In March 2020, the Centers for Disease Control and Prevention (CDC) confirmed COVID-19 as a pandemic. More than 18 months later, the nation has yet to return to ‘normal’. Hope for normalcy increased with the rollout of COVID-19 vaccines in the months that followed. Reluctance and resistance to vaccination, however, have made it difficult to achieve herd immunity. For a variety of reasons, pregnant women–specifically Black pregnant women–are among the least likely to be vaccinated for COVID-19.
The COVID-19 vaccines currently produced by Pfizer-BioNTech, Moderna and Johnson & Johnson are deemed safe for pregnant women. These vaccines bring a potential light at the end of the tunnel for the days of social isolation. However, not everyone is lining up to receive it. Racial demographics show that African Americans are the least likely to receive the COVID-19 vaccine. In this demographic, Black women are less likely than Black men to get vaccinated. It is important to understand why.
The Roots of Vaccine Hesitancy Among Black Pregnant Women
The reluctance that Black pregnant women may have toward the COVID-19 vaccine is likely rooted in the historical mistreatment, abuse, and exploitation of African Americans. For example, in the mid-1800s, Dr. James Marion Sims – recognized as the father of gynecology – conducted surgical experimentation on three enslaved black women – Anarcha, Betsey, & Lucy – without consent. His surgical experimentation resulted in the effective treatment of vesicovaginal fistula. But Sim’s legacy endures in the often-warranted mistrust of the medical establishment that many African American people carry to this day.
Many reasons warrant this distrust. For example, in the 2000s, studies revealed that rates of hysterectomy were highest in areas of the U.S. where the concentration of African American women is highest. Additionally, African American mothers are more likely to experience severe maternal morbidity (SMM), more likely to die in childbirth and have higher rates of infant mortality. The causes for these poorer experiences almost certainly involve race and racism, thoughtfully described in an earlier post here at The Medical Care Blog.
The Kansas Birth Equity Network, a population health intervention at the University of Kansas Medical Center, completed a study in 2021 to assess pregnant women’s (8 Black, 6 White, 1 American Indian) hesitancy toward the coronavirus vaccine. Their responses reflected specific historical events such as the Tuskegee Syphilis Study (mentioned by 20.0%) and knowledge of Henrietta Lacks (26.7%). Their responses also reflected hesitancy due to racial discrimination (33.3%), distrust for healthcare providers (33.3%), federal government involvement (20.0%), and the media (26.7%). Black women were more likely to report hesitancy due to previous experiences of racial discrimination and distrust of healthcare providers. Black women were also more likely to report hesitancy due to knowledge of the Tuskegee Syphilis Study.
Historical Context
The Tuskegee Syphilis Study and the experience of Henrietta Lacks are prominent historical events that the vaccine hesitant mothers identified.
The Tuskegee study began in 1932 and continued for 40 years in Alabama, supposedly ‘treating bad blood’ (a term used to describe multitude of health issues found in the blood) in the African American male population. The men did not give informed consent and the men did not receive any treatment. Researchers had neglected to share the true intent of their study. The purpose was not to treat their syphilis, but rather follow the progression of the disease throughout life. This led to many participants losing years of life because of the withholding of necessary treatment.
Henrietta Lacks was a cervical cancer patient at Johns Hopkins Hospital whose cells had extraordinary replication properties. Similar to the unethical behavior of the Tuskegee study, researchers did not inform her of her cells’ characteristics. For years afterward, researchers continually deceived Lacks and other members of her family to extract more tissue from their bodies. They were never informed that their cells were harvested to supply what became a medical research enterprise based on Lacks’s cell line – one that is still in use today.
These unethical events, coupled with the long history of racial discrimination and racism in the U.S., are why the biomedical profession has a trust problem with African Americans.
Rebuilding Trust and Increasing Vaccination
There is an opportunity for biomedical professionals to rebuild trust with African Americans. With an intentional strategy of listening, learning, and repairing trust, we can increase Black women’s vaccine uptake. Some of the strategies include:
- Affirming the validity of vaccine hesitancy by acknowledging the roots of medical mistrust in the Black community
- Providing specific vaccine safety information to Black pregnant women
- Providing accessible information about vaccine safety and vaccine clinical trials through pamphlets, social media campaigns, and open community discussions.
- Recommending the vaccine by a trusted healthcare provider who has received the vaccine.
- Ensuring that mistreatment, neglect and abuse of African Americans do not continue to occur in the medical system.
Utilizing these approaches, we can directly address the uncertainty of Black pregnant women and COVID-19. We can help them to make the decisions that are best for them and the lives of future generations.
Special thanks to Joi Wickliffe, Myesha Kennedy and Oluoma Obi for their contributions to this post.
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