Facilitators and Barriers to Vaccination Uptake in Pregnancy: A Qualitative Systematic Review

Abstract

Abstract Introduction Vaccination during pregnancy protects both the mother and the foetus from vaccine-preventable diseases. However, uptake of the recommended vaccines (influenza, pertussis, COVID-19) by pregnant women remains low in Europe and USA. Understanding the reasons for this is crucial to inform strategies to increase vaccination rates in pregnant women. This qualitative systematic review aimed to identify the barriers and facilitators to vaccination against influenza, pertussis and COVID-19 during pregnancy and identify strategies to increase vaccination during pregnancy. Methods We conducted a comprehensive search of electronic databases, including Medline, PsycINFO, CINAHL, Web of Science, WHO database, Embase and grey literature to identify qualitative studies that explored barriers and facilitators to vaccine uptake among pregnant women (PROSPERO CRD42023399488). The search was limited to studies published between 2012 and 2022 conducted in high-income countries with established vaccination programmes during pregnancy. Studies were thematically analysed and underwent quality assessment using the Joanna Briggs Institute validated critical appraisal tool for qualitative research. Results Out of 2681 articles screened, 28 studies (n = 1431 participants) were eligible for inclusion. Five overarching themes emerged relating to personal, provider and systemic factors. Barriers to vaccine uptake included concerns about vaccine safety efficacy, lack of information about the vaccine, fear of adverse effects on the foetus and low perception of disease severity. Facilitators included recommendations from trusted healthcare providers, easy access to vaccination, clear and consistent communication on the benefits of vaccination, and positive social influences from family and friends. Strategies for increasing vaccination uptake included strong and proactive vaccine recommendations by trusted healthcare professionals, provision of vaccines during routine antenatal care, clear and consistent communication about vaccines and addressing pregnant women’s concerns. Conclusion This review highlights the need for interventions that address the identified barriers to vaccine uptake among pregnant women. Provider recommendation can play a significant role in promoting vaccine uptake, as can clear and consistent risk and benefit communication and convenient access to vaccination. Addressing concerns about vaccine safety and providing accurate information about vaccines is also important.