DOI: https://doi.org/10.36347/sasjm.2026.v12i06.009

Pages: 629-632

Maternal immunization is a cornerstone of preventive antenatal care, protecting both pregnant women and their infants during increased vulnerability to infectious diseases. Recommended vaccines in pregnancy include influenza, tetanus–diphtheria–acellular pertussis (Tdap), COVID-19, and, more recently introduced, respiratory syncytial virus (RSV). Evidence consistently demonstrates favourable safety profiles and significant reductions in maternal and neonatal morbidity; however, uptake remains suboptimal worldwide. This review synthesizes current evidence on determinants of maternal vaccine hesitancy, key barriers to uptake, and evaluates evidence-based strategies to improve maternal immunization uptake. Maternal vaccine hesitancy, defined by the World Health Organization (WHO) as a delay in acceptance or refusal despite availability, is examined through the “3Cs” framework: confidence, complacency, and convenience. Confidence-related barriers include concerns about foetal safety, misinformation, and inconsistent recommendations from providers. Complacency arises from low perceived risk of infection among pregnant women, while convenience barriers reflect structural and logistical challenges such as missed opportunities during antenatal visits, limited access, and associated costs. Underlying these factors is the significant role of trust, particularly in healthcare professionals, whose clear recommendations strongly influence vaccine acceptance. Social and cultural influences, including family and community attitudes, further shape decision-making about vaccines. Facilitators of uptake include trusted provider endorsement, clear communication emphasizing dual protection for the mother and her infant, and integration of vaccination into routine antenatal care. Evidence from systematic reviews and meta-analyses strongly supports that multicomponent interventions are the most effective approach, combining patient education, provider engagement, and system-level support