Abstract
Background: The COVID-19 pandemic disrupted healthcare access and trust, influencing vaccine decision-making among pregnant and postpartum individuals. While vaccine hesitancy research has focused primarily on individual-level attitudes, this study applies the Healthy People 2030 Social Determinants of Health framework to explore the broader system-level factors that shaped COVID-19 vaccine decision-making among pregnant and postpartum women.
Methods: Between March and November 2022, pregnant (≥24 weeks) and postpartum (≤12 weeks) individuals (n=38 for survey; n=28 for interviews) were recruited in the southeastern region of the United States. A convergent mixed method approach was used to analyze both the quantitative and qualitative data through five Social Determinants of Health domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context. Data integration occurred during interpretation using the Social Determinants of Health framework.
Results: We found that economic pressures, with many reporting employment-related vaccine mandates as a significant factor influencing their decision to vaccinate, educational disparities, healthcare interactions, neighborhood conditions, and social contexts all influenced vaccine-related behaviors during the pandemic. Qualitative data revealed that pregnant and postpartum women relied on trusted entities, such as their trusted healthcare providers, as one of the sources for vaccine information.
Conclusion: COVID-19 vaccine decisions-making during pregnancy were influenced by a complex interplay system-level factors. Interventions should integrate SDOH-informed screening in perinatal care, expand community-based communication strategies, and prioritize public health responses tailored to maternal health, especially during time of health crises.