Attitude of pregnant and lactating women toward COVID-19 vaccination in Jordan: a cross-sectional study

Introduction

Pregnant and lactating women who contract COVID-19 are susceptible to many consequences such as premature birth, adverse pregnancy outcomes, and postpartum outcomes for mother and lactating child [1]. Besides, the COVID-19 pandemic is a cause of fear among pregnant women as it potentially affects the mother and the fetus [2]. Various studies showed that many could have developed and approved various regulations that ensure the health of pregnant, lactating women and their children during the pandemic [3, 4]. In a study that reviewed vaccine safety during pregnancy, Pratama et al. stated that Moderna and Pfizer BioNTech vaccines efficiently prevent infections and are safe for pregnant women and their babies [5].

Various arguments support COVID-19 vaccine safety and its importance in slowing down the pandemic. The COVID-19 vaccine contains mRNA with lipid nanoparticles that get into the cells after vaccination [6]. The host cells then create COVID-19 spike proteins that trigger the production of antibodies. The process takes place in the regional lymph nodes [7]. A notable fact is that the currently the available COVID-19 vaccines do not have live viruses or adjuvants that cause adverse effects on a fetus. Besides, a study on reproductive and developmental toxicity in rats used Modern mRNA and revealed no alarming signals about the safety of female reproduction, postnatal or intrauterine development [8]. A similar study also supported Pfizer’s safety and efficacy in pregnancy. The study showed that the vaccine benefited both the mother and the child. The COVID-19 vaccine is characterized by a fever that lasts up to two days. In pregnancy, the increased temperature should not be alarming as it can be successfully reduced by acetaminophen [9, 10]. Other scholarly research on pregnancy vaccination will offer important data on concerns regarding efficacy of vaccine and whether it is safe for mothers and infants. Information for healthcare workers that they can use for patient counseling has been developed to help in patient education.

It is important to acknowledge the factors that impact vaccine acceptance among different population groups, especially among pregnant and lactating mothers [11]. Pregnant and lactating mothers play a significant role in deciding if their child/fetus will be vaccinated. However, according to a study conducted by Skjefte et al., there are difference acceptance levels of COVID-19 vaccine among pregnant mothers. This finding was like past studies that considered the general population [1].Besides, the World Health Organization (WHO) reported that unwillingness to receive vaccines was the current threat to global health before the first COVID-19 case was reported. Prior research has also revealed unprecedented challenges regarding global COVID-19 acceptance [12].

Further, many associations for women recommended that pregnant and lactating to receive COVID-19 vaccinations. The two bodies also emphasize that obstetricians play a significant role of motivating pregnant mothers to go for the vaccine [13, 14]. Based on data analysis published around the words and from observations and research argue available COVID-19 vaccines are safe for pregnant and lactating women [15]. The objective of this study was to survey pregnant and lactating women toward COVID-19 vaccination in Jordan and determine the predictors of this attitude.

Materials and methods

This study used a 10 min anonymous, online, cross-sectional survey to collect data. The survey was carried out between September and October 2021. Eligible study participants included all pregnant and lactating women in Jordan. The participants were recruited through social media, midwives, and gynecologists. Since many of midwives and gynecologists were routinely contacted health care personnel (HCP), they had an easy access and direct contact to HCP. These midwives and gynecologists make it easy to recruit participants. They also sent many invitations to HCP and asked them to distribute online surveys to who they know. Women were recruited from all cities in Jordan since social media was used to collect the information. Before starting the study, the participants provided online written consent. When the participant was being recruited, 10% of the population had received the COVID-19 vaccine.

The researchers used a self-administered questionnaire. The variables included in this study included socio-demographic characteristics including gender, age, marital status, family income, educational levels, and health status. The study instrument was called Attitude of Pregnant and Lactating Women toward COVID-19 Vaccination (APLWC) and it was built based on a previous study that used a similar instrument to examine attitude of pregnant and lactating toward COVID-19 vaccination [16]. This instrument measures theoretical construct including perceived risk of contracting COVID-19, COVID-19 severity, COVID-19 vaccine benefits, barriers to receiving the COVID-19 vaccine, self-efficacy, behavioral control, trust in government, anticipated regret, knowledge, and subjective norms. Questions that were similar in both groups were then evaluated. The study participants filled the questionnaires, rating their perception with statements that range from “strongly agree” to “strongly disagree.” The participants were also asked if their school directed that child receive the COVID-19 vaccine. The Cronbach alpha of the instrument was 0.82.

Results

Discussion

This study examined attitude of pregnant and lactating women toward COVID-19 vaccination in Jordan. The findings of this study show that most pregnant and lactating women moderately support vaccination while pregnant or lactating. This finding is against a past study conducted in January 2021 among pregnant and lactating women in Italy [17].However, more pregnant mothers will support vaccination if studies prove vaccine safety for pregnant women because of their susceptibility to severe infections [18].

Our study found that there were no differences in attitude between pregnant and lactating women toward COVID-19 vaccination. However, both groups were worry about the side effect of vaccine on them and their fetus/children. In contrast, a study in Germany found that vaccine acceptance in the lactating group was higher than in the pregnant group. Both groups’ significant reasons are that there is little scientific evidence and information regarding vaccine safety and that they are anxious about the possibility of harm to their unborn babies when they receive the vaccination [18].Vaccine acceptance rate helps plan interventions to spread awareness and reaffirm the population that the available vaccines are safety and beneficial. In turn, it becomes easier to limit the transmission of the virus and prevents adverse effects of the pandemic. It is often the mothers who decide whether to have their children and their family members vaccinated [19, 20]. Therefore, measuring their trust and factors influencing COVID-19 acceptance among pregnant mothers is essential.

In our study, many factors were predicted the attitude of pregnant and lactating women toward COVID-19 vaccination. The factors were Source of data regarding COVID-19, level of income, and social status. These results mean lower income, people who frequently hearing news from news channel or ministry of health and married are showed more positive attitude toward COVID-19 vaccination. In Germany, the acceptance of vaccines among pregnant mothers can be affected by various demographic factors such as gender, age, income status, and demography, individual factors such as perception of risk, political views, and organizational factors [18].

This study found a varying vaccine acceptance pattern among pregnant and lactating women. Studies conducted in various countries such as India, China, Qatar, and South American countries found a relatively higher acceptance rate among pregnant and lactating women compared to the general population [1, 21, 22]. In contrast, studies conducted in North America, Europe, Russia, and Australia recorded low acceptance rates [23, 24]. Therefore, it can be argued that the vaccine acceptance rate depends on geographical location and the timing of the pandemic. For instance, countries whose population has been significantly affected by the pandemic, such as China and Italy, have a relatively higher vaccine acceptance rate among pregnant mothers. Besides, during summer and before vaccine introduction, a low acceptance rate was observed compared to studies conducted in the second wave. This can be due to the social assessment of the risks, which is essential in determining vaccine acceptance of the target population [21–24].

Change in the vaccine acceptance rate of pregnant women during the pandemic can be linked to personal and social or organizational factors. The review also found that the willingness to get vaccinated is influenced by perceived risks of infection, benefits of vaccines, the constant communication of associated threats, government restrictions, and penalties for not wearing a face mask [22, 25]. In our study, the main reason for not being vaccinated was: there is not enough time fear of unexpected side effects and fearing for their children. The main fears were the side effects of the vaccination and being pregnant. The main advantages for the vaccination for women will reduce their chance and their children/fetuses of contracting COVID-19 or its complications and vaccination will protect them and their families from contracting COVID-19 or its complications. Most of the studies reviewed in this paper state those higher educational levels, older age, and more income increase the vaccine acceptance rate. At the same time, these studies revealed that it is challenging to modify various factors influencing COVID-19 vaccine acceptance, such as socioeconomic and geographic influences [19–21, 25, 26].

Other factors that influence vaccine acceptance include confidence levels pregnant women have on healthcare institutions and their awareness of COVID-19 are related. The review identified recurring factors linked COVID-19 risks awareness level during pregnancy and vaccine safety during this period [15, 17]. Besides, factors such as confidence in the safety and vaccine efficacy, trust in available information, belief in the benefits of the vaccine, trust in vaccines received during childhood, concern about the pandemic [27], confidence in public health agencies, absence of anxiety over possible vaccine side effects [28], clear information regarding COVID-19 vaccine safety during pregnancy, obstetrician supervising pregnancy, and influenza vaccine are major factors that predict COVID-19 vaccine acceptance [20–22, 25, 26]. Further, these factors concern the provision of information to lactating and pregnant and lactating women about the present state of COVID-19 information and vaccine recommendations [27, 28]. Besides, this factor significantly influences the decision to receive a vaccine in various social groups and general populations. Therefore, effective communication strategies can provide a clear direction for action, including reassurance from trusted healthcare providers and family members. Considering the mentioned information, evidence-based professional ethics in gynecology and obstetrics can provide essential guidance regarding COVID-19 vaccine.

Conclusions

This is a large national study regarding attitude of pregnant and lactating women toward COVID-19 vaccination in Jordan. This study found that more than 50% for the parents were hesitant to allow their children to receive COVID-19 vaccination. There were no differences between pregnant and lactating women toward COVID-19 vaccination. Along with predictors that were determined in this project many other factors will impact the increase rate of getting COVID-19 vaccines for pregnant and lactating women in Jordan.