Cultural-Social-Economic Background and Community Engagement Impacting COVID-19 Vaccination Uptake Among Pregnant and Lactating Refugee Women.

COVID-19 vaccine uptake in pregnant and lactating refugee women remains understudied despite their high risk of severe health outcomes. Our survey of 672 refugee women who gave birth at an urban hospital in a southwestern U.S. state between 2020 and 2023 revealed a concerningly low vaccination rate, with only 45.4% receiving one or more COVID-19 vaccine doses. Vaccination status was highly heterogeneous, with uptake ranging from 76.9% among women relocated from Afghanistan and South Asia to merely 23.8% among those from Congo, Tanzania, and several other African nations. Women residing in low-income areas and socioeconomically segregated communities were less likely to be vaccinated. Importantly, engagement with cultural health navigators (CHNs)-certified, multilingual, and bicultural individuals who share lived experiences of forced displacement with refugees and facilitate their healthcare navigation, education, and trust-building-helped mitigate these disparities. CHN support increased vaccination uptake among initially reluctant individuals, with some initiating vaccination during pregnancy. The effectiveness of CHN support varied by country of origin, underscoring the need for culturally tailored interventions to promote health equity in underserved populations.