DOI: 10.7272/q6xd0zx8
title: The supply is there. So why can't pregnant and breastfeeding women in rural India get the COVID-19 vaccine?

description: Despite COVID-19 vaccines being available to pregnant women in India since
 summer 2021, little is known about vaccine uptake among this high-need
 population. We conducted mixed methods research with pregnant and recently
 delivered rural women in northern India, consisting of 300 phone surveys
 and 15 in-depth interviews, in November 2021. Only about a third of
 respondents were vaccinated, however, about half of unvaccinated
 respondents reported that they would get vaccinated now if they could.
 Fears of harm to the unborn baby or young infant were common (22% of
 unvaccinated women). However, among unvaccinated women who wanted to get
 vaccinated, the most common barrier reported was that their healthcare
 provider refused to provide them with the vaccine. Gender barriers and
 social norms also played a role, with family members restricting women’s
 access. Trust in the health system was high, however, women were most
 often getting information about COVID-19 vaccines from sources that they
 did not trust, and they knew they were getting potentially poor-quality
 information.  Qualitative data shed light on the barriers women
 faced from their family and healthcare providers but described how as more
 people got the vaccine, that norms were changing. These findings highlight
 how pregnant women in India have lower vaccination rates than the general
 population, and while vaccine hesitancy does play a role, structural
 barriers from the healthcare system also limit access to vaccines.
 Interventions must be developed that target household decision-makers and
 health providers at the community level, and that take advantage of the
 trust that rural women already have in their healthcare providers and the
 government. It is essential to think beyond vaccine hesitancy and think at
 the system level when addressing this missed opportunity to vaccinate
 high-risk pregnant women in this setting. 
description: To understand vaccine uptake, barriers, hesitancy, facilitating
 factors and sources of trusted information among pregnant and
 breastfeeding women, we conducted mixed-methods research in northern India
 in November 2021. In total, we conducted 300 phone surveys and 15 in-depth
 interviews with women from lower and upper middle-class populations. The
 eligibility criteria were to include pregnant and recently delivered women
 who were breastfeeding (up to one year postpartum). The surveys were
 conducted telephonically. The participants were active members of WhatsApp
 groups run by a local NGO that was a collaborator on the project. All
 women in the WhatsApp group were connected to the government health care
 system, which provides free services. A list of 552 eligible women, from a
 sample of about 5,000, was provided to the research assistants. Women who
 were either pregnant or had delivered within 1 year were eligible for the
 survey.  The list included their name, mobile and date of delivery. These
 women were called one by one down the list provided by the research
 assistant. Women were read an informed consent and asked to provide verbal
 consent. A survey call was scheduled based on a time convenient for the
 women. Most of the surveys were completed in one call and few were done in
 parts based on the availability of the participant. Out of about 450 women
 called, 300 complete surveys were taken. Some women did not pick up the
 call or only completed half of the survey. The team began to take the
 surveys in the first week of November 2021, and 300 surveys were completed
 by November 27, 2021. The survey included questions on vaccine acceptance,
 barriers, hesitancy and socio-demographics.
description: The quantitative data are uploaded in Stata format. For other
 data formats, please contact the study team.