Pregnancy and vaccine acceptance: A global review of hesitancy drivers and strategies for maternal immunization

During pregnancy, women are more susceptible to viral infections such as COVID-19, influenza, pertussis, Tdap, and respiratory syncytial virus due to changes in the physiological state and immune responses. Various research illustrates that vaccination confers strong protection against severe diseases and complications. The aim of this research is to identify the factors that influence vaccine hesitancy (VH) and proffer solutions that can improve maternal immunization. This review used a narrative synthesis approach to examine maternal vaccine acceptance and hesitancy. Literature was retrieved from sources such as PubMed, Scopus, and Google Scholar, and also from global health agencies [Centers for Disease Control (CDC), United Nations International Children’s Emergency Fund, World Health Organization (WHO), and National Health Services] from 2015 to 2025. Major data on prevalence, determinants, and interventions were extracted and synthesized thematically to identify global trends, equity gaps, and integrated strategies for improving maternal vaccine uptake. Unvaccinated women who contract SARS-COV-2 or influenza face a higher risk of severe illness, hospitalization, complications, and mortality in comparison to those vaccinated. One study reported vaccine effectiveness against severe COVID-19 complications at 48% (95% confidence interval [CI]: 22-65) with a full regimen, rising to 76% (95% CI: 47-89) after a booster. Influenza vaccination during pregnancy reduced confirmed infant cases by 63% and prevented roughly one-third of febrile respiratory illness in mothers and infants. Maternal immunization is vital for protecting mothers and infants, yet VH persists worldwide. Safety concerns, misinformation, low perceived risk, and institutional distrust hinder uptake, especially among vulnerable groups. Strengthening provider communication, integrating vaccines into antenatal care, and culturally tailored interventions are essential to ensure equitable access and improved outcomes. This review goes beyond summarizing hesitancy drivers by explicitly examining the normative-operational divide in maternal immunization policy, contrasting high-income and low- and middle-income countries (LMIC) contexts to identify implementation gaps and equity challenges.