Perceived barriers to accessing vaccination plans in pregnant women in Chile: a qualitative analysis

BACKGROUND: Vaccination is widely recognized as a cost-effective public health intervention. However, vaccination rates among pregnant women have been decreasing globally, especially in contexts of structural social and health inequalities. Hence, the purpose of this study was to unveil access barriers to vaccination plans and vaccine hesitancy among pregnant women, both locals and international migrants, in three large cities in Chile. METHODS: A multiple Case Study was conducted. Through snowballing technique, local and migrant pregnant women or women with toddlers (i.e., recently pregnant) were invited to participate (n = 28, 14 Chileans and 14 international migrants). Semi-structured interviews were held online based on a pre-defined guide and lasted for 60-90 min. Interviews were audio recorded and transcribed verbatim and analyzed thematically. The project was approved by the Scientific Ethics Committee at UDD. RESULTS: There was general consensus that the country has a very strong immunization program, along with a well-established vaccination culture and compliance with the national immunization plan. Participants identified two main domains of barriers to accessing vaccination plans: (i) structural barriers to vaccination plans and (ii) perceived subjective barriers responsible for vaccination hesitancy. The first dimension included: (i.a) economic constraints and lack of social support, and (i.b) unique access barriers faced by migrant women. The second dimension included: (ii.a) insufficient vaccine information, (ii.b) fears to potential adverse effects, and (ii.c) disrespectful or neglectful treatment. Perceived facilitators were the following three: (i) timely and comprehensive access to information, (ii) free provision of vaccines, and (iii) preferential care at health centers. CONCLUSIONS: There are multiple structural barriers to accessing vaccination plans among pregnant women in Chile, as well as perceived subjective barriers related to vaccination hesitancy. These barriers underscore the need for strengthening access to quality and timely information about the vaccination plan during pregnancy, improving client-provider communication, ensuring dignified treatment, and training healthcare workers about health rights of migrant pregnant women in the country.