Prevalence and determinants of fully vaccinated status for COVID-19 among pregnant women in Brazil, Ghana, Kenya, and Pakistan.

Maternal immunization provides essential maternal and fetal protection for several infectious diseases. The variability in vaccination guidelines for pregnant women across countries and through the course of the COVID-19 pandemic influenced the perception of both the general public and broader health care systems towards COVID-19 vaccination in pregnancy and moreover shaped the accessibility and decision-making trajectory of pregnant women to become fully vaccinated. As part of a larger multi-country, mixed-methods study, the purpose of this cross-sectional analysis is to assess what factors are associated with pregnant women being fully vaccinated for COVID-19 in Brazil, Ghana, Kenya, and Pakistan. In each country, participants were recruited from maternity hospitals and/or clinics which are representative of diverse socioeconomic and geographical strata. Data collection included cross-sectional surveys of 1,603 pregnant women and collected sociodemographic determinants of vaccine uptake along with personal COVID-19 vaccination decision-making experiences. This sub-analysis included 1,025 respondents who had ever received a COVID-19 vaccine. Adjusted regression models revealed that pregnant women who were able to choose their vaccine brand, were of older age, those with a partner, and those with a higher education level had higher odds of being fully vaccinated (defined as having the recommended dose number by country and brand). This analysis emphasizes the importance of countries providing clear, timely, and current immunization guidelines and resources for pregnant women, to ensure they are consistently educated and positively influenced to complete vaccination series for relevant infectious diseases to decrease related maternal and fetal morbidity and mortality.