Lessons learned from pregnant women's experiences with COVID-19 vaccination in Brazil: A qualitative study

To explore pregnant women's perceptions of COVID-19 vaccination and factors influencing their decision making.

This qualitative study, part of a multinational project led by WHO and Johns Hopkins University, was conducted in Brazil between August and December 2023. In-depth interviews were conducted with 25 pregnant women across all three trimesters of pregnancy and 25 postpartum women, exploring their knowledge, attitudes, and decision making regarding COVID-19. Data were analyzed thematically through an iterative process until saturation, examining confidence levels, vaccination history, risk perceptions, fears of adverse events, and the influence of healthcare professionals. Based on these dimensions, distinct profiles of vaccine hesitancy were developed.

Five profiles of COVID-19 vaccine attitudes during pregnancy were identified among 50 pregnant and postpartum women: trust in vaccination during pregnancy (n = 23), characterized by confidence in vaccine safety, science, and protection; need for external encouragement to vaccinate (n = 6), mainly influenced by healthcare professionals or family; waning interest in additional doses (n = 6), associated with low perceived risk, prior infection, or pandemic fatigue; concerns about vaccine safety or side effects (n = 7), often linked to previous adverse reactions and insufficient information; and concerns about vaccine effects on pregnancy or the fetus (n = 8), contributing to delayed or refused vaccination during pregnancy.

Despite overall high vaccine acceptance in Brazil, pregnancy introduced hesitations related to fetal safety, communication gaps, and trust in health information. The identification of five distinct profiles highlights lessons learned from the COVID-19 pandemic and reinforces the need for targeted communication strategies and consistent healthcare guidance to support maternal immunization in future public health scenarios.