Title : Decision-making regarding maternal vaccination: A multifactorial phenomenon from the perspective of pregnant women and healthcare staff
Abstract:
The WHO has identified vaccine hesitancy as one of the main threats to global health. Given that immunisation prevents around 4.4 million deaths worldwide each year, vaccination during pregnancy remains a key intervention for reducing the burden of disease in the first months of life and contributing to the achievement of maternal and neonatal survival targets.
Various studies indicate that vaccine hesitancy is not solely a matter of individual choice, but rather stems from the way in which emotions, knowledge and perceptions are shaped within specific social, institutional and territorial contexts. In Colombia, territorial and multi-ethnic diversity requires a multifactorial understanding of this phenomenon and its manifestation in specific practices of acceptance, delay or refusal of vaccination.
The CEIP is conducting a mixed-methods study, which began in May 2025, to understand decision-making regarding maternal vaccination from the perspective of pregnant women and healthcare staff, with a view to developing an intervention strategy. The study included the four cities with the highest maternal vaccination coverage and the four with the lowest coverage in Colombia. In the quantitative component, the GestVac questionnaire was designed and validated in the Colombian population, with 3,042 participants (1,570 pregnant women and 1,472 healthcare professionals); in the qualitative component, focus groups were conducted with 469 participants (274 healthcare professionals and 195 pregnant women).
In the questionnaire, pregnant women showed high adherence to the vaccination schedule (91.2%), attendance at appointments (85.7%), availability of the vaccine (85.3%) and receipt of information from healthcare staff (79.0%); lower proportions were observed in the active seeking of information (52.6%) and in discussions with the doctor regarding concerns (58.7%). Among healthcare professionals, favourable practices centred on counselling and communication regarding maternal vaccination, including information on influenza (80.0%), Tdap (71.3%) and COVID-19 (74.1%), as well as guidance for family members (80.6%), the provision of educational materials (70.0%), recording in medical records (68.4%) and monitoring vaccination status (66.5%).
Regarding the qualitative component, the most frequently mentioned categories were knowledge regarding vaccination, unfavourable attitudes, favourable and unfavourable factors within the health system, healthcare provision, unfavourable sociocultural factors, access to vaccination, and proposals regarding receiving information and training. This highlights the need for an intersectoral approach that takes social determinants into account, enabling us to address vaccine confidence beyond education alone. This involves re-evaluating the influence of various stakeholders and creating multipliers who promote a culture of vaccination and informed decision-making.
