Investigating predictors of pertussis vaccination in pregnancy across England: cross sectional studies of maternity staff and mothers

INTRODUCTION: Pertussis vaccination is recommended for all pregnant women in England. Uptake remains suboptimal, with regional and demographic variability, leaving neonates at risk. This persists despite expansion of vaccine provision across maternity services since 2017. This study aimed to identify determinants of inequity and opportunities for intervention. METHODS: Cross-sectional online surveys of: ii) 551 maternity healthcare professionals (HCPs), comparing those working in trusts within the highest- and lowest-vaccinating regions of England. i) 377 mothers of young babies from lowest-vaccinating regions, comparing women vaccinated versus unvaccinated against pertussis in their recent pregnancy; and Questionnaires were informed by the COM-B framework. Logistic regression modelling assessed factors associated with vaccination, alongside content analysis of free-text responses. RESULTS: i) HCP survey: Area-level deprivation was strongly associated with low-vaccinating regions. Controlling for this, low-vaccinating regions were associated with HCPs' lower confidence in vaccine discussions and more perceiving these as burdensome, greater desire for training, and increased perceived responsibility for vaccination. Free-text responses described midwifery culture of providing vaccination information neutrally, avoiding direct recommendations in favour of supporting women's choice. ii) Mothers' survey: Most mothers (90%) rated HCPs as influential in their vaccination decision. Non-vaccination (20% of sample) was most strongly associated with lack of awareness that pertussis vaccination was recommended and lack of conviction that their midwife supported vaccination. Main reasons for vaccination were safety for the baby and HCP recommendation. Clear midwife recommendation was associated with satisfactory perceptions of vaccine communication across groups. The importance of access was commonly recognised but did not differentiate between groups in either study. CONCLUSIONS: Midwives need support to avoid a neutral stance and provide clear, confident recommendations, including infant safety reassurance. Funding models should account for deprivation, not solely service size, to help reduce vaccination inequity.