vaccine hesitancy; attitudes; racial differences; mistrust; pregnancy


Maternal and Child Health | Medicine and Health Sciences | Public Health | Women's Health


Vaccination during pregnancy is critical to the health of birthing persons and infants. Yet, persistent racial disparities in vaccination threaten health outcomes in the U.S. (Lu et al., 2015). Vaccination coverage remains low among non-Hispanic Blacks and other racial minorities – a situation magnified by the COVID-19 pandemic (Freimuth, Jamison, An, Hancock, & Quinn, 2017; Stokes et al., 2020). Consequently, understanding vaccine attitudes for systemically disadvantaged groups is paramount to promoting public health. Illuminating barriers to vaccine uptake creates space for new strategies to reduce hesitancy.

To investigate Black women’s/birthing people attitudes toward influenza and pertussis vaccination during pregnancy, we conducted four focus groups and one interview between September-November 2019. Our sample included eighteen pregnant/recently pregnant Black women/birthing people from Baltimore, MD. Additionally, with the genesis of the COVID-19 pandemic, we returned to the same community between December 2020-March 2021. We conducted surveys with forty-two Black women/birthing people to examine the group’s attitudes towards COVID-19 vaccinations, as well.

Attitudes towards influenza and pertussis immunizations ranged from favorable to rejection. Yet, participants generally affirmed more favorable sentiments towards pertussis vaccines. Willingness to vaccinate was strongly connected to bolstering health. Even among those willing to vaccinate, participants voiced skepticism about vaccine safety. Barriers to vaccination included possible side effects; limited reliable information; and distrust. Finally, most participants planned to decline COVID-19 vaccines for themselves and their children.

For future communication strategies aimed at enhancing vaccine uptake, ensuring messages are delivered from trusted sources in local communities is critical (Fu, Haimowitz, & Thompson, 2019). Other possible methods include digital/social media campaigns and open conversations about hesitancy. Additionally, acknowledging decision-making processes of Black women/birthing people; listening to their opinions, and respecting their medical agency are essential.