New Mothers and the 2009 H1N1 Influenza Vaccine: The Maternal Conflict for Protecting Children

Background:  Pregnant women are at risk for serious complications from influenza, and a relatively high number required hospitalization when the 2009 H1N1 virus emerged in the U.S. The Advisory Committee on Immunization Practices recommended that pregnant women have priority for the H1N1 vaccine when it became available. However, pregnant women tend to distrust medications or vaccinations; the Centers for Disease Control and Prevention (CDC) reports that typically only 15% of pregnant women get the flu vaccine in any given year.

Program background:  The National Center for Immunization and Respiratory Diseases (NCIRD) promotes influenza vaccination through numerous channels. The severity of the 2009 H1N1 virus for pregnant women presented an urgent need for communication targeting this population. AED and Michael’s Opinion Research conducted formative research on behalf of the NCIRD to guide development of effective messages and communication to pregnant women about immunization against both H1N1 and seasonal influenza.     

Evaluation Methods and Results:  Online surveys and focus groups were conducted nationwide between August and October in 2009 with racially/ethnically diverse mothers of infants age 0 to 12 months of age. The research explored awareness of and concerns relating to the seasonal and H1N1 influenza vaccine, and gauged reactions to consumer health materials and advertisements developed for this audience. This presentation will highlight the key findings of this research. Focus group and survey participants showed mixed awareness of health risks from 2009 H1N1 influenza during pregnancy. Focus groups participants expressed that they were not well informed about the reasons why pregnant women are at higher risk for H1N1, nor were they well informed about the higher risks for newborns and how vaccination can protect both mother and child. The perceived safety of the 2009 vaccine topped questions and concerns of both survey and focus group participants. Messages that emphasized how immunization helped parents in their roles as protectors and nurturers resonated with all participants. Small changes in wording or ordering of information were frequently observed to facilitate improved understanding and agreement with messages.

Conclusions:  Misperceptions or concerns about the safety of vaccines contributed to new mothers’ reluctance to be vaccinated or to have their children over the age of 6 months vaccinated against the 2009 H1N1 influenza virus. Communications to this population need to provide sufficient information on why pregnant women and children are vulnerable to serious complications of influenza, and to assuage concerns about the safety of vaccines. New mothers depended heavily on advice from their obstetricians and pediatricians, therefore these key influencers should play a large role in promoting influenza immunizations.

Implications for research and/or practice:  The safety of immunizations for pregnant women and young children can be a polarizing topic, and findings from this research illustrate how formative research and pre-testing of materials can improve awareness and understanding of the facts.