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. 

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.

The quantitative data are uploaded in Stata format. For other data formats, please contact the study team.