COVID-19 vaccine acceptance among pregnant, breastfeeding, and nonpregnant reproductive-aged women

Abstract

Background: Although mass vaccination against COVID-19 may prove to be the most efficacious end to this deadly pandemic, there remain concern and indecision among the public toward vaccination. Because pregnant and reproductive-aged women account for a large proportion of the population with particular concerns regarding vaccination against COVID-19, this survey aimed at investigating their current attitudes and beliefs within our own institution.

Objective: This study aimed to understand vaccine acceptability among pregnant, nonpregnant, and breastfeeding respondents and elucidate factors associated with COVID-19 vaccine acceptance.

Study design: We administered an anonymous online survey to all women (including patients, providers, and staff) at our institution assessing rates of acceptance of COVID-19 vaccination. Respondents were contacted in 1 of 3 ways: by email, advertisement flyers, and distribution of quick response codes at virtual town halls regarding the COVID-19 vaccine. Based on their responses, respondents were divided into 3 mutually exclusive groups: (1) nonpregnant respondents, (2) pregnant respondents, and (3) breastfeeding respondents. The primary outcome was acceptance of vaccination. Prevalence ratios were calculated to ascertain the independent effects of multiple patient-level factors on vaccine acceptability.

Results: The survey was administered from January 7, 2021, to January 29, 2021, with 1012 respondents of whom 466 (46.9%) identified as non-Hispanic White, 108 (10.9%) as non-Hispanic Black, 286 (28.8%) as Hispanic, and 82 (8.2%) as non-Hispanic Asian. The median age was 36 years (interquartile range, 25-47 years). Of all the respondents, 656 respondents (64.8%) were nonpregnant, 216 (21.3%) were pregnant, and 122 (12.1%) were breastfeeding. There was no difference in chronic comorbidities when evaluated as a composite variable (Table 1). A total of 390 respondents (39.2%) reported working in healthcare. Nonpregnant respondents were most likely to accept vaccination (457 respondents, 76.2%; P<.001) with breastfeeding respondents the second most likely (55.2%). Pregnant respondents had the lowest rate of vaccine acceptance (44.3%; P<.001). Prevalence ratios revealed all non-White races except for non-Hispanic Asian respondents, and Spanish-speaking respondents were less likely to accept vaccination (Table 3). Working in healthcare was not found to be associated with vaccine acceptance among our cohort.

Conclusion: In this survey study of only women at a single institution, pregnant respondents of non-White or non-Asian races were more likely to decline vaccination than nonpregnant and breastfeeding respondents. Working in healthcare was not associated with vaccine acceptance.

Keywords: COVID-19; breastfeeding; risk reduction; vaccine.

Figure 1

All respondents declining vaccination were questioned on specific reasons for declination The bars represent the mean scores from 0 meaning “low or no concern” to 5 “highly concerned.”

Figure 2

All pregnant respondents declining vaccination were questioned on pregnancy-related reasons for declination The bars represent the mean scores from 0 meaning “low or no concern” to 5 “highly concerned.”

Figure 3

All respondents accepting vaccination were questioned on specific reasons for acceptance The bars represent the mean scores from 0 meaning “little or no influence” to 5 “strongly supports.”

Figure 4

All pregnant respondents accepting vaccination were questioned on pregnancy-related reasons for acceptance The bars represent the mean scores from 0 meaning “little or no influence” to 5 “strongly supports.”

Figure 5

All hesitant respondents were questioned on reasons for declination The bars represent the mean scores from 0 meaning “low or no concern” to 5 “highly concerned.”

Figure 6

All hesitant respondents were questioned on specific reasons for acceptance The bars represent the mean scores from 0 meaning “little or no influence” to 5 “strongly supports.”