Maternal and Child Health Journal

, Volume 17, Issue 1, pp 156–164 | Cite as

Reasons Why Women Accept or Reject the Trivalent Inactivated Influenza Vaccine (TIV) During Pregnancy

  • Pamela M. Meharry
  • Eve R. Colson
  • Alexandra P. Grizas
  • Robert Stiller
  • Marietta Vázquez


The aim of the study was to gain an in-depth understanding of the reasons why pregnant women accept or reject the seasonal influenza vaccine. The qualitative descriptive design used a face-to-face semi-structured interview format. Sixty pregnant and postpartum women at two hospitals in the Northeastern United States participated. Content analysis was the inductive method used to code the data and identify emergent themes. Six themes emerged from the data: differing degrees of influence affect action to vaccinate; two-for-one benefit is a pivotal piece of knowledge that influences future vaccination; fear if I do (vaccinate), fear if I don’t; women who verbalize ‘no need’ for the vaccine also fear the vaccine; a conveniently located venue for vaccination reduces barriers to uptake; H1N1—a benefit and barrier to the seasonal vaccine. Our study supports previous findings and reveals a deeper understanding and interpretation of the behavior and decision-making to accept or reject the influenza vaccine. Understanding the reasons behind the behavior of vaccine rejection gives us the chance to change it.


Pregnancy Influenza Vaccination Qualitative interviews 



We are thankful for the two other analysts Elaine F. Martin, PhD., and Cathleen Walker, MA., and transcriptionist Joanie G. D. Meharry. We also are indebted to our 60 women, whose participation and cooperation were central to this study.


  1. 1.
    Mullooly, J. P., Barker, W., & Nolan, T. (1986). Risk of acute respiratory disease among pregnant women during influenza A epidemics. Public Health Reports, 101, 205–211.PubMedGoogle Scholar
  2. 2.
    Neuzil, K. M., Reed, G. W., Mitchel, E. F., Simonsen, L., & Griffin, M. R. (1998). Impact of influenza on acute cardiopulmonary hospitalizations in pregnant women. American Journal of Epidemiology, 148(11), 1094–1102.PubMedCrossRefGoogle Scholar
  3. 3.
    Dodds, L., McNeil, S., Fell, D., Allen, V., Coombs, A., Scott, J., et al. (2007). Impact of influenza exposure on rates of hospital admissions and physician visits because of respiratory illness among pregnant women. Canadian Medical Association Journal, 176(4), 463–468.PubMedCrossRefGoogle Scholar
  4. 4.
    Siston, A. M., Rasmussen, S. A., Honein, M. A., Fry, A. M., Seib, K., & Callaghan, W. (2010). Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States. Journal of American Medical Association, 303(15), 1517–1525.CrossRefGoogle Scholar
  5. 5.
    Neuzil, K. M., Mellen, B. G., Wright, P. F., Mitchel, E. F., & Griffin, M. R. (2000). The effect of influenza on hospitalizations, outpatient visits, and courses of antibiotics in children. New England Journal of Medicine, 342(4), 225–231.PubMedCrossRefGoogle Scholar
  6. 6.
    Zaman, K., Roy, E., Arifeen, S. E., Rahman, M., Raqib, R., & Wilson, E. (2008). Effectiveness of maternal influenza immunization in mothers and infants. New England Journal of Medicine, 359(15), 1555–1564.PubMedCrossRefGoogle Scholar
  7. 7.
    Eick, A. A., Uyeki, T. M., Klimov, A., Hall, H., Reid, R., Santosham, M., et al. (2011). Maternal influenza vaccination and effect on influenza virus infection in young infants. Archives of Pediatrics and Adolescent Medicine, 165(2), 104–111.PubMedCrossRefGoogle Scholar
  8. 8.
    Benowitz, I., Esposito, D. B., Gracey, K. D., Shapiro, E. D., & Vázquez, M. (2010). Influenza vaccine given to pregnant women reduces hospitalization due to influenza in their infants. Clinical Infectious Diseases, 51(12), 1355–1361.PubMedCrossRefGoogle Scholar
  9. 9.
    American Academy of Pediatrics (2010). Policy statement recommendations for prevention and control of influenza in children, 2010-2011. Committee on Infectious Diseases. Pediatrics E-pub August 30, 2010.
  10. 10.
    Centers for Disease Control and Prevention (CDC). (2004). Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbidity, Mortality Weekly Report, 53(RR-06), 1–40.Google Scholar
  11. 11.
    American College of Obstetricians and Gynecologists (ACOG). (2004). Committee opinion no. 305, Influenza vaccination and treatment during pregnancy. Obstetrics & Gynecology, 104(5), 1125–1126.Google Scholar
  12. 12.
    Centers for Disease Control and Prevention. United States National Health Interview Survey. (2006). Self-reported influenza vaccination coverage trends 1989–2006. Retrieved June 1, 2011, from
  13. 13.
    Centers for Disease Control and Prevention. (2011). Influenza vaccination coverage among pregnant women—United States, 2011 influenza season. MMWR, Morbidity, Mortality Weekly Report, 60(32), 1078–1082.Google Scholar
  14. 14.
    Department of Health and Human Services. Healthy People 2020. Retrieved June 6, 2011.
  15. 15.
    Ahluwalia, I. B., Jamieson, D. J., Rasmussen, S. A., D’Angelo, D., Goodman, D., & Kim, H. (2010). Correlates of seasonal influenza vaccine coverage among pregnant women in Georgia and Rhode Island. Obstetrics and Gynecology, 116(4), 949–955.PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenstock, I. M. (1966). Why people use health services. Milbank Memorial Fund Quarterly, 44, 94–124.PubMedCrossRefGoogle Scholar
  17. 17.
    Becker, M. H. (1974). The health belief model and personal health behavior. Health Education Monographs, 2(4), 324–473.Google Scholar
  18. 18.
    Guba, E. G., & Lincoln, Y. S. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage Publications.Google Scholar
  19. 19.
    Morse, J. M. (2000). Determining sample size. Qualitative Health Research, 10(3), 3–5.CrossRefGoogle Scholar
  20. 20.
    Krippendorff, K. (2004). Introduction to content analysis (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  21. 21.
    Berelson, B. (1952). Content analysis in communication research. Glencoe, IL: Free Press.Google Scholar
  22. 22.
    MacQueen, K. M., McLellan, E., Kay, K., & Milstein, B. (1998). Codebook development for team-based qualitative analysis. Field Methods, 10(2), 31–36.CrossRefGoogle Scholar
  23. 23.
    Silverman, N. S., & Greif, A. (2001). Influenza vaccination during pregnancy: Patients’ and physicians’ attitudes. Journal of Reproductive Medicine, 46(11), 989–994.PubMedGoogle Scholar
  24. 24.
    Tong, A., Biringer, A., Ofner-Agostini, M., Upshur, R., & McGeer, A. (2008). A cross-sectional study of maternity care providers’ and women’s knowledge, attitudes, and behaviours towards influenza vaccination during pregnancy. Journal of Obstetrics & Gynecology Canada, 30, 404–410.Google Scholar
  25. 25.
    Fisher, B., Scott, J., Hart, J., Winn, V., Gibbs, R., & Lynch, A. (2011). Behaviors, attitudes, and perceptions regarding seasonal and H1N1 influenza vaccination during the 2009–2010 season. American Journal of Obstetrics and Gynecology, 204(6), S107–S111.PubMedCrossRefGoogle Scholar
  26. 26.
    Panda, B., Stiller, R., & Panda, A. (2011). Influenza vaccination during pregnancy and factors for lacking compliance with current CDC guidelines. The Journal of Maternal-Fetal and Neonatal Medicine, 24(3), 402–406.CrossRefGoogle Scholar
  27. 27.
    Tucker Edmonds, B. M. & Coleman, J. (2010). Risk perceptions, worry, or distrust: What drives pregnant women’s decisions to accept the H1N1 Vaccine? Maternal Child Health Journal, E-pub October, 09.Google Scholar
  28. 28.
    Brownlie, J., & Howson, A. (2005). ‘Leaps of faith’ and MMR: An empirical study of trust. Sociology, 39(2), 221–239.CrossRefGoogle Scholar
  29. 29.
    Benin, A. L., Wisler-Scher, D. J., Colson, E., Shapiro, E. D., & Holmboe, E. S. (2005). Qualitative analysis of mothers’ decision-making about vaccines for infants: The importance of trust. Pediatrics, 117(5), 1532–1541.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Pamela M. Meharry
    • 1
  • Eve R. Colson
    • 2
  • Alexandra P. Grizas
    • 2
  • Robert Stiller
    • 3
  • Marietta Vázquez
    • 2
  1. 1.School of NursingUniversity of ConnecticutStorrsUSA
  2. 2.Department of PediatricsYale School of MedicineNew HavenUSA
  3. 3.Department of Obstetrics and GynecologyBridgeport HospitalBridgeportUSA

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