Maternal immunisation, or vaccination of pregnant women, has prevented millions of deaths of infants and mothers globally. Tetanus-toxoid-containing vaccines are used extensively globally. Other vaccines, including vaccines to protect against influenza (flu), pertussis (whooping cough) and SARS-CoV-2 (COVID-19) are also used to varying degrees in pregnant women. Almost half of all childhood deaths occur in the first month of life, the neonatal period. In their pump-priming project 'Assessing community acceptancy and health facility preparedness for implementation of maternal immunisation programmes in urban and rural South Africa,' Clare Cutland from the University of the Witwatersrand and her team explored the knowledge and attitudes inhibiting vaccine acceptancy during pregnancy in Johannesburg and in the KwaZulu-Natal Province.

Key informant and semi-structured interviews were conducted with pregnant women receiving antenatal care at community clinics, antenatal care staff, women enrolled in maternal immunisation trials, community leaders and non-pregnant women residing in Soweto, Johannesburg, Gauteng (urban) and in the uMkhanyakude district of northern KwaZulu-Natal (rural). Focus group discussions were also held with the mothers and husbands/partners of the pregnant women.

The study established good knowledge, a positive attitude and high acceptability of maternal immunisation among pregnant women, non-pregnant women, antenatal staff as well as church and community leaders in an urban setting. The men interviewed in Soweto in this study were the least positive about maternal immunisation. In a rural setting, traditional beliefs and family pressure impacted acceptance of maternal immunisation. Traditional healers, however, encourage women to attend antenatal care facilities in addition to taking traditional medicines.

Apart from antenatal staff, there was poor knowledge about the different vaccines that are offered in antenatal care facilities, and the health benefits of immunisation across the study groups. Limited communication and information sharing about vaccines and maternal immunisation by health care workers (clinics and traditional healers) contributed to poor understanding of maternal immunisation principals by pregnant women, their families and community.

Healthcare workers should undergo detailed training on benefits and potential risks of maternal immunisation and should provide clear messages to pregnant women and their families. Improved communication about maternal immunisation will increase vaccine confidence and improve immunisation uptake.