‘‘Those who do not vaccinate don’t love themselves, or anyone else’’: a qualitative study of views and attitudes of urban pregnant women towards maternal immunisation in Panama

OBJECTIVES: To identify pregnant women’s views and attitudes towards maternal immunisation in Panama based on in-depth interviews and focus groups. SETTING: Two main urban centres in Panama (San Miguelito and Panama City). PARTICIPANTS: Fifty-six pregnant women from Panama City (n=29) and San Miguelito (n=27). METHODS: In-depth interviews and focus groups were conducted, audio-recorded, transcribed verbatim and analysed using a deductive-inductive approach. RESULTS: Our findings suggest that this population perceives vaccination as a key component of maternal healthcare, not an elective part of it. The pregnant women interviewed disclosed a heightened perception of vulnerability to infectious diseases. For this reason, safety and effectiveness of maternal vaccines were closely associated for many participants (a vaccine was perceived as safe if it was effective against disease). Refusal of maternal vaccination was strongly associated with parental negligence. Participants reported the participation of husbands and partners in the decision-making around their health. Most participants reported high information-seeking behaviour, particularly online; many interviewees confirmed any information obtained online with their healthcare professionals (HCPs). Vaccine recommendations from HCPs appeared to be one of the main predictors of maternal immunisations among the sample interviewed. While acceptability of maternal vaccines was high in this sample, some pregnant women expressed concerns and doubts (e.g., that maternal vaccines could cause miscarriages) which require attention. Finally, many participants reported difficulties in accessing maternal vaccination, pointing to financial and physical barriers. CONCLUSIONS: The acceptability of maternal immunisation was high among the interviewed women. The pregnant women’s receptiveness to maternal vaccinations, even when information provided was limited, is suggestive of high levels of trust in HCPs. Even so, HCPs and health officials should remain alert to apprehensions expressed by pregnant women. Many participants reported struggles in accessing maternal vaccination, pointing to issues that merit further examination.