Lessons from COVID-19: a qualitative study on the vaccination decision-making and experiences of black pregnant and postpartum women in the US

This study investigated the lessons learned from COVID-19 and the vaccination decision-making processes and experiences of Black pregnant and postpartum women in Greater Philadelphia. We interviewed 22 Black pregnant/postpartum women from November 2022 to May 2023, guided by the Public Health Critical Race Praxis. Inductive thematic analysis identified four key themes: the vaccination decision-making process, vaccination experiences, comparisons with other maternal vaccinations, and recommendations for protecting Black pregnant and postpartum individuals from COVID-19. The results highlight the complexity of vaccination decision making during the pandemic, revealing unequal access to information, education and prevention resources, which fueled existing mistrust in the health system among Black communities. However, we also identified opportunities to improve preventative and vaccination messaging through trusted community sources and the application of anti-racist frameworks in the organization and delivery of health services for Black women. These findings underscore the need to address structural barriers to equitable COVID-19 information and vaccine access, to increase vaccine acceptance and promote other maternal vaccinations. As COVID-19 is now managed as an endemic disease, the public health system must adapt approaches to routine vaccination and adopt policies, requiring intentional efforts to ensure equitable access to information and vaccines in Black communities.