COVID-19 Vaccination During Pregnancy: Barriers and Best Practices
Issue at Hand
COVID-19 increases the risk for severe illness, complications and death during pregnancy. In August 2021, the highest number of COVID-19-related deaths among pregnant people in a single month of the pandemic was reported, despite widespread availability of the COVID-19 vaccination, indicating that many of these deaths could have been prevented. At that time, uptake of COVID-19 vaccination by pregnant people was about 50%, far lower than that of non-pregnant people, with racial disparities in COVID-19 vaccination coverage during pregnancy being an important contributor of low uptake. At that time, COVID-19 vaccination uptake among non-Hispanic Black pregnant people was around 30%, compared with uptake among non-Hispanic white pregnant people around 50%, among non-Hispanic Asian pregnant people around 75%, and among Hispanic pregnant people around 45%.
Currently, there are still low vaccination coverage rates among pregnant individuals, and disparities in uptake persist. As of June 2023, approximately 60% of non-Hispanic Black pregnant individuals have received the primary COVID-19 vaccine series, compared to approximately 68% of non-Hispanic white pregnant individuals, around 90% of non-Hispanic Asian pregnant individuals, and about 70% of Hispanic pregnant individuals. Disparities also exist in the uptake of the updated bivalent booster dose before or during pregnancy, with approximately 13% of non-Hispanic Black pregnant individuals, 30% of non-Hispanic white pregnant individuals, 34% of non-Hispanic Asian pregnant individuals, and 14% of Hispanic pregnant individuals receiving a booster as of June 2023.
Real-Time Feedback
In September 2022, the American Hospital Association’s (AHA) Living Learning Network (LLN) collaborated with the Centers for Disease Control and Prevention (CDC) and AHA’s Vaccinate with Confidence team to conduct focus groups to gather information and gain a better understanding of the existing barriers, best practices and unique solutions in providing the COVID-19 vaccination to pregnant people. Participants in the focus groups were hospital policy staff and health care workers involved in the direct care of pregnant people. The combined, high-level results of the focus group discussions can be found below.
Focus Group Results
Shared Barriers
- Limited access to vaccine supply chain and storage issues at hospitals and health systems.
- Increase in mistrust and misinformation, along with lack of accurate information, among pregnant people.
- Influence of community opinions and media on decision-making among this population.
- Time constraints during appointments to provide sufficient education and counseling to patients and families.
Immediate Solutions
Despite improvements in COVID-19 vaccination rates among pregnant people, persistently low vaccination coverage indicates an ongoing public health concern that requires action to improve uptake among all pregnant people. Focus group participants offered the following solutions to improve vaccination rates:
- Encourage convenient access to vaccines for pregnant people and their families (including obstetric triage and post-partum clinics) and through mass vaccination events specifically for pregnant people staffed by obstetrician gynecologists (OB-GYN) and pediatricians to answer questions and address concerns.
- Bolster community involvement with local leaders and organizations to tailor messaging and host vaccination events. Stronger outcomes are noted when trusted community and faith leaders are involved in engagement. Other partners may include local medical societies, houses of worship, neighborhood nail/hair salons and sororities.
- Educate with evidence-based outcomes and vaccine benefits for baby during appointments, through physician led outreach in communities, through Facebook Live events and in local media.
- Tell stories of real time experiences and positive outcome stories.
- Maintain consistent, up-to-date messaging throughout hospitals, health systems and communities.
- Release targeted education campaigns for Black and Latinx communities with low vaccine adoption honoring the history of why there is mistrust in the health care system.
- Highlight Wildflower Health, a virtual health platform to keep pregnant people informed of their personal health and wellness information including making recommendations for when to get vaccinations and create appointment reminders. Wildflower Health app users also shared personal stories, which helps build confidence.
- Expand awareness through baby registry registration companies and promotional partnerships with other baby product companies.
- Engage fathers through focused messaging to influence their opinions.
Resources
AHA Podcast with Rachel Humphrey, M.D., on Encouraging COVID-19 Vaccination in Pregnant Women
Pregnant women around the country faced uncertainty upon the arrival of COVID-19. The medical community identified significant knowledge gaps in the impact of the virus on mothers’ and babies’ health at all stages of pregnancy.