A study in Midwifery in February 2023 examines the quality of maternal vaccination information available in pregnancy to patients in Aotearoa/New Zealand. The authors suggest that, although there is no fee to get vaccinated in the country, “less than half of all pregnant women are vaccinated”, leaving many women and infants at risk of disease. Furthermore, for pregnant Māori and Pacific women, lower vaccination coverage contributes to “severe morbidity and hospitalisation”.  

It is apparent, from historic and more recent experience, that access to information and adequate communication is a factor in determining a person’s vaccination status. Thus, the authors investigated the quality of information provided to the pregnant Māori and Pacific population. The aim was to investigate how they found out about vaccination during pregnancy, to what extent this information “suited their needs”, and how its delivery could be improved.  

The study  

The study took place in Dunedin and Gisborne, enrolling 15 participants who were or had been pregnant up to a year ago. Semi-structured, face-to-face interviews were conducted between May and August 2021, with each interview lasting between 20 and 60 minutes. The researchers describe efforts to build whanaungatanga (close connections, relationships) with their study participants, observing appropriate cultural practices.  

Results and observations 

Of the 15 participants, only 2 were had been vaccinated against both influenza and pertussis during pregnancy. Most women had been “informed” about maternal vaccines by their midwife, but “some were unaware of recommendations”. The authors note that the issue of vaccination was sometimes discussed without written materials or presented in written materials without discussion.  

“Insufficient information provision resulted in a lack of confidence in vaccination and an inability to make informed decisions.”  

The participants who sought more information suggested that they preferred to receive it in “face-to-face discussions” or group workshops and presentations. Videos and written information were also raised. Due to the “busy and information-loaded” nature of appointments, the authors recognise that information can be forgotten overlooked. However, they also emphasise that it “should not be the woman’s responsibility to find out information”.  

“At every health care contact there is the opportunity to make pregnant women aware of the recommendations for maternal vaccination and it should not only be the responsibility of a single healthcare professional.”  

Presenting and explaining information 

The study refers to previous research that indicates that recommending maternal vaccination “without discussion of benefits may be insufficient for women to prioritise vaccination”. Indeed, in this recent study, participants “appreciated” in-depth discussions and “felt confident” to get vaccinated after clear recommendations.  

Other influences 

Vaccine uptake is also influenced by discussions with whānau (extended family) or friends, and this study revealed that “more than half of participants were discouraged” by these discussions. Thus, “early” and “effective” communication with a “trusted healthcare provider” is essential to intercept misinformation or confusion. Furthermore, “addressing misunderstandings at the community level” as well as on an individual basis, will promote “more widespread knowledge and acceptance of maternal vaccination”. Once again, the study places the responsibility with the healthcare providers rather than the community.  

“The lack of provision of basic information to pregnant women about vaccination is an unacceptable system failure and must be addressed.” 

With this need in mind, the authors identify research that suggests some midwives feel insufficiently supported or trained to discuss vaccination or find time pressures overwhelming. 


“Women who do not receive appropriate information cannot make informed decisions about their own and their infant’s health.”  

The study highlights the link between unvaccinated women and lack of effective communication. The authors call for “system changes” to ensure that vaccine recommendations “reach every pregnant woman”.  

Although the study had a small sample size, the authors believe that it gives an insight into possible shared experiences of pregnant patients. What more can be done to encourage maternal vaccination across all communities? If you have experienced pregnancy, were you able to access adequate information on maternal vaccination?  

For more discussion on the importance of pregnant populations in vaccine development and deployment, join us at the World Vaccine Congress in Washington.