Qualitative exploration of factors associated with COVID-19 vaccination among pregnant women in Kenya

The COVID-19 pandemic significantly disrupted societies worldwide, and COVID-19 vaccination has been identified as instrumental in the fight against the pandemic. While studies have examined uptake of COVID-19 vaccination, more research is needed to gain a better understanding of the factors influencing pregnant women's decisions to get vaccinated. In this study, we used a cross-sectional descriptive qualitative study to explore the attitudes, beliefs, and behaviors related to COVID-19 vaccination during pregnancy in Kenya. A total of 50 in-depth interviews were conducted between October 2023 to March 2024 with a purposively drawn sample of 25 pregnant and 25 postpartum women during their clinic visits. Interviews were conducted by trained personnel, audio-recorded, transcribed into English, and coded using NVivo 12 software. Thematic findings were organized using the SAGE Vaccine Hesitancy Model categories to provide a comprehensive report of the factors perceived to influence COVID-19 vaccination among pregnant women in Kenya. There were similarities in perceptions reported by pregnant and postpartum women. Contextual influences included communication and media, policies, and geographic factors. Six individual and group influences were personal, family, and community experiences with vaccination, beliefs and attitudes about health and prevention, knowledge and awareness about COVID-19 vaccines, knowledge of the health system and trust in healthcare workers, perceived risks and benefits, and social norms. There was only one vaccine-specific influence (the scientific evidence on benefits versus risks), and five vaccination-specific issues, including mode of administration, design of the vaccination program, reliability and source of vaccine supplies, vaccination schedule, and the strength of healthcare workers' recommendations. The COVID-19 pandemic highlighted challenges of maternal vaccine acceptance, and this calls for more research to increase understanding of factors associated with pregnant women's decision-making on maternal vaccines, such as the COVID-19 vaccination, which can help inform interventions aimed at supporting this population.