Investigating predictors of vaccination in pregnancy across England, focusing on pertussis

: MAVIS Study: Maternal vaccination in the NHS

Abstract

Introduction:
Pertussis (whooping cough) vaccination is recommended for all pregnant women in England. Uptake is suboptimal and declining, with large variability across regions and demographic groups, leaving neonates at risk. This is despite maternity services (in addition to primary healthcare providers) being commissioned since 2017 to offer vaccines. I aimed to identify determinants of inequity and potential for intervention.

Methods: Three cross-sectional online surveys of:
1. Twelve maternity service vaccine commissioners for all England regions (13/06/22 to 31/03/23)
2. 551 maternity healthcare professionals (HCPs) from the highest- and lowest-vaccinating regions of England (11/2022–05/2023);
3. 337 mothers of young babies from lowest-vaccinating regions (06/2023–05/2024)

Questionnaire design and analysis applied the ‘COM-B’ framework and logistic regression modelling to assess vaccination determinants.

Results:
1. There was high variability in vaccine provision between maternity services (vaccinating 0-81% of their pregnant women).
2. Deprivation was strongly associated with low-vaccinating regions. Controlling for this, low-vaccinating regions were associated with HCPs: lower confidence and higher burden in vaccine discussions, wanting more training, and feeling more responsible for vaccination. Free-text responses indicated a midwifery culture of providing vaccination information neutrally, avoiding direct recommendations.
3. The majority (90%) of mothers rated HCPs as influential on their vaccination decision. Non-vaccination against pertussis in recent pregnancy (20% of sample) was associated with: lacking awareness that maternal pertussis vaccination was recommended; lacking conviction that their midwife thought they should have the vaccine; thinking most pregnant women do not accept vaccination; holding vaccine-hesitant views and having social/informational influences against maternal vaccination. Access was not a main barrier.

Conclusions:
Midwives should clearly recommend vaccination, so women know it is the safe choice for the baby. Midwives need more training and time to talk confidently about vaccination. Funding maternity services should consider deprivation, not just service size, so deprived areas receive more support.

Date of Award	30 Sept 2025
Original language	English
Awarding Institution	University of Bristol
Supervisor	Christie L Cabral (Supervisor), Peter S Blair (Supervisor), Adam H R Finn (Supervisor) & Jenny Ingram (Supervisor)