity and efficacy of influenza immunization during pregnancy: recent and ongoing studies.
        Am. J. Obstet. Gynecol. 2012; 207: 28-32
        • Mohammed H.
        • Clarke M.
        • Koehler A.
        • Watson M.
        • Marshall H.
        Factors associated with uptake of influenza and pertussis vaccines among pregnant women in South Australia.
        PLoS One. 2018; 13: e0197867
        • Danchin M.H.
        • Costa-Pinto J.
        • Attwell K.
        • et al.
        Vaccine decision-making begins in pregnancy: correlation between vaccine concerns, intentions and maternal vaccination with subsequent childhood vaccine uptake.
        Vaccine. 2018; 36: 6473-6479
        • Clarke R.M.
        • Sirota M.
        • Paterson P.
        Do previously held vaccine attitudes dictate the extent and influence of vaccine information-seeking behavior during pregnancy?.
        Hum. Vaccin. Immunother. 2019; 15: 2081-2089
        • Smith S.E.
        • Sivertsen N.
        • Lines L.
        • De Bellis A.
        Decision making in vaccine hesitant parents and pregnant women — an integrative review.
        Int. J. Nurs. Stud. 2022; 4100062
        • Bradshaw A.S.
        • Shelton S.S.
        • Wollney E.
        • Treise D.
        • Auguste K.
        Pro-vaxxers get out: anti-vaccination advocates influence undecided first-time, pregnant, and new mothers on facebook.
        Health Commun. 2021; 36: 693-702
        • Diaz Crescitelli M.E.
        • Ghirotto L.
        • Sisson H.
        • et al.
        A meta-synthesis study of the key elements involved in childhood vaccine hesitancy.
        Public Health. 2020; 180: 38-45
        • Omer S.B.
        • Betsch C.
        • Leask J.
        Mandate vaccination with care.
        Nature. 2019; 571: 469-472
        • Glanz J.M.
        • Wagner N.M.
        • Narwaney K.J.
        • et al.
        A mixed methods study of parental vaccine decision making and parent-provider trust.
        Acad. Pediatr. 2013; 13: 481-488
        • Moniz M.H.
        • Beigi R.H.
        Maternal Immunization: Clinical Experiences, Challenges, and Opportunities in Vaccine Acceptance.
        Taylor & Francis, 2014: 2562-2570
        • Smith S.E.
        • Gum L.
        • Thornton C.
        An exploration of midwives’ role in the promotion and provision of antenatal influenza immunisation: a mixed methods inquiry.
        Women Birth. 2020; 11: 11
        • Costa-Pinto J.C.
        • Willaby H.W.
        • Leask J.
        • et al.
        Parental immunisation needs and attitudes survey in paediatric hospital clinics and community maternal and child health centres in Melbourne, Australia.
        J. Paediatr. Child Health. 2018; 54: 522-529
        • Facciola A.
        • Visalli G.
        • Orlando A.
        • et al.
        Vaccine hesitancy: an overview on parents’ opinions about vaccination and possible reasons of vaccine refusal.
        J. Public Health Res. 2019; 8: 1436
        • Lama Y.
        • Hancock G.R.
        • Freimuth V.S.
        • Jamison A.M.
        • Quinn S.C.
        Using classification and regression tree analysis to explore parental influenza vaccine decisions.
        Vaccine. 2020; 38: 1032-1039
        • Braun V.
        • Clarke V.
        • Boulton E.
        • Davey L.
        • McEvoy C.
        The online survey as a qualitative research tool.
        Int. J. Soc. Res. Methodol. 2020; : 1-14
        • Jenkins M.C.
        • Moreno M.A.
        Vaccination discussion among parents on social media: a content analysis of comments on parenting blogs.
        J. Health Commun. 2020; 25: 232-242
        • Tustin J.L.
        • Crowcroft N.S.
        • Gesink D.
        • Johnson I.
        • Keelan J.
        Internet exposure associated with Canadian parents’ perception of risk on childhood immunization: cross-sectional study.
        J. Med. Internet Res. 2018; 20
        • ABS
        Australian Bureau of Statistics.
        2019
        • Braun V.
        • Clarke V.
        Using thematic analysis in psychology.
        Qual. Res. Psychol. 2006; 3: 77-101
        • Australian Bureau of Statistics
        Socio-Economic Indexes for Areas (SEIFA).
        2018 (accessed 04/08/2021 2021)
      1. IBM Corp. IBM SPSS Statistics for Windows (Version 25.0.0.1). Armonk NY, IBM Corp., Released 2017.

        • Pairman S.
        Midwifery: Preparation for Practice. Book 1.
        fourth ed. Elsevier, Chatswood, NSW2019
        • Pairman S.
        Midwifery: Preparation for Practice. Book 2.
        fourth ed. Elsevier, Chatswood, NSW2019
        • Betsch C.
        • Bodeker B.
        • Schmid P.
        • Wichmann O.
        How baby’s first shot determines the development of maternal attitudes towards vaccination.
        Vaccine. 2018; 36: 3018-3026
        • Klotter J.
        Homeoprophylaxis.
        Townsend Lett. 2016; : 24
        • AIR
        Australian Immunization Register.
        2019
        • SA Health
        Perinatal Outcomes South Australia.
        2016
        • Government of South Australia
        Pregnancy Outcome Statistics.
        2017
        • Attwell K.
        • Wiley K.E.
        • Waddington C.
        • Leask J.
        • Snelling T.
        Midwives’ attitudes, beliefs and concerns about childhood vaccination: a review of the global literature.
        Vaccine. 2018; 36: 6531-6539
        • Attwell K.
        • Yusuf A.
        • Frawley J.
        Is immunisation education in midwifery degrees adequate?.
        Hum. Vaccin. Immunother. 2019; 15: 109-112
        • Talukdar S.
        • Dingle K.
        • Miller Y.D.
        A scoping review of evidence comparing models of maternity care in Australia.
        Midwifery. 2021; 99102973-
        • Gidengil C.
        • Chen C.
        • Parker A.M.
        • Nowak S.
        • Matthews L.
        Beliefs around childhood vaccines in the United States: a systematic review.
        Vaccine. 2019; 37: 6793-6802
        • Helps C.
        • Leask J.
        • Barclay L.
        “It just forces hardship”: impacts of government financial penalties on non-vaccinating parents.
        J. Public Health Policy. 2018; 39: 156-169
        • Government of South Australia
        SA Pregnancy Record Guidelines.
        2021