Examining the hesitations of pregnant women towards COVID-19 vaccines during the pandemic: A mixed methods approach

Background: Various reasons stemming from direct vaccine concerns, individual factors, and sociocultural and environmental factors contribute to vaccine hesitancy among pregnant women regarding COVID-19 vaccines. Aims: The study described and compare pregnant women's perspectives on COVID-19 vaccination during the pandemic and to identify barriers and facilitators. Findings: A mixed-methods research design was adopted to integrate quantitative and qualitative descriptive methods. At a state hospital in the western region of Turkey, 249 pregnant women attending the maternity clinic from March to August 2022 were surveyed using questionnaires, and in-depth individual interviews were conducted with 17 of them. The interview topics were based on the participants’ perceptions and attitudes toward COVID-19 vaccines. A mixed-methods research design was adopted, using quantitative purposive sampling to describe and compare their COVID-19 vaccination status and qualitative purposive sampling to identify their hesitations regarding COVID-19 vaccines, analyzed through content analysis. Reporting followed the GRAMMS guidelines. Discussion: Sixty-six percent of pregnant women had not received the COVID-19 vaccine. Those with advanced age, lower education levels, and lower income exhibited higher levels of vaccine hesitancy. The hesitations of pregnant women toward COVID-19 vaccines revealed three main themes: direct vaccine-related hesitation, hesitation arising from individual factors, and hesitation stemming from socio-cultural and environmental factors. Conclusion: Vaccine hesitancy, which emerged during the COVID-19 pandemic, was a significant cause for concern. This hesitancy was explained by three main themes: vaccine hesitancy arising from the vaccine itself, vaccine hesitancy due to individual factors, and vaccine hesitancy stemming from socio-cultural and environmental factors. Additionally, sub-themes such as perceptions related to the management of the vaccination program, personal and infant-related risk-benefit assessments, the influence of anti-vaccine activists on social media, and political factors were also identified as playing a significant role in vaccine hesitancy.