Parental decision-making regarding vaccination: the role of preschool enrolment sanctions, family policies and childcare expectation

ABSTRACT The Czech Republic exemplifies a country with a mandatory childhood vaccination system. A child who has not completed compulsory vaccinations cannot be admitted to preschool until age 5. This paper discusses this measure's impact on parental decision-making processes, interactions with healthcare professionals, and activities and discourses employed by organisations that unite vaccine-hesitant parents. The analysis draws on data from 30 in-depth interviews with vaccine-hesitant parents (all of whom intentionally postponed or refused at least one compulsory vaccination), 19 in-depth interviews with healthcare professionals and 60 hours of observation at three paediatrician surgeries during vaccination consultations. The paper departs from the notion of vaccine hesitancy as a state of indecisiveness or a particular behavioural phenomenon and leans towards specific contexts within which decisions are made. It analyses specific effects of indirect sanctions that are part of mandatory vaccination policies on vaccine-hesitant parents’ interactions with healthcare professionals, strategies, public discourses and decision-making processes regarding vaccination. The paper discusses the measures’ impact in the context of family policies in the Czech Republic (availability of preschool facilities, gender division of labour and social expectations regarding the length of paternal leave).