Despite evidence that maternal immunization can reduce the risk of diseases such as RSV, influenza, COVID-19, and whooping cough, uptake among pregnant women remains low.
It is typically recommended that pregnant individuals receive vaccinations before, during, and after pregnancy to protect their health and that of their child. However, a 2024 CDC report reported that only 47.4 percent of pregnant female survey respondents reported receiving the flu vaccine, while only 59.6 percent reported receiving the Tdap vaccine, which prevents tetanus, diphtheria, and whooping cough. In addition, only 30.9 percent reported receiving the COVID-19 vaccine.
For many mothers, there can be barriers to receiving vaccines, such as lack of health literacy, access to proper resources, and medical mistrust. Additionally, Black women specifically suffer from multiple medical obstacles. There is also an ongoing, never-ending fear-mongering debate about vaccine safety, with professional health organizations choosing to go against the federal agency’s updated vaccine schedule.
August is National Immunization Awareness Month. For providers, this month of advocacy can help shed more light on the importance of vaccine and immunization guidance, supporting vulnerable populations, like pregnant mothers — particularly Black mothers — to make the best choices for the health and safety of themselves and their family.
Recommendations for maternal immunization will vary case by case. The most common vaccines administered to pregnant women are for influenza, Tdap, and respiratory syncytial virus (RSV).
Louis Lerebours, MD, a family medicine physician at Freeman Recovery Center in Tennessee, notes the importance of vaccines and how a provider’s advice can change per patient.
“[Vaccines] provide immunity against infection, which may result in more severe illnesses either in the mother during her pregnancy or early infancy,” Dr. Lerebours told BlackDoctor Pro. “Recommendations regarding vaccinations will vary depending upon several factors including but not limited to: gestational age at time of administration, the seasonal timing, prior history of receipt of other vaccines, an assessment of each woman’s specific risk factors for developing complications from various infections (e.g., underlying medical conditions), and current clinical guidelines.”
Some vaccinations are also advised against during pregnancy, including, but not limited to, the human papillomavirus (HPV) vaccine, measles-mumps-rubella (MMR) vaccine, and the chickenpox vaccine.
Vaccinations are also recommended at specific periods throughout the course of a pregnancy.
Kecia Gaither, MD, double board-certified in OB/GYN and Maternal-Fetal Medicine and an Associate Professor of Clinical Obstetrics and Gynecology at Cornell Weill Medicine, explained how vaccinations work to safeguard the mother and child. “These vaccinations are timed to fully maximize transplacental antibody transfer to the baby, typically administered in the late second and early third trimester of pregnancy,” she told BlackDoctor Pro.
Pregnant women, fetuses, and newborns are at higher risk for contracting serious diseases; vaccinations are highly recommended for these vulnerable populations. Mothers should receive an annual flu vaccine, a Tdap vaccine each pregnancy, and the COVID-19 vaccine.
“Maternal vaccinations protect both in the maternal-fetal dyad, since both are at elevated risk of severe diseases like influenza, COVID-19, and RSV,” Dr. Gaither said. “The antibodies that are generated by the mother’s body serve to cross the placenta and provide passive immunity to the newborn during the most vulnerable early months of life before the infant can be vaccinated directly.”
The double defense of maternal vaccinations is widely beneficial to the child’s health, Dr. Lerebours said. “Because infants have limited ability to fight off infection until they reach an age when they can be vaccinated themselves, this early protective factor is very helpful in protecting them during the critical period of time when they are most susceptible to many types of infection,” he explained.
Despite being at risk for the same illnesses during pregnancy as mothers of other races, Black women tend to have the lowest vaccination coverage.
“Black women encounter a range of disparities throughout their pregnancies as a result of social and structural issues that exist outside of race itself,” Dr. Lerebours said. “For example, Black women may have less-than-optimal access to quality maternity care. They often receive inconsistent or discontinuous care, delayed or inadequate responses to maternal-fetal complications, and/or lack an effective outlet for expressing concerns regarding their care.”
The gap in care, Dr. Gaither explained, is driven by countless factors, including higher rates of being uninsured, reduced access to reproductive healthcare, historical and ongoing racial trauma, marginalization, discrimination within healthcare settings, and systemic racism and implicit bias among providers.
These disparities don’t just affect health — they affect mortality.
“Black women in the U.S. are at a minimum of three times more likely to die from a pregnancy-related cause than white women,” Dr. Gaither said.
To help and support Black women through a healthy pregnancy, providers must equip patients with strong, culturally responsive vaccine counseling. Provider recommendation remains one of the strongest predictors of vaccine acceptance and provides practical strategies clinicians can use to improve uptake.
“Counseling does not only provide direction — good counseling provides space for the patient’s questions and allows them to make their own informed decision using clear and evidence-based information,” Dr. Lerebours said. “When a patient receives an unambiguous message regarding vaccination from a healthcare provider they trust, that is likely to increase the likelihood of the patient understanding how vaccines will benefit them.”
Vaccine counseling and other initiatives to increase uptake can include disease framing — explaining the why and how of a vaccine — improved communication, and community engagement, Dr. Gaither explained. Providers can also help patients establish reminder systems and train other staff members to address vaccine misinformation and hesitancy.
“Given the disproportionate burden on Black maternal health outcomes, integrating vaccine counseling into a broader, equity-focused, prenatal care approach — particularly one that explicitly addresses bias, builds trust, and reduces access barriers — can help close both the immunization and outcomes gap simultaneously,” she added.
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