Vaccination hesitancy more prominent among pregnant women of lower socioeconomic status

Reviewed by Emily Henderson, B.Sc.Sep 9 2022

A questionnaire of 1,899 pregnant women nationwide representing all 50 states reveals that during the Covid-19 pandemic if a pregnant woman had lower socioeconomic status and/or were African American, she was less likely to have the intention of taking a Covid-19 vaccine or actually receiving it. The study, led by Heidi Preis, MSW, PhD, of Stony Brook University, is published in Health Psychology.

Pregnant women are a vulnerable population for Covid-19 due to their risk for severe symptoms and adverse perinatal outcomes. This survey included women 18 and older who enrolled in the study during the second major wave of the pandemic in December 2020 and completed the survey three to four months later during the first quarter of 2021.

We examined predictors of vaccine intention around social determinants of health and how those lead to actual vaccination uptake. We found significant vaccination hesitancy that was clearly more prominent in socioeconomically disadvantaged, and this concerning given the vulnerability of pregnant women."

Heidi Preis, Lead Author, Research Scientist in the Department of Psychology, and an Assistant Professor in the Department of Obstetrics, Gynecology and Reproductive Medicine at the Renaissance School of Medicine at Stony Brook University

Preis added that while the study did not provide a specific call to action to increase vaccine intention and uptake within certain populations of pregnant women, potential routes to increase vaccination in perinatal populations include reducing medical care accessibility barriers and providing information within communities about vaccine safety and efficacy.

The results of the survey indicated that, overall, participants with below average financial status, only a high school education, and the uninsured or having Medicaid reported lower vaccination intention or lower vaccine uptake. In a comparison among racial and ethnic groups, African Americans reported the lowest vaccine intention among all the groups. Women who were older or had a chronic illness were more likely to have a vaccine, yet vaccine intention and uptake were not significantly associated with pregnancy risk status.

The authors say the strength of the study is its large cohort, design, and answers from pregnant women from all over the country. However, it had several limitations, namely that vaccination status was based on self-reports, participants were not asked whether or not they were fully vaccinated, and the sample was not educationally, economically or racially representative of the entire U.S. population.

They conclude that "lower uptake of Covid-19 vaccination among groups of pregnant women who face barriers because of their marginalized identity or insufficient socioeconomic resources is of particular concern because these groups already experience disparate rate of poor health, including worse perinatal outcomes and higher rates of Covid-19 morbidity and mortality."

This study was funded in part by a Stony Brook University Office of the Vice President for Research, and an Institute for Engineering-Driven Medicine Covid-19 Seed Grant by the National Institutes of Health Office of the Director (grant # R21DA049827).