Abstract
COVID-19 vaccines are safe and effective in pregnancy, but vaccine hesitancy limits uptake and effectiveness. This study explored COVID-19 vaccine hesitancy in pregnancy in Kilifi, coastal Kenya, to elicit reasons for vaccine hesitancy and acceptance, and to compile misconceptions around vaccination in pregnancy. Twenty-three in-depth interviews were conducted with pregnant women, mothers who had given birth in the previous 2 years and health workers (community health promoters, nurses, and supervisors). Data were analyzed using thematic template analysis based on the Vaccine Hesitancy Determinants Matrix. Concern about vaccine safety for the unborn baby was a major driver of hesitancy. Many pregnant women had limited knowledge of the potential benefits to the unborn baby, leading to postponing vaccination until after pregnancy. The initial government exclusion of pregnant women from vaccination led many to believe that vaccines were unsafe in pregnancy, long after the eligibility was revised. Aggressive promotion of the vaccine by the government was a source of mistrust and misconceptions. Integrating COVID-19 vaccination into routine antenatal care improved acceptance and development and dissemination of local guidelines boosted healthcare workers' confidence in offering vaccines to pregnant women. Future rollouts of vaccines for pregnant women should consider vaccination within antenatal care clinics alongside other routine pregnancy vaccines to enhance vaccine acceptance.