Perceptions of the COVID-19 Vaccines and Rationale Surrounding the Decision to Vaccinate Among Pregnant Women of color in the United States: Lessons Learned From Four Focus Groups

Abstract

Background Prior to the COVID-19 pandemic, the United States was facing a maternal health crisis grounded in health disparities. People of color have been disproportionately burdened by COVID-19. Simultaneously, maternity patients are at higher risk of severe complications and death due to COVID-19 infection. In spite of this, COVID-19 vaccination rates among pregnant women are low, and they are lowest among non-Hispanic Black women. To understand barriers and inform public health actions, this paper describes knowledge about COVID-19 infection in pregnancy, perceived infection risk, and reasons for vaccinating or not vaccinating against COVID-19 among pregnant women of color. Methods Four virtual focus group discussions were held with 32 participants in the United States. Two groups included women who had received at least one COVID-19 vaccine dose and two included those who stated they had not been vaccinated, but were considering it. Results Findings showed that both unvaccinated and vaccinated participants were knowledgeable about the risks of COVID-19 infection in pregnancy and were taking prevention precautions. Perceived benefits of vaccination included having a healthy pregnancy and baby, reduced stress about COVID-19 infection, and resuming social activities. All vaccinated participants reported having conversations with providers about vaccination, but the same provider engagement was not found among the unvaccinated. Concerns about the vaccines centered on bias in health care and vaccine safety. Conclusion Since vaccination benefits included having a healthy pregnancy and delivery, information about how the vaccines improve maternal and infant outcomes should be incorporated into health messaging. Addressing the historical and current racist practices in healthcare is critical to improve care and to improve trust in the health care system. Because health care provider engagement appears to be important for patient vaccination decisions, efforts should be made to support providers to talk to pregnant patients in culturally-sensitive ways about COVID-19 vaccines in pregnancy.