Contextualizing Racial and Ethnic Inequities in COVID-19 Vaccination Uptake During Pregnancy Through a Community-Led Evaluation

Background: Massachusetts Department of Public Health (MDPH) disaggregated data on vaccine coverage for pregnant people by their specific racial and ethnic identities, finding lower coverage among several subpopulations, including Puerto Rican and Haitian pregnant people. Quantitative data could not explain contexts shaping vaccine decisions; thus, MDPH partnered with Tufts Interdisciplinary Evaluation Research (TIER) to conduct a community-led evaluation to understand COVID-19 vaccine perceptions and decision-making among Hispanic/Latina and Haitian residents pregnant when COVID-19 vaccine access became widespread. Methods: The evaluation included a bilingual (English/Spanish) survey (n = 19) and in-depth interviews (n = 8) conducted in Haitian Creole. TIER trained two community members who identified as Latina (Puerto Rican) and Haitian in evaluation methods and mentored them to collect, analyze, and interpret data, and co-develop recommendations for improved community-level vaccine outreach. Results: Two-thirds of participants across subpopulations (18/27) reported receipt of at least one COVID-19 vaccine dose. All but one Latina survey respondent received pregnancy-specific vaccine information. While 10 received information from medical providers, only three indicated that providers helped them make COVID-19 vaccine decisions. Most (n = 16) cited partners and family as helping them make vaccine decisions. In-depth interviews with Haitian participants revealed concerns about the COVID-19 vaccine including its safety in pregnancy, faith-based objections, harm to Black communities, workplace mandates, and misinformation. Conclusions: Coupling disaggregated data with community-led evaluation contextualized variations in vaccination during pregnancy. Strategies to support voluntary, informed vaccine decisions should emphasize provider communication, engage partners and families, and address concerns via trusted messengers. This replicable framework can support equitable outreach for vaccines recommended in pregnancy.