"I said no for a reason": Understanding factors influencing vaccination acceptance during pregnancy in Hackney, London

Background: In England, influenza and pertussis vaccinations were recommended to all pregnant women from 2010 and 2012 respectively. However, in some areas, vaccination uptake rates have been low. The aim of this study was to gain a contextualised understanding of factors influencing vaccination acceptance during pregnancy in Hackney, a borough in north-east London, UK. Methods: Hackney was chosen as the study site because it has one of the lowest vaccination coverage rates in pregnancy in the UK. A maximum variation sampling method was used to recruit 47 pregnant and recently pregnant women from a wide range of backgrounds, as well as ten healthcare professionals from three general practices; two community antenatal clinics; nine parent-toddler groups; and four community centres. In-depth interviews and a focus group discussion with pregnant and recently pregnant women, as well as a video-recording of a pregnant patient’s consultation, explored experiences of care within the National Health Service during pregnancy, and women’s views about maternal vaccination. In-depth interviews with healthcare professionals explored their views towards, and how they discuss and provide maternal vaccination. Study data were analysed both deductively, through drawing on insights from anthropological works that address diverse conceptualisations and practices around vaccination as well as on notions of governmentality, biopolitics and relational autonomy; and inductively, with a thematic analysis approach. Findings: Reasons for hesitancy surrounding maternal vaccination are complex. The findings of this study indicated three broad themes influencing acceptance of, and access to maternal vaccination. These include; the various constellations of governance involved in vaccination; the socio-economic positions of both pregnant women and healthcare professionals; and patient-healthcare professional relationships. A major finding was that while many participants had received no recommendation to vaccinate during their pregnancy (and often instead were just provided with an information leaflet), they said that if a conversation with their healthcare professional had taken place, where their concerns could be discussed, they would have been likely to accept the vaccines.